What Are Skin Pigmentation Disorders?

A skin pigmentation disorder is a condition that affects the color of the skin. Some common types of skin pigmentation disorders include albinism, melasma, vitiligo, and pigment changes from skin damage.

The pigment melanin gives skin its color. It is made by specialized skin cells called melanocytes. When melanocytes become damaged, skin color can be affected. It can affect one small area of the body or the entire body, depending on the cause and progression of the disorder.

This article discusses the different types of skin pigmentation disorders along with their symptoms, causes, and treatments.

Types of  Skin Pigment Disorders

There are many types of skin pigment disorders, with different patterns of skin changes, and sometimes with other effects too.

Albinism

Albinism is a genetic disorder caused by defects in genes that provide instructions for 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 have other effects, such as blood clotting issues, pulmonary fibrosis, and inflammation of the large intestines.

There is no cure for albinism, but there are treatment options that can relieve symptoms. The course of treatment depends on how severe the albinism is.

• People who have albinism have to protect their eyes and skin from the sun by using sunscreen, covering up while out in the sun, and wearing 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.  

Melasma

Melasma is a common skin pigmentation disorder. It is also referred to as chloasma or the mask of pregnancy, and it usually affects women. Melasma is 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. 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
• Heat

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:

• 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

When skin is damaged, it can become discolored. For example, wounds and burns can cause skin discoloration that is long-lasting or permanent, depending on the severity.

In the case of burns, the extent of skin discoloration will depend on the severity of the burn. Third-degree burns, second-degree burns, and superficial partial-thickness burns will typically cause skin discoloration.

The symptoms of discoloration caused by burns include:

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

A larger wound is more likely to result in abnormal pigmentation because of the formation of scar tissue, whereas a smaller wound can heal without leaving any scars.

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, scars can appear lighter or darker than the natural color of the skin.

Stretch marks are also a type of scar with abnormal pigmentation. They are typically caused by the rapid growth or shrinking of the skin, such as during 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 for 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 damaged.

Vitiligo

Vitiligo is a chronic skin pigmentation disorder. 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 have 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 can affect small or large patches of skin.

The most likely places for vitiligo to appear 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 at the hair roots 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 affected areas
• 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 is an autoimmune disease that occurs when a person's immune system attacks their melanocytes. Though it is not clear what triggers this process, vitiligo is associated with other autoimmune disorders such as Grave’s disease, Lupus, and pernicious anemia.

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

Treatment options include:

• Opzelura (ruxolitinib) cream to restore pigment
• 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 Healthcare Provider

If you develop skin discoloration, it’s best to book an appointment with your healthcare provider—even if it’s not painful. 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 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 treated medically or safely covered with cosmetics (if you choose to do so). It’s important to stay positive when facing a skin pigmentation disorder and to remember that all skin is beautiful.