What Is Skin Pigmentation?
Melanin is a pigment that provides various shades and colors to human skin. Skin pigmentation is determined by the amount and levels of melanin in the skin. Sunlight contributes to melanin production. Hormonal changes can also affect melanin production.
What Causes Pigmentation Abnormalities?
Melanin pigment is produced by specialized cells called melanocytes in the skin. When melanocytes become damaged, it affects melanin production. Birthmarks and skin pigmentation disorders are common pigmentation abnormalities that affect many people.
What Are the Different Types of Birthmarks?
Birthmarks involve abnormal skin coloration at birth or a few weeks after birth. Certain birthmarks can pose health risks. Following is the list of pigmented and vascular birthmarks.
Pigmented Birthmarks:
1. Nevus of Ota
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This birthmark is characterized by bluish or grayish discoloration of the face and sometimes the white part of the eye (sclera).
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Nevus of Ota occurs due to increased amounts of melanin and the cells producing this pigment (melanocytes) in and around the eyes.
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People with this type of birthmark are at a greater risk of developing melanoma cancer of their eye or central nervous system. They may also develop glaucoma.
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Treatment: Treatments for this skin discoloration include topical bleaching agents and laser treatments.
2. Mongolian Spots or Congenital Dermal Melanocytosis
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These birthmarks appear bruised or bluish and often develop on the back or buttocks of babies.
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Mongolian blue spots are harmless and happen when pigment cells make melanin under the skin's surface.
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Treatment: This form of birthmark usually disappears by the age of four and does not need to be cured. However, adults with Mongolian blue spots prefer laser treatment for cosmetic purposes.
3. Café-au-lait spots (Coffee With Milk)
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They are a birthmark characterized by flat light brown-to-dark brown spots with smooth or irregular borders on the skin.
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These spots are usually present at birth or in early life.
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These birthmarks are associated with several genetic syndromes like neurofibromatosis (NF1, NF2), McCune-Albright Syndrome, ring chromosome syndromes, constitutional mismatch repair deficiency, tuberous sclerosis, Bloom syndrome, and Silver-Russell syndrome.
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Treatment: They are generally treated with laser therapy for cosmetic purposes.
4. Nevi (Moles)
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These spots are small flesh-colored, brown, tan, or pink flat or raised spots.
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Most moles are non-cancerous and do not cause any problems; some may develop melanoma skin cancer.
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Treatment: Most moles do not require treatment. Cancerous moles are removed through excisional biopsy.
Vascular Birthmarks:
1. Macular Stains or Salmon Patches
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These stains typically appear anywhere on the body as mild red marks.
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Macular stains are the most common type of vascular birthmark.
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The exact cause of macular stains is not known.
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They occur in two forms:
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"Angel Kisses" - Marks located on the forehead, nose, upper lip, and eyelids that usually disappear with age
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"Stork Bites" - Marks appear on the back of the neck and can last into the adult years.
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Treatment: These marks are always harmless, and they do not need any cure.
2. Hemangioma
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Hemangiomas are growths made up of many tiny blood vessels bunched together.
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They appear more common in females and premature babies.
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Hemangiomas develop due to an abnormal proliferation of blood vessels in one body area.
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This birthmark usually develops as a small mark on the face, trunk, or extremities (arms and legs). However, hemangiomas can be large in some children and grow rapidly through the first year of life.
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There are two types of hemangiomas:
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Strawberry Hemangiomas - They are slightly raised birthmarks that can appear anywhere on the body.
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Cavernous Hemangiomas - They are deeper birthmarks marked by a bluish color.
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Treatment: Most hemangiomas usually go away on their own. Small hemangiomas do not require treatment. However, hemangiomas cause problems with functions, ulceration, bleeding, or pain; treatment options include beta-blockers, corticosteroids, laser treatment, medicated gel, and surgery.
3. Port-Wine Stains
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Port-wine stains appear as flat pink, red, or purple marks on the face, trunk, arms, or legs, lasting a lifetime.
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These stains are caused by the abnormal development of blood vessels (capillaries). The port-wine stains may become raised and thickened over time.
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Port-wine stains on eyelids pose an increased risk of glaucoma.
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Rarely, port-wine stains are a sign of Sturge-Weber syndrome and Klippel-trenaunay-weber syndrome.
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Treatment: Laser therapy is most successful in removing port-wine stains. Laser therapy is the only method that destroys capillaries in the skin without causing damage to the rest of the skin.
What Are the Different Types of Skin Pigmentation Disorders?
The different types of skin pigmentation disorders include:
1. Albinism
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Albinism is a group of inherited disorders caused by little or no production of the melanin pigment.
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People with albinism or albinos have an abnormal gene that restricts melanin production.
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The symptoms of albinism include very light skin, hair, eye color, vision problems, sensitivity to sun exposure, and a greater risk of developing skin cancer.
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Albinism can occur in any race.
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Treatment: There is no cure for albinism. People affected with this disorder may wear sunscreen, hats, and sunglasses to avoid sun damage and skin cancer.
2. Melasma
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Melasma, also called chloasma, is marked by tan, brown, or blue-gray patches appearing on the forehead, cheeks, upper lip, nose, and chin.
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Melasma usually occurs due to radiation (ultraviolet, visible light, or infrared light) or hormones.
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Melasma is sometimes called the "pregnancy mask because it frequently affects pregnant women. Men can also develop melasma.
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Treatment: Melasma may go away after pregnancy, but if it persists, prescription creams, serums and pills, chemical peels, microdermabrasion, micro-needling, and some over-the-counter skin care products may be helpful. Wearing sunscreen with iron oxides and an sun protection factor (SPF) of 30 to 50 is essential for people with melasma to protect them from sun damage.
3. Pigmentation Loss from Skin Damage
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If there is a skin infection, blisters, burns, or other trauma to the skin, there may be a decrease or increase in pigmentation in the affected area.
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Treatment: This alteration is usually not permanent but may take several months to fade. For hyperpigmentation (dark spots), prescription or over-the-counter lightening creams and sunscreens may help decrease the time for the areas to fade.
4. Vitiligo
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Vitiligo is a skin condition when pigment-producing cells die or stop producing melanin causing pigmentation loss.
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Vitiligo may be related to autoimmune diseases, hereditary, trigger events such as stress, sunburn, or skin trauma.
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Vitiligo clinically manifests as smooth, white skin patches, usually around the mouth and eyes or on the back of the hands. These patches may present all over the body.
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Treatment: There is no specific cure for vitiligo, but certain medications and light therapies help restore skin color or even out skin tone, including topical steroid preparations, corticosteroid pills or injections, calcineurin inhibitor ointments, such as Tacrolimus or Pimecrolimus, light therapy, a combination of light therapy and psoralen (plant-derived substance), and de-pigmentation.
Conclusion
Birthmarks and other skin pigmentation disorders are common and may need medical or surgical treatment. Dermatologists can help identify the cause of pigmentation disorders and develop an appropriate treatment plan.