Skin discoloration is a common presenting complaint to the dermatology office. It can be a source of great distress for patients both aesthetically and by creating anxiety about possible malignancy or permanent scarring.
Generally speaking discoloration falls into two broad categories: hyperpigmentation (dark or brown discoloration) and hypopigmentation (white or pale discoloration). It is important to note that are many causes of skin discoloration and we highly recommend evaluation by a board-certified dermatologist for proper diagnosis if you are experiencing any skin discoloration.
What is Melasma?
Melasma mostly affects women with darker skin tones who present with brown to brown-gray patches commonly on forehead, cheeks, above the upper lip, bridge of the nose, chin and other sun exposed areas.
While the cause is not yet fully understood we know of several triggers of melasma including sun exposure, change in hormones and use of irritating skin products. Commonly melasma starts during pregnancy when it’s referred to as “mask of pregnancy” or with use of hormonal treatments such as birth control pills or hormone replacement therapy.
Melasma must be differentiated from other hyperpigmentation disorders including a common cause of hyperpigmenation known as post-inflammatory hyperpigmentation (PIH) whereby dark or brown skin discoloration occurs at sites of prior skin inflammation.
Any effective treatment strategy for melasma or PIH must include strict sun protection. There a number of treatment modalities a dermatologist will utilize in treatment of melasma. Topical creams that include one or more ingredients that promote bleaching and fading are the mainstay of treatment. However, procedures including chemical peels, lasers, microneedling and dermabrasion can also be powerful tools in treating melasma when utilized by an experienced dermatologist.
Melasma can be stubborn and requires longitudinal care but many patients do experience a good outcome. The first step is evaluation by a dermatologist for confirm diagnosis and devise an appropriate treatment plan.
What is Vitiligo?
Vitiligo occurs when cells that given skin its natural color, called melanocytes, slowly die off turning the affected areas pale or white. Dermatologists refer to this process “depigmentation”.
Besides affecting the skin this depigmentation can also occur inside the mouth, hairs, eyes and genitals. While most affected by vitiligo do not have any other symptoms and otherwise feel healthy, vitiligo can often be a source of great distress.
The cause of vitiligo is not fully understood but we do know that it is not a contagious process and it does not imply an internal disorder. Genetics seem to play a role as the risk goes up if a close blood relative has vitiligo. It also seems to be associated with other autoimmune diseases such as alopecia areata and Hashimotos’ thyroditis.
Depending on type and subtype of vitiligo its natural course can be variable from being limited to only a few areas of the skin to a more generalized involvement. It is important to differentiate vitiligo from several other skin conditions that may mimic its appearance including other common conditions such as tinea versicolor and pityriasis alba.
Treatment options for vitiligo include various topical anti-inflammatory medications, light-based devices including phototherapy and excimer laser treatment. Proper evaluation by an experienced dermatologist is needed to establish the diagnosis and a tailored treatment strategy.
Skin Discoloration FAQs
What are some of the causes of skin discoloration?
Skin discoloration can result from excessive sun exposure which leads to sunspots, hormonal imbalances that may trigger conditions like melasma, and certain medications that can cause photosensitivity. Injuries to the skin, such as cuts, burns, or acne, can also lead to post-inflammatory hyperpigmentation once they heal.
How can I prevent skin discoloration?
To prevent skin discoloration, regularly apply a broad-spectrum sunscreen with an SPF of 30 or higher, even on cloudy days. Wearing wide-brimmed hats and UV-protective clothing can also shield the skin. Incorporating antioxidants in your skincare routine, like vitamins C and E, can protect against UV damage and help maintain even skin tone.
What are some of the emotional and psychological effects of skin discoloration?
Skin discoloration can lead to significant emotional distress, affecting individuals' perception of their appearance. This can cause feelings of embarrassment or frustration, potentially leading to social isolation or depression. The visibility of skin discoloration, especially on the face, can impact daily interactions and self-confidence.
What are some of the latest innovations in the treatment of skin discoloration? Advanced treatments for skin discoloration include laser therapy that targets and breaks down pigment without damaging surrounding tissue. Chemical peels with specific acids can help shed the outer layer of skin, lightening dark spots. Topical agents like hydroquinone and retinoids have also been reformulated for better efficacy and reduced side effects.
How is melasma different from post-inflammatory hyperpigmentation?
Melasma typically appears as large, symmetrical patches of darkened skin primarily on the face and is often associated with hormonal changes such as pregnancy or birth control use. It is chronic and often recurring. In contrast, post-inflammatory hyperpigmentation is a temporary condition that arises after an inflammatory skin event and appears as localized dark spots where the inflammation occurred.
Can skin discoloration be a sign of an underlying health issue?
While often a cosmetic concern, skin discoloration can be a sign of more serious underlying health issues like Addison's disease, which causes increased pigmentation due to adrenal insufficiency, or liver disease, which may manifest as jaundice or increased skin pigmentation around the eyes and other areas. It's crucial to consult a healthcare provider for an assessment if skin discoloration is persistent or accompanied by other unusual symptoms.
What are the treatment options for vitiligo?
Treatment options for vitiligo focus on restoring color to the affected areas of skin. These may include topical medications such as corticosteroids and calcineurin inhibitors to control inflammation and promote skin color. Light therapies, including narrowband UVB therapy, are often effective, especially in early stages. For more extensive vitiligo, skin camouflage and depigmentation of unaffected skin areas might be considered. In some cases, skin grafting or micropigmentation (tattooing) can be options.
What are long-term care suggestions for chronic skin conditions like melasma?
Managing chronic skin conditions like melasma requires a comprehensive approach. Consistent use of broad-spectrum sunscreen and wearing protective clothing are crucial to prevent worsening of pigmentation. Treatments such as topical tranexamic acid, kojic acid, or azelaic acid can help lighten dark patches. Incorporating gentle skin care products and avoiding harsh treatments that can trigger inflammation is important. Regular follow-ups with a dermatologist to monitor the condition and adjust treatments as necessary can also help manage melasma effectively over the long term.
If you are ready to restore your skin’s natural radiance, The Skin & Beauty Center is here to help. With offices conveniently located throughout Los Angeles, we are never too far away. Contact us today at 818.842.8000 to schedule an appointment today.
