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. Here we touch on a two common causes of discoloration that patients typically present with.
Melasma mostly affects women with darker skin type 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.
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.