Hyperpigmentation: Description, Causes and Risk Factors:HyperpigmentationHyperpigmentation is a common, usually harmless condition in which patches of skin become darker in color than the normal surrounding skin. This darkening occurs when an excess of melanin, the brown pigment that produces normal skin color, forms deposits in the skin. Hyperpigmentation can affect the skin color of people of any race.Types:Age or "liver" spots are a common form of it. They occur due to sun damage, and are referred to by doctors as solar lentigines. These small, darkened patches are usually found on the hands and face or other areas frequently exposed to the sun.
  • Melasma or chloasma spots are similar in appearance to age spots but are larger areas of darkened skin that appear most often as a result of hormonal changes. Pregnancy, for example, can trigger overproduction of melanin that causes the "mask of pregnancy" on the face and darkened skin on the abdomen and other areas. Women who take birth control pills may also develop hyperpigmentation because their bodies undergo similar kind of hormonal changes that occur during pregnancy. If one is really bothered by the pigment, the birth control pills should be stopped.
  • Other causes of dark spots are injuries to the skin, including some surgeries. Freckles are small brown spots that can appear anywhere on the body, but are most common on the face and arms. Freckles are an inherited characteristic. Freckles, age spots, and other darkened skin patches can become darker or more pronounced when skin is exposed to the sun. This happens because melanin absorbs the energy of the sun's harmful ultraviolet rays in order to protect he skin from overexposure. The usual result of this process is skin tanning, which tends to darken areas that are already hyperpigmented.
People with darker Asian, Mediterranean or African skin tones are also more prone to hyperpigmentation, especially if they have excess sun exposure.Hyperpigmentation is associated with a number of diseases or conditions, including:Cushing's disease or other excessive adrenocorticotropic hormone (ACTH) production, because MSH production is a byproduct of ACTH synthesis from proopiomelanocortin (POMC).
  • Acanthosis nigricans - hyperpigmentation of intertriginous areas associated with insulin resistance.
  • Melasma, also known as ''chloasma'' - patchy hyperpigmentation often found in pregnant women.
  • Addison's disease and other sources of adrenal insufficiency, in which hormones that stimulate melanin synthesis, such as melanocyte-stimulating hormone (MSH), are frequently elevated.
  • Linea nigra - a hyperpigmented line found on the abdomen during pregnancy.
  • Peutz-Jeghers syndrome - an autosomal dominant disorder characterized by hyperpigmented macules on the lips and oral mucosa and gastrointestinal polyps.
  • Certain chemicals such as salicylic acid, bleomycin, and cisplatin.
  • Smoker's melanosis.
  • Celiac disease.
  • Cronkite-Canada syndrome.
  • Porphyria.
  • Tinea fungal infections such as ringworm.
  • Haemochromatosis - a common but debilitating genetic disorder characterized by the chronic accumulation of iron in the body.
  • Powdered jet injections.
Symptoms:Hyperpigmentation may be present from birth in the form of many different types of birthmarks. More commonly, affected individuals will notice a darkening of the skin, either in specific spots or throughout a general area. Many people will notice that their birthmarks or moles become darker when they are exposed to sunlight, and they may worsen significantly during the summer.People who notice new or changing dark spots should consult a dermatologist to rule out skin cancers. Always provide the doctor with a full list of medications and supplements so that any contributing to hyperpigmentation can be identified and possibly stopped.Diagnosis:Often a dermatologist will be able to identify the cause of hyperpigmentation simply by examining the lesions. In more complicated cases, examination with a special light or even a skin biopsy may be necessary to fully evaluate and diagnose the process.A simple way to approach hyperpigmentation is to consider whether the increase in color is caused by an increase of melanin, an increase in melanocytes, or the deposition of another substance that adds color to the skin.A directed history and physical examination offer clues to the underlying cause of hyperpigmentation. The history should address the time of onset of the lesion, because some disorders (e.g., neurofibromatosis) are congenital, while others develop in childhood (e.g., ephelides) or during pregnancy (e.g., melasma). Systemic symptoms may indicate the presence of hyperthyroidism, Addison's disease, or diabetes-related disorders. A review of medication use, supplement use, and exposure to plants and ultraviolet radiation can help determine whether it is caused by a medication side effect or a phototoxic reaction.The size and number of the lesions are useful in diagnosing neurofibromatosis, ephelides, and lentigines. The border, color, and character of a lesion help to distinguish melanoma from a benign lesion, while the distribution of skin changes assists in the diagnosis of melasma and acanthosis nigricans.Treatment:There are a wide range of treatments for hyperpigmentation. The success of a given treatment depends on the cause of the hyperpigmentation, the severity of the lesion and factors that are specific to the person. Strict sun protection is required in order to prevent worsening and recurrence of hyperpigmentation before, during and after treatment.Some forms of hyperpigmentation can be treated with topical medications. Bleaching creams, such as hydroquinone, are some of the most commonly used. These creams are applied to the affected area daily for several weeks to months, in cycles. They cannot be used continuously for long periods of time. Bleaching creams do not work for all types of hyperpigmentation and results may not always be dramatic.Hyperpigmentation is often treated with laser or intense pulsed light therapy. Most of these treatments target the pigment in the skin that causes skin to appear darker. There are many different laser and light treatments which may be highly effective, but these treatments can be expensive and multiple treatments may be required to achieve the desired result. Rarely, these treatments may cause worsening of hyperpigmentation, so a test spot should be performed prior to widespread treatment.Instead of targeting the pigment in the skin, other lasers are used to resurface the skin. This type of treatment can improve hyperpigmentation by removing discolored skin and allowing new healthy skin to replace it. These treatments may require more downtime due to the temporary damage they do to the skin. Other types of resurfacing that may be effective for hyperpigmentation include chemical peels and dermabrasion. Often a mix of the above procedures, combined with strict sun protection will prove most effective.Microdermabrasion is one form of treatment that can minimize hyperpigmentation of the skin. Skin resurfacing procedures such as microdermabrasion can easily remove dark spots caused by hyperpigmentation because the unevenly pigmented skin cells are usually close to the skin's surface. In more mild cases of hyperpigmentation, microdermabrasion can work very well for you. If you have a more severe case of hyperpigmentation, you may need to seek another method of dealing with your hyperpigmentation.Whatever form of hyperpigmentation you do have, and however severe your hyperpigmentation, you need to practice caution when in the sun. Exposing unevenly pigmented skin to the sun can cause the hyperpigmentation to worsen and areas of your skin will become darker. So make sure you use broad-spectrum SPF protection (that protects your skin from UVB and UVA radiation) when you're outside.NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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