It is not surprising that many people believe that pigmentation disorders are minor. They are, after all, not life threatening, and most don’t even impact the person’s overall health. However, the damage that is done to the person’s self-esteem can be devastating, especially if the pigmentation problem occurs in the face. People with noticeably uneven pigmentation may be so unhappy about their condition that they do not want to leave their home. This can have terrible effects on their ability to seek employment or personal relationships. Worse, other people may be put off by the sight of a person who has a pigmentation disorder, even though none of the ones discussed are contagious.
1. Skin Damage
Damage to the skin can occur for many reasons. Third degree burns, whether from fire, radiation, acids or other corrosive chemicals leave lasting scars that can be disfiguring. Also disfiguring are scars left by gunshot and knife wounds and accidents. Animal and even human bites can cause lasting damage on the skin. In the past, diseases could deform a person’s features. They included smallpox and Hansen’s disease or leprosy. Even acne leaves scars and pits on the face, especially the type of acne that forms cysts or nodules.
Scars are the way the skin heals after an injury, even if they are unattractive. They are different colors than the surrounding skin because they are not formed the same way that normal skin is. Scars and normal skin are made of collagen, but in a scar the collagen is arranged like a row of bricks. Normal skin has a more basket weave look. Scar tissue is also weaker than normal skin, lacks hair and sweat glands and is more susceptible to damage by UV radiation. It also loses water faster than normal skin, which stimulates the body to build more collagen to protect it. This only makes the scar more unsightly.
2. Vitiligo
The signs of vitiligo are a loss of pigment that results in random white patches over the skin. Though it is more noticeable in people of color, vitiligo can affect people of any race and affects both sexes equally. People with vitiligo are usually in good general health.
Areas that are most often affected include the hands, face and lips. This can make vitiligo especially difficult for dark-skinned people. The white patches don’t hurt or itch but can spread to form even larger patches of depigmented skin. In some people the signs and symptoms of this disease are so mild that it’s not noticeable. The entire body may be affected in other people.
3. Pityriasis Alba
Pityriasis alba is Latin for “scaly white,” and its symptoms are a temporary loss of pigmentation on the cheeks, necks and shoulders. It is common in children of both sexes but may also strike young adults. The signs and symptoms begin as small white or pink patches with fuzzy borders that sometimes have tiny raised bumps. Otherwise these patches, like the patches of vitiligo, are smooth to the touch.
The white patches on the skin don’t tan, so they can be readily seen. They turn scaly in cold, dry weather and may itch, though they don’t hurt. A child can have one patch or many at a time, and they are generally 1/4 of an inch to 2 inches around. Doctors do not know what causes pityriasis alba, but the condition is benign and goes away completely when the child reaches adulthood.
4. Tinea Versicolor
Tinea versicolor is a fungal infection that changes the color of the patient’s skin. The one good thing about this type of pigment disorder is that it doesn’t usually affect the face. It is usually found on the chest, upper arms, back, shoulders, groin or trunk. Both sexes are affected, and it mostly affects teenagers and young adults.
The fungus that causes tinea versicolor is found on the skin of healthy people, and doctors do not know why it becomes active and starts to cause symptoms. Despite the fact that it’s a fungal infection, tinea versicolor isn’t contagious.
The signs and symptoms of this disease are spots or patches on the skin whose color is different than the color of the surrounding skin. The color of the infected skin depends on the normal color of the skin, so the patches can be white, pink, tan or dark brown. The spots may enlarge, join and form larger patches. The patches may itch, especially in the heat. They tend to fade in cool weather.
5. Halo Moles
Halo moles get their name because a white halo surrounds the mole. They are usually found on children or teenagers and affect both sexes. The halo around the mole means that the body is attacking it because it recognizes it as abnormal. Eventually the color of the mole fades, and it disappears. The halo often appears after the person suffers sunburn.
Halo moles are mostly found on the person’s trunk and are not common on the face, arms or legs. The body may attack a few of these moles at a time, while leaving others unharmed. When the mole is gone, the normal pigment usually returns, but it can take several years for this to happen.
These types of moles are benign and don’t need treatment, but the person should wear sunscreen over the area when they go outside.
6. Photo Damage
Photo damage to the skin can be caused by exposure to the sun’s ultraviolet rays. Using tanning beds can also lead to photo damage. Because it can be caused by the sun, most people have some measure of photo damage. Patches of skin that are lighter or darker than the surrounding skin is one of the signs that a person has suffered photo damage.
These are liver spots and sunspots and are found on the areas of the skin that get the most sun exposure. They are caused by an increase in the number of melanocytes, which are cells that carry skin pigment. Lentigines are benign. Their number increases with age, and there are many types. They include ink spot lentigines, mucosal lentigines and PUVA lentigines.
Unlike lentigines, freckles are not an increase in melanocytes but an increase in melanin, the pigment that gives skin its color. They are seen most easily on fair-skinned people. They are most often found on the face and fade when the person stays out of the sun. Unlike other types of pigmentation disorders, many people find freckles attractive on some people, especially children.
Actinic keratoses are different from the other disorders discussed here because they are precancerous. They are common on the face, as well as the scalp, lips, arms and hands. They are seen in people over age 50. They are scaly patches with an irregular shape and can be pink, red, brown or skin-colored. A person who believes they have developed an actinic keratosis should have it treated by a dermatologist.
7. Melasma
A melasma is a patch of skin that is darker than the surrounding skin. It is often found on the face including the forehead, nose, lips and upper cheek. It is benign and has no symptoms besides the hyperpigmentation. Melasma is often found on pregnant women and is called the mask of pregnancy. Women who take birth control pills or are on hormone replacement therapy can also have melasma.
Doctors believe women are so susceptible to melasma because the melanocytes are stimulated by female hormones. The condition usually goes away after the woman gives birth or stops hormone therapy or birth control pills.
8. Chemical Peels
Chemical peels are used cosmetically to soften the look of wrinkles and lines and, ironically, uneven pigmentation. During a chemical peel, an aesthetician paints a patient’s face with fruit acids of varying strengths. The acids are left on for a few minutes then washed off. Usually, the results are pleasing to the patient, but people with darker skin are warned to avoid chemical peels because it can lead to uneven pigmentation. A badly applied chemical peel can also result in scarring.
