HYPERPIGMENTATION

The appearance of skin patches that are darker that the surrounding skin color is usually caused by natural body processes, and sometimes by external causes. The term for this skin darkening is epidermal hyperpigmentation. Epidermal refers to the upper layer of the skin. Hyperpigmentation means excess color.

Normal skin color is formed by melanin, a natural pigment that also determines eye and hair color. Epidermal hyperpigmentation occurs when too much melanin is produced and forms deposits in the skin. The condition is quite common and can affect the skin color of people of any race.

Is hyperpigmentation harmful?

Hyperpigmentation is not a medically harmful condition. It is advisable, however, to have darkened skin patches checked by a physician to make sure they are not a type of skin cancer. Usually people seek treatment for hyperpigmentation because it is cosmetically displeasing to them. Skin lightening products prescribed by a physician can reduce the unwanted excess color of hyperpigmented skin patches.

Types of epidermal hyperpigmentation.

Although all hyperpigmenation is a result of excess melanin, different names are used to describe it based on the cause of the excess melanin production and its appearance on the skin.

• Melasma. Melasma is a skin coloration that appears as blotchy brown spots often occurring on the cheeks, forehead, or temples. The condition is usually associated with hormonal changes. Pregnancy, for example, can trigger over production of melanin causing the mask of pregnancy on the face and on the darkening of skin on the abdomen and other areas. This facial hyperpigmentation sometimes occurs with menopause too. Women who take birth control pills also may develop this type of hyperpigmentation because their bodies undergo the same kind of hormonal changes that occur during pregnancy. Another name for melasma is chloasma.

• The "Mask of Pregnancy"

A new mother may find that moles and other pigmented lesions on her face may have gotten darker and enlarged during her pregnancy due to increased melanin production. While they may either retain their darkened color or fade over the six months following delivery, moles that look multipigmented or that have irregular borders should be examined to rule out skin cancer.

• Age spots and liver spots. Age spots and liver spots are small darkened patches on the skin of older adults who have been regularly exposed to the sun over many years. Usually the face and the backs of the hands are most affected by these spots, which may have a somewhat depressed surface. Solar lentigines (or lentigo) is a medical name for this naturally occurring condition. It is usually light complexioned people with a tendency to burn, rather than tan, who develop age spots in later years.

• Freckles. Freckles are small, flat, tan to brown spots that can by anywhere on the body. Often a hereditary characteristic, freckles can darken with sun exposure and fade when there is little exposure to sunlight.

• Post inflammatory Hyperpigmentation. Post inflammatory hyperpigmentation may occur following any process that causes skin inflammation. For example, skin diseases such as acne or shingles may leave darkened spots after the condition clears up. Scars from skin injury or surgery may also become hyperpigmented. Cosmetic procedures such as chemical peels and dermabrasion may also leave the affected area darker that the normal skin color.

To avoid hyperpigmentation avoid the sun

Hyperpigmented skin patches may become more pronounced when skin is exposed to the sun. This happens because the skin’s pigment, melanin, absorbs the energy of the sun’s harmful ultraviolet rays in order to protect the skin from overexposure. Skin tanning occurs as a result of this process, causing hyperpigmented areas to become even darker.

Minimizing your exposure to sunlight can help prevent further darkening of existing hyperpigmented patches, as well as the formation of new ones. This is especially important for women who take birth control pills or hormone supplements and for people who have had hyperpigmentation in the past. To protect your skin, dermatologists recommend the use of a sunscreen product with an SPF(sun protection factor) of at least 15 that protects against both UVA and UVB light. A sunscreen should be used year-round on areas of the skin that are regularly exposed to sunlight such as the face and hands. Many skin moisturizers and cosmetics contain sunscreens, providing an easy way to make sure your skin is protected. Wearing long-sleeved clothing, long pants, and hats can also block the effects of sunlight exposure.

Treatment

To help patients with hyperpigmentation achieve more even skin tone, physicians may prescribe the use of skin bleaching products. Skin bleaches slow the production of melanin, causing dark spots to gradually fade and return to normal skin color. These skin medications must be applied regularly, usually twice a day to be effective. The skin lightening process may take several months to achieve the desired results.

The active ingredient in skin lightening products is called hydoquinone. The maximum prescription strength is 4% hydroquinone, which contains twice the amount of active ingredient as over-the-counter bleaches. Some hydroquinone products contain sunscreens or sunblock, so you don’t have to bother with applying a separate sun protection product. Hydroquinone may also be combined with glycolic acid for its skin moisturizing benefits. Ask your physician about skin bleaching medications and whether one is right for treating your hyperpigmented skin patches.

VITILIGO

Melanin is the substance that normally determines the color of skin, hair, and eyes. It is the pigment produced in cells called melanocytes. If melanocytes cannot form melanin or if their number decreases, skin color will become lighter or completely white-as in vitiligo.

Vitiligo is a condition in which pigment cells are destroyed, resulting in irregularly shaped white patches on the skin. Any part of the body where pigment cells are present may be involved.

Common sites of pigment loss are:

• Eposed areas-face, neck, eyes, nostrils, nipples, navel, genitalia
• Body folds-armpits, groin
• Sites of injury-cuts, scrapes, burns
• Surrounding pigmented moles
• Hair-early graying of hair on scalp, graying of hair in some areas of vitiligo other than the scalp.

Who gets vitiligo?

Vitiligo affects at least 1% of the population. About half the people who develop this skin disorder experience some pigment loss before they are 20 years old. About one fifth of all vitiligo patients say that other family members also have this condition.

Even though most people with vitiligo are in good general health, they face a greater risk of having:

• Hyperthyroidism and hypothyroidism-increases or decreased thyroid function
• Pernicious anemia-Vitamin B12 deficiency
• Addison’s Disease-decreases adrenal gland function.
• Alopecia areata-round patches of hair loss

What is the cause of vitiligo?

The cause of vitiligo is not known. Many people have reported a pigment loss shortly after suffering emotional stress or physical injury such as sunburn. There are three theories on the cause of vitiligo.

1. Abnormally functioning nerve cells may injure nearby pigment cells
2. The body may destroy its own tissue (an autoimmune reaction). Researchers speculate that the pigment in cells may be destroyed in response to a substance the body perceives as foreign.
3. Some researchers believe that pigment-producing cells are self-destructive (autotoxic). While new skin cells form, the body produces highly toxic by-products which may destroy pigment cells.

How does vitiligo develop?

The beginning of vitiligo and the severity of pigment loss differs with each individual. Light skinned people usually notice the pigment loss during the summer as the contrast between the vitiligo skin and the suntanned skin becomes more distinct. People with dark skin may observe the onset of vitiligo any time. Individuals who have severe cases will lose pigment over their entire bodies, except for their eyes which do not change color. There is no way to predict how much pigment an individual will lose. Illness and stress can result in more pigment loss.

The degree of pigment loss can vary within each vitiligo patch which means that there may be different shades of pigment in a vitiligo patch. A border of darker skin may circle an area of light skin.

Can cosmetics be used to make vitiligo less noticeable?

Most patients, even those who are responding well to therapy, would like to make the vitiligo less obvious. Many find that a combination of cosmetics effectively de-emphasizes their skin disorder. Patients who are interested in dyes and stains should consult a dermatologist for the names of suitable commercial products.

Treatment

Vitiligo is probably caused by a variety of factors interacting in specific ways. Research has advanced the understanding of the physical and phychosocial aspects of vitiligo, but the cause and cure for this disease are unknown.

The Cheyenne Skin Clinic is now using Narrow Band UVB light therapy for vitiligo patients. Albeit slowly, our patients are seeing pigment return to their skin after several treatments. Please contact the Cheyenne Skin Clinic at (307)635-0226 for more information about this exciting treatment breakthrough.