Encountering the distinctive Skin Pigmentation problems

Melanin is a brown pigment which imparts skin its characteristic color. Fair skin people have a low composition of melanin and it increases with each tone darker. This melanin is produced by melanocytes situated in the epidermis.

Skin discoloration

It is the deviation of the color of skin from its natural identity. The skin can get lighter, darker or reddened depending upon the underlying factors. It is also observed after cuts, scratches, burns etc.

 The diverse skin pigmentation complications

• Hypopigmentation– generally caused due to damage to skin, inflammatory conditions or hereditary conditions

This involves the decrease in the constituent melanin beneath the skin surface. This mostly occurs due to a decrease in melanin production.

1. Generalized– pallor that is paleness of skin is observed in case of anemia. Generalized hypopigmentation usually occurs due to congenital or racial problems. Eg- albinism
2. Localized– this is due to partial or complete loss of melanin in a given area. Eg- vitiligo, leprosy, lichen sclerosus, pityriasis alba, pityriasis versicolor, piebaldism, idiopathic or progressive macular hypomelanosis.

Vitiligo– It is an acquired autoimmune disorder in which white patches of skin are present on the body focally, symmetrically or universally.

Albinism– This is a birth defect in which there is a complete loss of pigmentation in skin, hair, and eyes.

•  Hyperpigmentation

Here the skin is darker in color than usual due to deposition of increased amounts of melanin. The most common problems behind it are a side effect of drugs, over sun exposure and disorders causing inflammation.

1. Generalized – it is seen in 95% people with Addison’s disease, 90% of people with hemochromatosis, rarely in metastatic melanoma and in people treated with afamelanotide.
2. Localized–  it can be due to melanin, hemosiderin or externally derived pigment.

Some examples are as followed-

• Naevi and lentigos
• Skin cancer such as melanoma, basal cell carcinoma.
• Pigmentation prior to injury, eczema etc
• Superficial skin infection
• Photocontact dermatitis
• A chronic pigmentary disorder like melasma
• Thickened skin, pigmented purpura.

Melasma- In this disease brown patches are seen, most commonly on the face. It also occurs in pregnancy but resolves after pregnancy and is called chloasma.

Everything you need to know about Melasma.

• Depigmentation

Complete loss of pigment. Eg- vitiligo. Onset is on life experiences, there is no sex predisposition, lesions are milky white, round or oval in shape and spread. 

Some other skin pigmentation problems are acanthosis nigricans, xeroderma pigmentosum, incontinentia pigmenti, lentigines etc.

 Red skin is seen in the case of pityriasis alba. It is scaly in nature and is believed to be a manifestation of atopic dermatitis.

Why am I facing pigmentation?

Pigmentation is the accumulation of dark pigments that is melanin beneath the skin which leads to dark facial spots. Melanin production is triggered by sun exposure, so take care everytime you go out on a bright sunny day.

What are the causes?

• Melasma- it is prone in people with darker skin types and women undergoing pregnancy.
• Rosacea– red acne on the skin which is idiopathic in origin for now.
• Acne–  caused due to overproduction of oil or sebum which combine with dead skin and bacteria to clog pores and cause lesions.
• Sun damage is also a major factor in the race to skin damage and can cause cancer.

Treatment

• Wood’s lamp examination is done to emit UV light in 365 nm range and assist in the diagnosis of various pigments and infectious disorders. 
• Fungal and bacterial infections, lice and nits, vitiligo, erythrasma, porphyria cutanea tarda, and other pigmentary disorders can be diagnosed by it.
• The treatment usually prescribed by a physician include- microbiological culture and microscopy of affected skin and skin biopsy.

In hyperpigmentation treatment suggested are-

• Hydroquinone 
• Topical Retinoid
• Topical steroid
• Glycolic, azelaic and ascorbic acid.

In hypopigmentation therapy, chemical peels, corticosteroids, surgery and removing remaining pigment works.

A chemical peel is used to exfoliate and peel the skin off so that new skin is generated at the site of a lesion. They are of three types – superficial, medium and deep peels. It should not be used in nursing or pregnant woman, psoriasis, eczema, dermatitis or rosacea, having taken Accutane in last 6 months or used retinoid in last 48 hours.

Dermabrasion is used to remove the upper layer of the skin. It is used to treat brown spots, skin scars, skin lesions, sun damaged skin, wrinkles etc.

Laser therapy is used to improve the appearance of skin. It is accompanied by effects like swelling, itching, burning sensation, scarring etc and should be thought of properly before administration.

Visiting the doctor

• When injuries like burn surface you must visit the doctor for there is a strong potential for infection.
• In severe cases of acne, hypopigmentation and rosacea visiting the doctor is a must.
• Birthmarks do not need treatment but in case of an increase in size visit to the doctor is necessary.

On the positive front most of these problems are easy to treat and will only traumatize you temporarily but prevention is better than cure so visit a doctor in case of any discomfort.

What are the types of Skin Pigmentation?