What Are Skin Pigmentation Disorders?

A skin pigmentation disorder is a health condition that affects the color of the skin. The pigment melanin is made by specialized skin cells called melanocytes. They are what gives skin its color. In the event that melanocytes become damaged or unable to create melanin, the color of the skin can change. A lack of pigment can affect one small area of the body or the entire body, depending on the cause and progression of the disorder. Skin pigmentation disorders can be caused by any number of health issues. Some specific diseases that cause skin discoloration include melasma, albinism, and vitiligo.

beautiful girl with a pigmentation on her half face and white eyelaces. close up portrait.

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Types of  Skin Pigment Disorders

There are many types of skin pigment disorders. Some can occur due to other underlying health conditions like Addison’s disease.

Albinism

Albinism is a genetic disorder caused by defects in genes that provide instructions on melanin production. Several genetic defects makes the body unable to produce or distribute melanin.

The main symptom of albinism is a lack of color in the hair, skin, or eyes. These symptoms can affect the entire body or just small patches of skin. In some cases, a person with albinism will have some color in their hair, skin, and eyes, but it will be lighter than normal. Other symptoms of albinism can include vision problems, such as:

  • Crossed eyes
  • Increased sensitivity to light
  • Involuntary rapid eye movements
  • Impaired vision or total blindness

There are different types and subtypes of albinism, all of which are caused by different genetic defects. Oculocutaneous albinism (OCA) is the most severe form, and it has several subtypes. In the case of the first subtype, OCA1, the defect occurs in the tyrosinase enzyme. Other genes affected are the OCA2 gene, the TYRP1 gene, and the SLC45A2 protein. OCA1 is the most severe form.

Ocular albinism is a form of the condition caused by a mutation in the X chromosome, and symptoms are seen in the eyes only. The pigment in the skin and hair is typically normal, but the iris and retina lack pigmentation, resulting in vision problems.

Albinism can also be caused by certain hereditary syndromes. Hermansky-Pudlak syndrome is associated with oculocutaneous albinism, and is caused by mutations in one of eight specific genes involved in melanin production. This condition has the same typical symptoms of albinism, but it can also has other symptoms such as blood clotting issues, pulmonary fibrosis, and inflammation of the large intestines.

There is no cure for albinism, but there are treatment options to relieve symptoms. The course of treatment will depend on how severe the albinism is. It takes a protective approach. Those with albinism have to protect their eyes and skin from the sun by using sunscreen, covering up while out in the sun to avoid exposure, and wear sunglasses. For those with symptoms affecting vision, glasses are often prescribed, and in more serious cases, eye muscle surgery can be done to correct rapid eye movements.  

Vision Problems and Albinism

Some people with albinism may have issues with their eyes, eyesight, and light sensitivity. If you experience any eye issues and have albinism, it's important to see an ophthalmologist to have your eyes examined.

Melasma

Melasma is a common skin pigmentation disorder. It is also referred to as chloasma or the mask of pregnancy, and the majority of documented cases of the disorder are found in women. Melasma is also more likely to occur in people with darker skin tones.

The main symptoms of melasma are brown or gray patches of skin discoloration on the face, though, areas of the body that are often exposed to the sun can also be affected. The patches tend to be symmetrical on both sides of the face or body, and are darker than the natural skin tone. The coloration does not pose any health risks, but many people with the condition will seek treatment for cosmetic reasons.

The actual cause of melasma isn’t known. It is thought that those with darker skin tones may be more susceptible to the disorder because their melanocyte activity is higher than in those with lighter skin tones.

Common triggers for the condition include:

  • Exposure to the sun
  • Hormonal changes such as those that occur with pregnancy
  • Certain skincare products

If melasma is caused by a specific trigger, such as hormonal changes, the condition will clear up on its own when the hormones return to normal or the trigger is eliminated. The condition can last a lifetime.

The first-line treatment for melasma is topical medications, including:

  • Hydroquinone in the form of a lotion, gel, cream, or liquid to help lighten the skin
  • Tretinoin and corticosteroids to help enhance the lightening effects of hydroquinone

If the medications don’t work, certain cosmetic procedures may be done, such as derma- and microdermabrasion, chemical peels, or laser treatment.

Pigment Changes from Skin Damage

The skin can become damaged, leaving discoloration on parts of the skin. Things such as wounds and burns can cause discoloration of the skin that is long-lasting or permanent depending on the severity.

In the case of burns, the level of skin discoloration will depend on the severity of the burn. Second-degree burns, or superficial partial-thickness burns, will typically present with skin discoloration, as will the most severe type of burn, a third-degree burn. The symptoms of discoloration caused by burns include:

  • Hyperpigmentation
  • Hypopigmentation
  • Red, white, or charred skin
  • Blistering
  • Peeling skin
  • Swelling

The size of the wound will be the deciding factor when it comes to changes in pigmentation. A larger wound will likely result in abnormal pigmentation because of the formation of scar tissue, whereas a smaller wound will likely heal without leaving any scars. In the event that a wound, large or small, does leave scarring, it will typically look different as the wound heals.

The majority of scars are known as flat scars, and during the initial stages of healing, they will be pink or red and slightly raised on the skin. In some cases, the scar will revert back to the normal skin tone, but in other instances, they can appear either lighter or darker than the natural color of the skin.

Stretch marks are also a type of scar that can affect the pigmentation of the skin. They are typically caused by the rapid growth or shrinking of the skin seen in pregnancy or weight loss and gain. When stretch marks first begin to form, they are red, purple, or dark brown, and they eventually fade to a white or silver color.

Other types of skin damage discolorations include freckles and liver spots, which are caused by exposure to the sun, and post-inflammatory hyperpigmentation, which can be caused by injury scarring or acne scarring.

Treatment for changes in skin pigmentation caused by wounds is mostly ineffective. In the case of burns, skin grafts can be used, but they tend to leave discoloration following the procedure. To help minimize the appearance of scars and potential discoloration:

  • Keep the injury clean while it’s healing
  • Use petroleum jelly on the wound while it’s healing
  • Cover the wounded area with a bandage and ensure it is changed daily
  • Follow any instructions on the removal of stitches to help minimize the appearance of a future scar
  • Use sunscreen on the wound to help reduce discoloration 

Scars will fade over time, but there is no effective way to remove all of the discoloration that scarring leaves after the skin has been wounded.

Vitiligo

Vitiligo is a skin pigmentation disorder that develops over time. Roughly 1% to 2% of the world’s population has vitiligo, and cases are equally spread out over all racial groups. Although there are no detrimental health effects, vitiligo has been shown to cause psychological distress in those who live with the condition.  

The main symptom of vitiligo is a complete loss of pigment in the skin which results in patches of white. It can occur on any area of the body and affect small patches of skin or large ones. The most likely places for vitiligo to occur are in areas where sun exposure is frequent, including the hands, feet, face, and arms. It can also affect the mouth, eyes, groin, and genitals. Parts of the head can also be affected, mainly where the hair roots are on the scalp, and in some instances, a person’s hair could turn white or gray. Other symptoms of vitiligo include:

  • Itching and discomfort in the areas affected
  • Loss of color in the tissues that line inside the nose
  • Graying of the eyelashes, eyebrows, or other facial hair

There are two types of vitiligo: non-segmental, which is characterized as symmetrical patches that appear on both sides of the body, and segmental, which is localized and typically only affects one area of the body asymmetrically. Segmental vitiligo is not as common as non-segmental vitiligo, although it is the type that occurs more often in children.

Vitiligo occurs when a person’s immune system begins to attack healthy cells, which makes it an autoimmune disease. The cells that are attacked in the case of vitiligo are melanocytes, the cells that produce melanin. Though it is not clear what leads the immune system to destroy melanocytes, it is associated with other autoimmune disorders such as Grave’s disease, Lupus, and Pernicious anemi.

Although the condition doesn’t pose any health risks, many people seek treatment for cosmetic reasons. Treatment options include:

  • Long-lasting dyes in the affected areas
  • Light-sensitive medications
  • UV light therapy
  • Corticosteroid creams to try to restore pigment
  • Surgery
  • Removing the remaining pigment in the skin

When To See A Doctor

It can be difficult to decide whether or not a skin pigmentation issue warrants a visit to the doctor. You’ll know when to see a doctor by monitoring the discoloration, its severity, and how it affects you. If a new discoloration doesn’t subside, it’s best to book an appointment with your doctor even if it’s not bothering you physically. This will help you rule out any serious skin diseases, and put you on the road to treatment that much quicker.

A Word From Verywell

Dealing with a skin pigmentation disorder can be difficult, even if it doesn’t cause any physical harm to your health. The emotional struggle can take a huge toll on your mental well-being. The good news is that many skin pigmentation disorders are not serious and can be dealt with easily whether through treatment options or the use of cosmetics and other creams to restore pigmentation or cover up patches you don’t like seeing. It’s important to stay positive when facing a skin pigmentation disorder and remember that all skin is beautiful.

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Article Sources
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