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Facts about the skin from DermNet New Zealand Trust. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z



Pigmentation disorders

Introduction

Pigmentation of the skin normally varies according to racial origin (Fitzpatrick phototypes 1 to 6) and the amount of sun exposure.

The pigment cells or melanocytes are located at the base of the epidermis and produce the protein melanin. Melanin is carried by keratinocytes to the skin surface. The melanocytes of dark skinned people produce more melanin than those of people with light skin. More melanin is produced when the skin is injured, for example following exposure to ultraviolet radiation. The melanin in dark skin is protective against sun damage, but melanin produced in white skin (for example after sunburn) is not very protective.

Hormonal effects of oestrogen during pregnancy or due to medication can cause pigmentation of nipples, vulva and abdomen (linea nigra).

Some skin diseases and conditions result in generalised or localised hyperpigmentation (increased skin colour), hypopigmentation (reduced skin colour) or achromia (absent skin colour).

A Wood lamp may be used to assess pigmentation during the examination of the skin, as pigmentary changes are often easier to identify while exposing the affected skin to long wavelength ultraviolet rays (UV-A).

Suntan in dark skin
Suntan in dark skin
Suntan in dark skin
Suntan in fair skin
Hormonal hyperpigmentation. 5 days of oestrogen cream
Hormonal pigmentation
(5 days of oestrogen cream)
Hormonal hyperpigmentation. Linear nigra during pregnancy
Hormonal pigmentation
(pregnancy)
Skin colour

Generalised hyperpigmentation

Generalised hyperpigmentation may arise due to excessive circulating melanocyte stimulating hormone (MSH), when it often has a bronze hue. It occurs:

Localised hyperpigmentation

If dark patches are observed, the main diagnoses to consider are:

Diffuse lentiginosis
Diffuse lentiginosis
Postinflammatory dyspigmentation following laser epilation
Postinflammatory pigmentation
(laser epilation)
Postinflammatory hyperpigmentation due to acne
Postinflammatory pigmentation
(acne)
Flagellate pigmentation due to drug eruption
“Flagellate” pigmentation
(drug eruption)
Melasma
Melasma
Poikiloderma of Civatte
Poikiloderma of Civatte
Capillaritis
Capillaritis
Post-sclerotherapy staining
Post-sclerotherapy staining
Localised hyperpigmentation

What is the treatment of hyperpigmentation?

If pigmentation affects an exposed site, daily application of broad-spectrum SPF 50+ sunscreen is important to minimise darkening caused by UVR. Cosmetic camouflage can be used.

The following agents can be used to lighten epidermal melanosis, alone or, more effectively, in combination:

Resurfacing using chemical peels, laser, intense pulsed light (IPL) or dermabrasion may be effective but unfortunately risks further damage to the epidermis and formation of more pigment. Cautious cryotherapy to small areas of postinflammatory pigmentation can be effective but risks causing permanent hypopigmentation.

Cosmetic camouflage using make-up is sometimes the best advice.

Generalised hypopigmentation

Generalised reduction in pigmentation at birth (congenital) may be racial in origin or due to albinism. Pituitary failure resulting in lack of MSH rarely results in acquired generalised hypomelanosis. Pallor is much more frequently due to blood loss or anaemia.

Localised hypopigmentation

Localised hypopigmentation may be due to partial or complete loss of melanin (achromia or leukoderma).

If single or multiple pale or white patches are observed, the main diagnoses to consider are:

Pityriasis alba
Pityriasis alba
Pityriasis alba
Pityriasis alba
Hypopigmented pityriasis versicolor
Pityriasis versicolor
Postinflammatory hypopigmentation: Thermal burn
Thermal burn
Postinflammatory hypopigmentation: Longstanding prurigo
Longstanding prurigo
Postinflammatory hypopigmentation: Surgery and cryotherapy to multiple skin cancers
Surgery and cryotherapy
(multiple skin cancers)
Vitiligo Vitiligo
Localised hypopigmentation

What is the treatment of hypopigmentation?

The hypopigmentation due to inflammatory skin disorders and infections usually resolves by itself over weeks to months once the underlying disorder has been cleared. There is no effective treatment for achromia due to scarring. The response of vitiligo to therapy is highly variable.

Related information

References:

On DermNet NZ:

Other websites:

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Author: A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Updated September 2014.

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If you have any concerns with your skin or its treatment, see a dermatologist for advice.