Do you have patches of skin that are darker than normal? Lighter than normal?
Changes in the color of your skin fall into two categories– hyperpigmentation and hypopigmentation.
Hyperpigmentation is when areas of skin are darker than normal for your skin tone. It is caused by increased melanin production. In the opposite way, hypopigmentation occurs when melanin production is lower in certain areas of your skin, causing patches of lighter-colored skin. But why do these irregularities happen and should you be concerned?
What causes hyperpigmentation?
A number of things can cause hyperpigmentation, or darkening of the skin. Some of the most common causes are:
- Sun damage. Age spots, also called liver spots, are dark specks or small areas of the skin where an accumulation of sun damage has resulted in excess melanin deposits on the skin.
- Post-inflammatory hyperpigmentation (PIH). Sometimes hyperpigmentation occurs after an injury, leaving you with darkened scars from healed acne lesions, burns or psoriasis flare-ups.
- Melasma. This form of hyperpigmentation causes brown or grayish patches on the face, typically the cheeks, upper lip, bridge of the nose, forehead or chin. It can also appear on the forearms and neck. Melasma is more common in women and is often the result of hormone changes resulting from pregnancy or the use of birth control pills. It is so common during pregnancy that it is also called “the mask of pregnancy.”
- Medications. Drug-induced hyperpigmentation is a side effect of certain medications. The most common cases of drug-induced pigmentation involve non-steroidal anti-inflammatory drugs (NSAIDs), antimalarials, phenytoin,amiodarone, cytotoxic drugs, antipsychotic drugs, tetracyclines and heavy metals.
- Addison’s Disease (also called primary adrenal insufficiency). Hyperpigmentation can be a symptom of Addison’s Disease, a disorder where the adrenal glands do not produce adequate amounts of hormone. Skin darkening associated with Addison’s Disease tends to be in areas where the skin stretches (i.e. knuckles, elbows, knees), in sun-exposed areas, and in newly-formed scar tissue.
Treatment for Hyperpigmentation
Some cases of hyperpigmentation resolve on their own, such as pregnancy-related melasma or drug-induced hyperpigmentation (when the medication is discontinued). One way to minimize hyperpigmentation is to stay out of the sun or use sunscreen and protective clothing if you can’t avoid sun exposure. Dermatologist-recommended treatments for hyperpigmentation include:
- Over-the-counter or prescription skin-lightening medications like hydroquinone.
- Chemical peels to strip away the upper layers of skin that have excess melanin deposits.
- Intense Pulsed Light therapy (IPL) to break down melanin in deeper layers of the skin.
What causes hypopigmentation?
Hypopigmentation, or lightening of the skin, can occur for different reasons, some of which include:
- Previous skin trauma. Healed burns, blisters, infections or rashes can cause temporary hypopigmentation. For a while your skin may appear lighter in these areas until melanin production returns to normal.
- Fungal Infections. Tinea versicolor is a common fungal infection of the skin that usually occurs on the back, trunk and shoulders. It most commonly affects teens and young adults and often appears as light-colored patches of skin, although in some cases the rash can appear darker than surrounding skin.
- Vitiligo. Hypopigmentation is an identifying characteristic of vitiligo, a condition where melanocytes (pigment-producing cells) are damaged or die off. This creates patches of lighter skin (and hair) that often spread over time. Vitiligo can affect the skin on any part of the body, but it usually begins on the hands and face. The causes of vitiligo are not well understood. In many cases it is an autoimmune response. Vitiligo also runs in families or can be triggered by external events.
Treatment for hypopigmentation
Whenever you have lightened areas of skin, it is especially important to use sunscreen and protective clothing to avoid sunburn. Having a dermatologist treat tinea versicolor with antifungal medications will cause the associated skin changes to resolve, although it can take several weeks or months for your skin to completely return to normal.
Treatment for vitiligo is often a combination of medications and laser or light therapy. At Arizona Dermatology, we have had tremendous success with our XTRAC® Excimer laser, which uses a targeted approach to bring back pigmentation to lightened areas of skin while protecting surrounding tissue. We also treat vitiligo with UVB rays in a form of phototherapy. This light-based treatment stimulates melanocytes to produce pigment, helping to return your skin to its natural color.
Any time you have skin changes that concern you, we are here to help! Learn more about all things skin-related in our resource library.