The Ultimate Guide to Pigmentation and Skin Blemishes
1st of July, 2024
What do we mean by pigmentation?
Skin colour is determined by a pigment (melanin) made by specialised cells in the skin (melanocytes). The amount and type of melanin determines a person's skin colour – or skin pigmentation.
Pigmentation is the colouring of a person's skin. When a person is healthy, his or her skin will appear normal in colour. In the case of illness or injury, the person's skin may change colour, becoming darker (hyperpigmentation) or lighter (hypopigmentation).
What causes hyper or hypo pigmentation and skin blemishes?
Irregular areas in which there are changes to skin colour are much more common than you might think. Often, you may have changes in the pigmentation of a certain area of your skin due to a difference in the level of melanin it contains.
Melanin is the substance that provides colour to the skin and protects it from the sun. However, there are a wide range of reasons and causes of pigmentation – some of which are listed below...
BURNS
Your skin is much more delicate than you think, and burns – either from the sun or otherwise (hello, hot oven!) – may cause scar tissue of a different colour to form. Some medications can make the skin more susceptible to the suns rays, and radiation therapy can also cause a kind of burn that changes the colour of your skin.
INFECTIONS
Infections are a common reason for localised changes in skin colour. Cuts and scrapes regularly develop infections that turn the surrounding skin red or white and change the texture too. Erythrasma, Tinea versicolour and ringworm are all infections that can cause patches of skin to turn white, pink, tan, or brown and scaly. The patches can occur all over the body, depending on the exact type of fungus.
AUTOIMMUNE DISEASES AND ALLERGIES
Autoimmune diseases, such as lupus erythematosus and dermatomyositis, can be responsible for changes in skin colour, whilst Eczema is a type of hypersensitivity reaction (allergy) that can cause red, scaly patches that ooze. Related to eczema, pityriasis alba can cause dry, white patches on the skin in children. A wide variety of rashes, such as dermatitis herpetiformis, contact dermatitis, poison ivy rashes, and others can be caused by an allergic reaction. Scleroderma can create thick, shiny patches of skin. Vitiligo is a condition in which
cells that produce melanin are attacked by the immune system, leaving behind patches of skin with no colour at all.
HORMONAL CHANGES
Hormonal changes, especially during pregnancy, can cause skin colour changes. Melasma, or chloasma, can cause dark patches on the face, often called the “mask of pregnancy.”
BIRTHMARKS
Birthmarks are also a cause of skin colour changes. Café-au-lait spots are light-coloured spots on the skin. A few café-au-lait spots are perfectly normal, but more than six may be an indicator of neurofibromatosis—a genetic disorder that negatively affects the growth and formation of nerve cells.
Moles are brown spots that can appear on the skin at birth. Changes in the size or shape of these spots can signal trouble, and should be checked by your doctor.
Mongolian blue spots are bluish patches that can appear on the backs of babies and young children, usually of Asian descent. They are harmless and often fade over time. Port-wine stains are a type of birthmark caused by swollen blood vessels. They are usually flat and appear pink or red in colour.
SKIN CANCER
Cancer can change skin colour or texture. Your doctor should examine moles or other rapidly changing skin lesions.
Is it possible to treat, diminish or remove pigmentation and skin blemishes?
Firstly, don’t panic! There are a number of ways to treat your pigmentation changes, from great make up, to microdermabrasion or topical bleaching creams. Diagnosis of the reason behind your pigmentation changes is key though, as not all ‘dark spots’ are created equal. If you’re unsure or worried, then make an appointment to see your doctor before attempting any drastic treatments. Below we look at hyper and hypopigmentation in more detail...
Hypopigmentation – the specifics
Much of this blog focuses on hyperpigmentation (when a person's skin may change colour to become darker) due to the more varied and proven treatments. However, Hypopigmentation, which is the absence of normal amounts of melanin (the chemical that gives skin its colour), is almost as common. This type of pigmentation – usually caused by disease, injury, burns or other trauma to the skin is trickier to treat then its skin-darkening cousin. Improperly administered skin- resurfacing treatments, such as Photo facials, laser peels, or chemical peels can also cause skin damage that result in hypopigmentation.
Hypopigmentation causes
Some chronic skin disorders can also cause hypopigmentation, such as the following:
Albinism - characterised by colourless skin, hair, and eyes that occurs because skin cells produce little or no melanin
Vitiligo - characterised by patchy loss of skin colour that occurs when skin cells that produce melanin die or stop production for no known reason
Seborrheic dermatitis - an inflammatory skin disease characterised by red, scaly, itchy patches of skin in areas prone to oiliness
Tinea versicolor – we mentioned this briefly before, but this is caused by fungal (yeast) infection and characterised by scaly, itchy patches of lighter or pinkish skin
Pityriasis alba - most commonly affects children and is characterised by colourless, scaly skin patches
Post inflammatory hypopigmentation (PIH) - In situations where hypopigmentation is the result of skin inflammation or damage, the condition may be referred to as post-inflammatory hypopigmentation, or PIH.
This can get confusing because PIH is also used to refer to post-inflammatory hyperpigmentation, a skin condition where pigmentation is increased, not decreased.
Hypopigmentation treatments
Hypopigmentation treatment options are often limited. Treating post-inflammatory hypopigmentation may involve the use of topical corticosteroids or tars (topical cream), light or laser treatment, or surgical skin grafting. Although the numerous lasers and other light-based treatments available today are often perceived as a cosmetic cure-alls, IPL, excimer lasers, and the Fraxel Restore laser are the only light-based procedures that have been suggested by the doctors on RealSelf for hypopigmentation treatment. For patients who experience extreme hypopigmentation on over half of their body (a rare occurrence of vitiligo), overall depigmentation is an option.
Topical medications: topical agents such as hydroquinone, TriLuma, and other skin lightening agents, may be used to bleach skin not affected by hypopigmentation so that it can blend in better with hypopigmented skin. For hypopigmentation that is unresponsive to medications, camouflaging with cosmetic tattooing or permanent makeup may be the best option.
At home treatment - there is an ‘at home’ remedy that may assist with easing the symptoms of hypopigmentation. Simply take a small piece of fresh ginger and dab it on the area of skin that has hypopigmentation. Do not rinse this off. Do this twice a day. It will take time to work but within a few months, scars will apparently have faded away completely.
Note* we haven’t tried this and would recommend a trip to your doctor or dermatologist for hypopigmentation!
Different treatments for skin
blemishes or pigmentation
