Skin pigmentation disorders are relatively widespread, often resulting in considerable stress in patients because their appearance is involved. Most of the concerns raised are merely aesthetic, but some skin pigment changes may indicate more serious, underlying conditions, such as lupus. All skin pigmentation disorders are directly related to the amount of skin pigment, melanin, that is present. A skin disorder with an excess of melanin is known as hyperpigmentary, whereas a disorder with a shortage of melanin is termed hypopigmentary. Loss of pigment in hair can result in white hair.
The following are examples of skin pigmentation disorders:
Melasma
Melasma is a very common hyperpigmentary disorder in women, which affects the parts of the body exposed to the sun. Persistent exposure to the sun and tanning will make the condition worse. The main areas affected are the cheeks, forehead, the upper lip and chin. It can arise in men, but only accounts for 10% of reported cases. An excess of hormones is usually involved, such as the use of the oral contraception, pregnancy and endocrine disorders. In fact, some 30% of women taking oral contraception develop melasma. It can also be related to some cosmetics, medications and liver disease. Treatment of melasma may involve skin lightening agents, camouflage makeup, avoiding tanning and refusing any medications known to have a causative effect.
Vitiligo
Vitiligo is a disorder that causes loss of pigment by destroying melanocytes, the melanin carrying cells. The actual cause of vitiligo is unknown, although many experts believe that genetic factors are involved, since 30% of vitiligo sufferers have another affected family member somewhere in their family tree. It can affect all races, but is more noticeable in those with darker complexions, with men and women affected equally. The more frequently affected areas are the face, back of the hand, wrists, armpits, abdomen and the genitals. Treatment can be very difficult, and may include topical steroids, surgery and ultraviolet light exposure.
Tinea Versicolor
Tinea versicolor is a superficial infection of the stratum corneum, the outermost of the 5 layers of the epidermis, caused by the yeast, malassezia furfur. Although it can be found worldwide and in all races, it is more frequently found in tropical climates. It consists of many, small circular hypopigmented lesions, usually developing on the torso. These areas become more noticeable during the summer, as they do not respond very well to tanning. Elimination of the infection is difficult, with very high rates of re-occurrence. Topical antifungal medicine is typically used to treat the infection.
Any injury to the skin may result in skin pigmentation changes, causing either an increased or decreased area of pigment production. Inflammation may be considered to be a type of injury, and as such may also lead to pigment changes. This is a rare but well known complication of plastic surgery using laser therapy. Skin pigmentation disorders as a result of injury appear to be more common in people with more natural pigment than in fair skinned people.