Pigmentation refers to the colouring of a person’s skin. In a healthy person, the skin appears normal in colour. However, when a person is ill or it sustains an injury, the skin might change its colour. When it becomes darker, it is known as hyper pigmentation. When it becomes lighter, this is called hypo pigmentation.
Hyper pigmentation irregularities are common and many times associated with the aging process. Though different circumstances may cause this condition, hyper pigmentation occurs when the pigment producing cells known as melanocytes become overactive. This fuels the production of melanin, which is the substance in the body responsible for colour. Melanin gives colour to the skin, the iris of the eye, as well as hair. Levels of melanin vary greatly by race as well as by the amount of exposure to the sun. Sun exposure increases this production of melanin, as it is the body’s mechanism in order to protect the skin against the harmful ultraviolet rays. Certain conditions, like Addison’s disease or pregnancy may cause the body to produce more melanin and causing hyper pigmentation.
Exposure to sunlight is a major cause of hyper pigmentation and causes the already dark areas to become even darker. Hypo pigmentation is a directly opposite condition, which is not that common. It occurs when the melanocytes get either damaged or destroyed and thus halting the production of melanin. Consequently, the skin will become lighter. In the following paragraphs, we will review some the most common pigmentation disorders.
Skin conditions which are known as hyper pigmentation
Hyper Pigmentation
Hyper pigmentation can be caused by inflammation, sun damage, or due to other skin injuries, including those related to acne. People who have darker African, Asian or Mediterranean skin tones are more prone to hyper pigmentation especially in case they have excessive sun exposure. Some of the more prevalent conditions are detailed below:
Freckles
Freckles refer to flat, tanned circular spots which are usually the size of the head of an ordinary nail. These are multiple spots and may develop randomly on the skin, especially after repeated sun exposure.
Freckles
They are more common in people with a fair complexion and usually appear on the upper-body skin areas, such as the nose, cheeks, arms as well as shoulders. They can even appear on people who are as young as 1 or 2 years old. Mostly the freckles on a person’s skin are uniform in colour, though the shades may vary on different people, which may be yellow, tan, light brown, reddish, or even brown or black, but these are usually darker than the surrounding skin. They normally get darker after sun exposure and can lighten in the winter months when exposure to sunlight is reduced. Researchers have isolated a receptor gene (MC1R) and found that people who have this gene tend to develop freckles. Simple freckles are usually tan in colour, round, as well as small. Sunburn freckles are often darker and they can have irregular borders, besides being larger than a pencil eraser. These freckles are more common on the shoulders as well as upper back where people typically get the most severe sunburns. Mostly freckles are perfectly harmless but are considered a cosmetic annoyance.
Age Spots
These are sometimes referred to as “sun spots” or even as “liver spots” and are seen in adults, usually on the arms, face as well as on the back of the hands. The term “liver spot” is actually an inappropriate name for this condition as these spots are not caused by any liver problems. Actually, these spots are not to be considered an indication of age but they tend to develop over time and due to repeated sunlight exposure. It is thought that UV radiation in sunlight triggers a mutation which, in turn, causes an increase in the production of melanin. It is this increase in melanin which produces the so-called age spots, which are totally harmless.
Melasma/Chloasma
This refers to a condition that is characterized by tan or brown patches, commonly on the face. This disorder can occur during pregnancy and is sometimes also referred to as “the mask of pregnancy”. However, even men can develop this condition. Melasma tends to go away after childbirth. Besides pregnancy, melasma can also be triggered by oral contraceptives as well as other hormone imbalances. These hormonal changes are assumed to be the leading cause of developing melasma, though other factors too may contribute to its formation. The combination of sun damage as well as the use of certain products, like as deodorants, toiletry and other personal care items to which a person has sensitivity, play a role in the development of melasma. In the case of hormone induced melasma, once childbirth has taken place or the using of oral contraceptives has been discontinued, this condition will usually dissipate on its own. In case the cause is non-hormonal, avoiding sunlight exposure may highly limit the severity of this condition.
Hypo pigmentation skin conditions
Hypo pigmentation occurs much lesser than hyper pigmentation. It is due to a reduction or absence of melanin production. This condition is caused due to a serious injury to the skin, such as a burn, or due to an autoimmune disease which attacks the melanocytes, which stimulate melanin production. Listed below are some of the better known examples:
Albinism
This is an inherited disorder caused by the absence of an enzyme which produces melanin. This condition results in a complete lack of pigmentation in the hair, eyes or skin. Albinos have an abnormal gene that inhibits the body from producing melanin, thus the lack of pigmentation. A cure for albinism is not there.
Pigmentation loss due to skin damage
When somebody sustains an injury to the skin, which may be a skin infection, blisters, burns or any other types of trauma, it is common to experience a loss of pigmentation around the affected area. This is usually a temporary condition, though it may take quite a long time for this skin to return to its normal colour. This depends mainly on the severity of the skin injury.
Vitiligo
This is a condition which causes smooth, white patches on the skin, which in some cases can appear all over the body. This is related to an autoimmune disorder which damages the melanocytes, which reduces the production of melanin. A cure for vitiligo is not there.
How to prevent the pigmentation disorders
Almost all the problems which are associated with hyper pigmentation can be traced to the over-exposure to sun. Thus routinely using a sun protection product is very important. Women having a history of developing melasma may be able to lower the risk of a recurrence by using a non-hormonal type of birth control. This needs to be discussed with a physician so that all the factors as well as risks can be evaluated.
The various pigmentation disorder treatments
Various different treatments are available foe those affected by hyper pigmentation disorders. These include chemical peels, cryotherapy, as well as laser/intense pulsed light, besides topical lightening agents.
The treatments for hypo pigmentation conditions are definitely much more challenging. Pigment damage to that part of the skin where a burn or any other severe trauma has occurred can resolve itself over time. The melanocytes too can migrate to the affected area and, slowly, the damaged skin can start to regain its normal pigmentation. The process can be very slow. Treatments being used for vitiligo currently have very little effectiveness. Many people choose to apply the sunless tanning products to these affected areas.