Pigmentation Disorders

Pigment cells (melanocytes)  produce melanin that is carried to the skin surface. Some skin conditions may result in increased (hyperpigmentation), reduced (hypopigmentation) or even absent skin colour.

Hyperpigmentation

Dark patches:               

  • Post-inflammatory pigmentation (eg acne, eczema, psoriasis)
  • Inflammatory skin disorders (lichen planus)
  • Medications

Facial pigmentation

  • Melasma
  • Lichen planus
  • Auto-immune conditions

Generalized hyperpigmentation

  • Addisons disease
  • Haemochromatosis

Common types of skin darkening

  • Pigment spots
  • Melasma
  • Post-inflammatory
  • Sun exposure

Pigment spots such as age spots and freckles appear on frequently sun-exposed areas

Melasma occurs as a result of hormonal influences and birth control pills, but can also develop in men.

Post-inflammatory hyperpigmentation occurs when a skin injury or trauma heals and leaves a flat area of discolouration behind.

Sun exposure cause hyperpigmentation, but can also exacerbate any dark spots.

If you are concerned that any of your dark spots changes in size, colour or bleeds, you have to consult your dermatologist urgently.

How do dermatologists treat hyperpigmentation?

Depending on the skin diagnosis:

  • Broad-spectrum daily SPF 50+ sunscreen
  • Anti-pigmentation procedures
  • Specially compounded creams
  • Cautious cryotherapy
  • Cosmetic camouflage using make-up
  • Resurfacing using chemical peels and microneedling

Hypopigmentation

Hypopigmentation may be due to partial or complete loss of melanin pigment.

If single or multiple pale or white patches appear, there is a long list of conditions to consider. The most common conditions are:

  • Postinflammatory pigmentation
  • Pityriasis alba
  • Pityriasis versicolor
  • Vitiligo

How do dermatologists treat hypopigmentation?

Dermatologists first need to make a diagnosis. Special investigations including a skin biopsy may be necessary to exclude serious systemic conditions.

Hypopigmentation due to inflammatory skin disorders and infections usually resolves by itself over weeks to months once the underlying disorder has been cleared.

Vitiligo affects 1-2% of the population. White patches are due to total loss of pigment in that area and can affect any part of the body. It can be associated with other systemic conditions. Response to therapy is highly variable. Treatment consists of sun protection, topical steroid and phototherapy.