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Skin Pigmentation - Types, Causes, and Treatment

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Skin Pigmentation - Types, Causes, and Treatment

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The amount of melanin in the skin determines skin pigmentation or coloration. Read the article to learn more about skin pigmentation and its related disorders.

Medically reviewed by

Dr. Nidhin Varghese

Published At July 28, 2022
Reviewed AtMay 8, 2023

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

  • This birthmark is characterized by bluish or grayish discoloration of the face and sometimes the white part of the eye (sclera).

  • Nevus of Ota occurs due to increased amounts of melanin and the cells producing this pigment (melanocytes) in and around the eyes.

  • 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.

  • Treatment: Treatments for this skin discoloration include topical bleaching agents and laser treatments.

2. Mongolian Spots or Congenital Dermal Melanocytosis

  • These birthmarks appear bruised or bluish and often develop on the back or buttocks of babies.

  • Mongolian blue spots are harmless and happen when pigment cells make melanin under the skin's surface.

  • 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)

  • They are a birthmark characterized by flat light brown-to-dark brown spots with smooth or irregular borders on the skin.

  • These spots are usually present at birth or in early life.

  • 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.

  • Treatment: They are generally treated with laser therapy for cosmetic purposes.

4. Nevi (Moles)

  • These spots are small flesh-colored, brown, tan, or pink flat or raised spots.

  • Most moles are non-cancerous and do not cause any problems; some may develop melanoma skin cancer.

  • Treatment: Most moles do not require treatment. Cancerous moles are removed through excisional biopsy.

Vascular Birthmarks:

1. Macular Stains or Salmon Patches

  • These stains typically appear anywhere on the body as mild red marks.

  • Macular stains are the most common type of vascular birthmark.

  • The exact cause of macular stains is not known.

  • They occur in two forms:

    • "Angel Kisses" - Marks located on the forehead, nose, upper lip, and eyelids that usually disappear with age

    • "Stork Bites" - Marks appear on the back of the neck and can last into the adult years.

  • Treatment: These marks are always harmless, and they do not need any cure.

2. Hemangioma

  • Hemangiomas are growths made up of many tiny blood vessels bunched together.

  • They appear more common in females and premature babies.

  • Hemangiomas develop due to an abnormal proliferation of blood vessels in one body area.

  • 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.

  • There are two types of hemangiomas:

    • Strawberry Hemangiomas - They are slightly raised birthmarks that can appear anywhere on the body.

    • Cavernous Hemangiomas - They are deeper birthmarks marked by a bluish color.

  • 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

  • Port-wine stains appear as flat pink, red, or purple marks on the face, trunk, arms, or legs, lasting a lifetime.

  • These stains are caused by the abnormal development of blood vessels (capillaries). The port-wine stains may become raised and thickened over time.

  • Port-wine stains on eyelids pose an increased risk of glaucoma.

  • Rarely, port-wine stains are a sign of Sturge-Weber syndrome and Klippel-trenaunay-weber syndrome.

  • 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

  • Albinism is a group of inherited disorders caused by little or no production of the melanin pigment.

  • People with albinism or albinos have an abnormal gene that restricts melanin production.

  • 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.

  • Albinism can occur in any race.

  • 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

  • Melasma, also called chloasma, is marked by tan, brown, or blue-gray patches appearing on the forehead, cheeks, upper lip, nose, and chin.

  • Melasma usually occurs due to radiation (ultraviolet, visible light, or infrared light) or hormones.

  • Melasma is sometimes called the "pregnancy mask because it frequently affects pregnant women. Men can also develop melasma.

  • 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

  • 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.

  • 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

  • Vitiligo is a skin condition when pigment-producing cells die or stop producing melanin causing pigmentation loss.

  • Vitiligo may be related to autoimmune diseases, hereditary, trigger events such as stress, sunburn, or skin trauma.

  • 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.

  • 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.

Frequently Asked Questions

1.

What Are the Treatments to Lighten Skin Pigmentation?

Treatments for skin pigmentation can include topical bleaching agents, laser treatments, beta-blockers, corticosteroids, laser treatment, surgery, prescription creams and serums, chemical peels, microdermabrasion, or micro-needling.

2.

Can Dermatologists Remove Skin Pigmentation?

Dermatologists can help identify the cause of pigmentation disorders and develop an appropriate treatment plan. If over-the-counter treatment fails to deliver results, one should see a dermatologist for prescription-strength treatment.

3.

How to Remove Pigmentation Permanently?

Some approaches can help get rid of skin pigmentation permanently, such as:
 - Chemical peels.
 - Cryotherapy.
 - Microdermabrasion.
 - Laser resurfacing.
 - Intense pulsed light (IPL).

4.

What Is the Fastest Way to Cure Pigmentation?

The American Academy of dermatology (AAD) advises the following treatments for skin pigmentation:
 - Azelaic acid.
 - 2% Hydroquinone.
 - Glycolic acid.
 - Kojic acid.
 - Vitamin C.
 - Retinoids, like retinol, tretinoin, adapalene gel, or tazarotene.

5.

Can Aloe Vera Remove Skin Pigmentation?

Aloe vera is a natural depigmenting compound called aloin and is known to lighten skin and work effectively as a nontoxic hyperpigmentation treatment. Applying pure aloe vera gel to pigmented areas before bedtime is recommended.

6.

Is Skin Pigmentation Serious?

Skin pigmentation is generally harmless and is not a sign of a serious medical condition. Most pigmentation fades on its own with good sun protection. In other cases, for more aggressive cases, treatment is required.

7.

Can Stress Cause Skin Pigmentation?

Chronic emotional stress can manifest on the skin as hyperpigmentation. Adrenocorticotropic hormone (ACTH) is secreted by the anterior pituitary gland, usually in response to biological stress. This hormone triggers the process of skin pigment production (melanogenesis).

8.

What Is the Best Way to Treat Pigmentation on the Face?

Laser therapy, microdermabrasion, dermabrasion, and chemical peels, are some of the best ways to help rid skin of hyperpigmentation. These methods work by gently removing the top layer of the skin where the dark spots lie.

9.

How Long Can Skin Pigmentation Last?

Fading can take time, depending on what is causing the dark spots or patches. For example, a spot a few shades darker than the natural skin color usually fades within 6 to 12 months. However, fading can take years if the color lies deep in the skin

10.

Is Pigmentation Treatment Safe?

Most laser therapies nowadays are non-ablative lasers used for pigmentation and rejuvenation. The treatment is safe for the skin when performed in the right setting. Hence, it is essential to get the treatment done by trained doctors.

11.

When to Worry About Skin Pigmentation?

See a doctor if any new discolored skin patches occur or if existing moles alter. The doctor can help make early diagnosis and treatment possible, which usually leads to a better outlook.

12.

Which Skin Type Is Prone to Pigmentation?

Individuals with darker skin tones are generally more susceptible to dark spots. The skin is already producing melanin, which gives it a darker color. When hormones or trauma trigger an increase in this melanin production, one becomes more susceptible to skin pigmentation.

13.

Can Skin Pigmentation Be Cancerous?

Skin pigmentation is not cancerous itself, but few people with nevus or other skin pigmentation are at a greater risk of melanoma of their eye or central nervous system. In a few cases, skin cancer might develop from moles or birthmarks.

14.

Which Food Is Best for Skin Whitening?

The following are the best foods for skin whitening:
 - Eggs. 
 - Strawberries.
 - Pineapples. 
 - Lemon.
 - Tomatoes.
 - Walnuts. 
 - Avocados.
 - Garlic. 

15.

What Does Pigmentation Skin Look Like?

Skin pigmentation can appear as brown, black, gray, red, or pink spots, patches, or freckles. These spots can vary in size and develop anywhere on the body. It is important to note any pigmentation patch or spot for change in size and color as it may undergo malignant transformation. Any such changes, if noticed, should be reported to the skin specialist immediately.

16.

Can Skin Pigmentation Be Removed?

Depending on the causes of pigmentation, the healthcare provider may suggest some lifestyle changes, such as avoiding sun exposure by using sunscreen and wearing protective clothing, stopping any medications that may be causing it, or taking vitamins. The healthcare provider can also recommend a prescription or over-the-counter creams or ointments like azelaic acid, corticosteroids, glycolic acid, and Hydroquinone. Other treatments may include chemical peels, cryotherapy and laser skin resurfacing.

17.

Does Vitamin D Help With Skin Pigmentation?

Although vitamin D is vital for skin health, its leading role is promoting melanin formation, which can cause more skin darkening. Vitamin D plays a role in growth and differentiation of skin cells but it does not play any direct role in pigmentation of skin.

18.

Does Drinking Water Help Reduce Pigmentation?

Drinking about two to three liters of water daily can help fight pigmentation effectively. In addition, drinking plenty of water increases blood flow to the skin, which can help even out the skin tone and complexion.
Dr. Nidhin Varghese
Dr. Nidhin Varghese

Dermatology

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pigmentationmelanin
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