Pigmentary Skin Disorders


Pigmentary skin disorders

Description, Causes and Risk Factors:

In the skin, melanin functions as an absorptive pigment (any substance whose presence in plant or animal tissues produces a characteristic color). Melanin is produced in specialized skin cells located at the `bottom' of the epidermis termed melanocytes. In humans, the two types of melanin present in the skin eumelanin and pheomelanin, which are responsible for different skin tone.

    Eumelanin is a black or brown pigment, and is mainly concerned with the protection of the skin by absorbing incoming UV radiation.

  • Pheomelanin is a reddish pigment, a very weak absorptive of UV radiation, further it also acts as a photosensitizer (makes your skin sensitive to light), where it increases sun sensitivity and skin ageing.

Skin color is determined by:

    The ratio of eumelanin to pheomelanin, where the more eumelanin present, the darker tone of an individual.

  • The absolute amount and concentration of melanin in the skin.

  • The size of the packets that melanin travels in (melanosomes), the number of melanosomes, and how well spread the melanosomes are.

Types of pigmentation:

    Hyperpigmentation: Hyperpigmentation in skin is caused by an increase in melanin, the substance in the body that is responsible for color (pigment). Moles, age spots, freckles and birthmarks, are other examples of hyperpigmentation

  • Hypopigmentation: Hypopigmentation in skin is the result of a reduction in melanin production

Skin pigment disorders affect the coloration of a person's skin. The skin can become darker or lighter in various areas of the body. Although most pigmentation disorders are not dangerous and do not cause a person to become physically ill they can cause emotional distress especially when the affected skin is in a visible area such as the face. These disorders are extremely common in blacks, Hispanics, and Asians.

Types and causes:

    Two very common pigmentary disorders in blacks are postinflammatory hyperpigmentation and hypopigmentation. Postinflammatory hyperpigmentation is a common sequel of many inflammatory dermatoses; especially papulosquamous and vesiculobullous type. Inflammatory diseases that may lead to postinflammatory hypopigmentation include pityriasis alba, atopic dermatitis, irritant and allergic contact dermatitis, sarcoidosis, lichen striatus, secondary syphilis, tinea versicolor, diaper dermatitis, and discoid lupus.

  • Melasma is another pigmentary disorder that occurs frequently in people with skin of color. Clinically it presents as areas of hyperpigmentation ranging from light-brown/gray to dark-brown/gray macules and patches usually in a symmetric pattern.

  • Vitiligo is a condition in which pigment cells are destroyed and irregular white patches result. The exact cause is unknown, but it is thought to be an autoimmune disorder. The extent of color loss differs with each person. There is no way to predict how much pigment will be lost. Although rare, people may lose pigment over their entire body. Most patients with vitiligo do not regain skin color without treatment.

  • Pityriasis alba is another condition presenting as hypopigmentation in dark skinned people, in which there are round, light patches of skin covered with fine scales, most noticeable on the face and upper arms, most commonly found in children. The white patches are the result of mild eczema and the loss of color is only temporary.

  • Dry skin is a problem for individuals of all skin colors, but may be especially distressing to people with darker skin tones. It is uncomfortable and is easily noticed in people with darker skin because of its grayish, "ashy" appearance. Ashiness also can affect the scalp.

  • Albinism: When someone suffers from albinism - i.e., he or she is an albino - they most certain have a pigmentation problem. This problem, however, is inherited. The condition is characterized by pale skin, pale hair, and pale eyes. The problem here is that sufferers do not even have skin pigmentation.

  • Pregnancy: Sometimes, during a woman's pregnancy, she might start to notice brown spots appearing on her face. This is typically the fault of the way her hormones are fluctuating because of being pregnant.

  • Menopause: Like pregnancy, menopause can cause pigmentation problems because of the way the hormones fluctuate. Women who have to have their ovaries and/or uterus removed will likely suffer from more severe pigmentation.

  • Illnesses like pneumonia and other health problems which affect the amount of oxygen getting to the bloodstream can cause a certain type of pigmentation. Rather than dark spots, this cause manifests in purple or blue patches of skin.

Risk factors may include:

    Excessive sun exposure is one of the most common causes of pigment disorders.

  • Heredity may also play a factor in who develops such a condition.

  • Trauma or injury to the skin.

  • Believe it or not, eating the wrong foods can also cause pigmentation problems. It can occur when you are undernourished or malnourished, or when you simply have a very poor diet.

  • Some autoimmune disorder can also leads to skin pigmentation.

  • Wounds and scars often develop dark patches which cause skin discoloration in the affected area.

  • Drug reactions have also been known to cause skin discoloration.

  • Hormonal changes can affect the production of melanin in the body causing de-pigmentation or increased pigmentation.

Symptoms:

    In Melasma discoloration develops over the bridge of the nose and cheeks. This often disappears after childbirth.

  • An Albino typically has a pale skin, white, yellow or pale hair, and light eyes.

  • Vitiligo is a condition characterized by smooth, depigmented white spots on the skin.

  • Lamellar ichthyosis an inherited disease characterized by dark, dry and scaly patches of skin.

  • Lichen simplex chronicus is a skin disorder in which dark patches develop. It is often accompanied by severe itching.

  • People with systemic lupus, an autoimmune disease, may develop a butterfly-shaped, dark- colored mask on their faces.

Diagnosis:

Diagnostic tests vary for different types of skin pigmentation disorders. Physicians usually can diagnose skin pigmentary disorders by looking carefully at a person's hair, skin, and eyes. They may order blood tests and eye exams as well.

For most hyperpigmentation disorders, doctors can make a diagnosis by looking at a person's appearance. To detect conditions like lichen simplex chronicus or lamellar ichthyosis, or skin cancer, they may also do a biopsy to remove some of the affected skin for further study under a microscope.

Some physicians also use a wood's lamp, or black light test, to diagnose skin conditions. Affected areas would absorb the ultraviolet light and stand out with fluorescent colors in the darkened room.

Treatment:

The first step is to confirm a diagnosis of a skin disorder is by seeing a physician or dermatologist.

    In the case of hyperpigmentary disorders, the physician may prescribe a cream, such as hydroquinone, retinoids, or azelaic acid, to help lighten the skin.

  • In the case of postinflammatory hyperpigmentation, it is important to first eliminate the underlying cause of the pigmentation (acne, eczema, etc.) before treating the excess pigmentation.

  • Vitiligo has no cure. However, the symptoms can be masked with a combination of cosmetic products and treatments that can be discussed with a dermatologist.

  • For lichen simplex chronicus, doctors could prescribe antihistamines and topical steroid creams to stop the itching.

  • Counseling with a dietitian may help in cases caused by poor nutrition.

Disclaimer: The above information is educational 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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