The different types of pigmentation problems

From the age of 30, a number of women develop pigmentation irregularities on their skin. This can be the result of different problems:

• Lentigo, is also called age spots if it is mainly due to the intrinsic ageing of the skin, or solar lentigo if it is caused by regular and considerable sun exposure.
• Melasma, generally due to hormone imbalances. This can occur when taking certain medicines, or can be caused by sun exposure during pregnancy when no protection is worn. This is called pregnancy mask.
• Liver spots, also called ephelids.
• Post-inflammatory pigmentation, following an acne spot for example. The mark is then due to an excess of melanin produced by the inflammation.

While these marks are completely harmless, they can be unsightly.

Melanin is the pigment that gives the skin its characteristic color. Vitiligo is caused by a loss of pigment in the skin, due to destruction of pigment-forming cells known as melanocytes. Although vitiligo affects all races equally, it is more noticeable in dark-skinned people. Vitiligo can cause cosmetic problems.

Hyperpigmentation occurs when melanin is overproduced in certain spots on the skin. … Pigment spots such as age spots are caused by sun exposure. For this reason, they appear mainly on body parts that are frequently exposed, such as the face, hands and arms. They tend to be small, darkened patches of skin.

1. It could be genetic
   Some of us are born with freckles. We’re usually fair-skinned and possibly have red hair. Our skin’s melanin clusters are clumped closely together rather than evenly spread out, causing these gorgeous “angel kisses” on our skin. This kind of skin is very sensitive to UV light and prone to sunburn, as well as skin cancers, so sun protection is essential.

Some of us are also born with mole-prone skin – when dark clumps of pigment tend to form. As we age, they usually become raised and may have a hair growing out of them. Most are benign, but you need to watch them in case they change size, colour, shape or outline. A yearly checkup by a dermatologist is recommended.

2. Then there’s the sun
   We may get a sprinkling of freckles on our skin after exposure to the sun, but they fade in winter. These are the body’s effort to protect skin cells from UV damage.

Freckles may become permanent, however, and UV damage may not become visible until we get older, when they rise to the surface as “liver” or “age” spots on our hands, cleavage, face etc. These can become darker and permanent unless we take preventive and corrective measures.

3. Blame it on your hormones
   Melasma is the catchall term given to hormone-induced excess pigmentation. It can be caused by hormonal fluctuations, so it’s quite common when taking birth control hormones like the “Pill”; it can also happen during pregnancy, when it is called pregnancy mask, butterfly mask or chloasma; and it’s common after the menopause, when the sun damage of your youth becomes visible as age spots.
4. Inflammation information
   Post-Inflammatory Pigmentation (PIH) can arise if your skin is chronically inflamed – it can be common in people who battle with dermatitis/eczema, acne and Addison’s disease.

Some medication – including tetracycline antibiotics, certain cancer drugs etc., can also cause hyperpigmentation. If you’re prone to pigmentation, do some research.

Physical injury to the skin can also heal and leave dark marks. These include scratches, burns, pimples that have been squeezed, even repeated friction – where a repeated action on the same area on a daily basis year after year results in dark marks, such as thighs rubbing together or “violin neck” (pigmented skin where the violin touches players’ necks) or wearing a cap that rubs against the forehead day after day.

5. The opposite extreme
   Sometimes we get the opposite of hyperpigmentation – hypopigmentation – where patches of skin completely lack melanin or have decreased melanocytes. This can be caused by a variety of systemic disorders, such as vitiligo, as a result of prolonged, chronic inflammation, or by skin damage.

While these pigment changes are often irreversible and camouflage make-up may be the simplest and most effective intervention, there are more and more medical treatment options available.

The key to treating all of these types of pigmentation mentioned above is early intervention. If you leave it and the melanin leaches into the dermis, it becomes known as dermal pigmentation. The deeper the pigment, the more difficult it is to treat.

Visit the skin experts at Skin Renewal branches to identify your type of pigmentation and familiarise yourself with your treatment options both in clinic and at home. Find out more at Skin Renewal and on their Online Skin Shop.

Common causes of hyperpigmentation include postinflammatory hyperpigmentation, melasma, solar lentigines, ephelides (freckles), and café-au-lait macules. Although most hyperpigmented lesions are benign and the diagnosis is straightforward, it is important to exclude melanoma and its precursors and to identify skin manifestations of systemic disease. Treatment options for postinflammatory hyperpigmentation, melasma, solar lentigines, and ephelides include the use of topical agents, chemical peels, cryotherapy, or laser therapy. Café-au-lait macules are amenable to surgical excision or laser treatment. Disorders of hypopigmentation may also pose diagnostic challenges, although those associated with health risks are uncommon and are usually congenital (e.g., albinism, piebaldism, tuberous sclerosis, hypomelanosis of Ito). Acquired disorders may include vitiligo, pityriasis alba, tinea versicolor, and postinflammatory hypopigmentation. Treatment of patients with widespread or generalized vitiligo may include cosmetic coverage, psoralen ultraviolet A-range therapy (with or without psoralens), or narrow-band ultraviolet-B therapy; whereas those with stable, limited disease may be candidates for surgical grafting techniques. Patients with extensive disease may be candidates for depigmentation therapy. Other acquired disorders may improve or resolve with treatment of the underlying condition.

Albinism: There is no cure for albinism. People with this condition should avoid sun damage to the skin and eyes by wearing sunscreen, hats, and sunglasses.

Melasma: Sunscreens and avoiding sun exposure can prevent melasma from becoming worse. Other treatment may include prescription creams containing hydroquinone and tretinoin to lighten the patches.

Chemical peels and laser treatment can also be used.

Pigment loss after skin damage: No treatment is needed. Makeup can usually cover the blemish.

Vitiligo: There is no cure. Treatment may include covering smaller patches with long-lasting dyes, light-sensitive medicines, UV light therapy, corticosteroid creams, surgery, and removing the remaining pigment from the skin (depigmentation).

Treatments

Combating hyperpigmentation

To prevent dark spots from appearing and regain a radiant and even complexion, it is important to adopt a good daily skin care regime:

• Each morning apply an anti-dark spot treatment to the face and neck. The formation of hyperpigmentations is a continuous process that requires daily treatment.
• Protect your skin from the sun’s rays using UVA and UVB sun protection, and choose one with a high factor if significant sun exposure is likely. The sun is the overriding factor in the appearance and worsening of dark spots. Protecting yourself from it is therefore the basis of any treatment.

Your dermatologist can also recommend various techniques for correcting dark spots (lasers, peeling treatments, cryotherapy, etc.) He alone can make an accurate diagnosis and offer you a suitable treatment for the type of dark spots you have.

Doctor will decide the treatment protocol. So, patient needs a doctor’s consultation.

• Oxford hand Book of medical Dermatology
• ABC Of Dermatology
• Clinical Dermatology