What Is It?
Skin pigmentation disorders can range from simple to complex, with the more complex pigmentation conditions occurring on darker skin types, which many doctors prefer not to treat or do not know how to manage. Excess pigmentation may be superficial and may be easily treated with topical creams or can be deep, requiring a combination of topical creams and/or systemic medications, in conjunction with laser and light treatments. At the Skin Specialist Centre, we specialize in the treatment of loss of or excess pigmentation for all types of skin – light, dark or anywhere in between. Our comprehensive approach takes into account your condition, prior treatments, lifestyle and identifying specific treatments to help regain your skin to normal pigmentation.
In addition to excess pigmentation, some people suffer from loss of pigment. This can present as hypopigmentation (partial loss of pigment such as due to trauma) or depigmentation (total loss of pigment – vitiligo).
Alteration in skin pigmentation can be concerning from either a cosmetic or medical perspective, or both. Several medical conditions of the skin can cause changes to the skin pigment. These may be treated with topical applications, lasers (Excimer laser, Fraxel Restore Dual) or other in-office procedures. If you are interested in treatment for your skin pigmentation disorder, the Skin Specialist Centre welcomes you to make an appointment with us to provide a diagnosis and formulate a treatment plan for your specific pigmentation concern.
Skin discoloration is a most distressing issue for many patients, most frequently as a result of sun exposure and/or hormones. These brown patches and darkened areas can be an ongoing problem for someone of any age. The skin gets its colour (whether light or dark) from melanin. Melanin is a pigment that your body produces which determines the colour of your eyes, hair and skin. An over-production of melanin shows up as brown patches and spots, and an under-production of melanin shows up as white, flat patches. Due to the high amounts of UV exposure in the upper part of the North Island, Asian and dark-skinned persons residing in this area will often develop uneven and patchy pigmentation. The pigmentation is usually mixed, consisting of age spots, sun-damage and melasma. It is essential that the type of pigmentation is identified for the patient to receive optimal treatment. A specialist dermatologist can differentiate between melasma, sun-induced pigmentation and potential skin cancer pigmentation. Each form of pigmentation has a specific approach for an optimal outcome.
There are typically three reasons why your skin becomes overly pigmented:-
Hyperpigmentation from sun exposure.
Hyperpigmentation – melasma – this is a condition characterised by dark patches of pigment, usually on the face. Melasma can be caused by hormones such as the oral contraceptive pill or pregnancy, as well as the sun, or a combination of factors. Melasma is not a harmful condition but it can have a dramatic effect on one’s appearance (see melasma section)
Where topical treatment to remove excess skin pigment is found to be less than adequate, or should a patient desire more aggressive treatment we offer numerous options for laser and light removal of brown spots. These may include Excel V, Fraxel Restore Dual, Gemini KTP, Picoway, Revlite Q-switched Yag laser and photo-rejuvenation using Broad Band light (BBL) or some combination of multiple modalities.
Hypopigmentation and the skin
Hypopigmentation in skin is as a result of a reduction in melanin production.
This is a rare, inherited disorder caused by the absence of an enzyme that produces melanin. This results in a complete lack of pigmentation in skin, hair and eyes. Albinos have an abnormal gene that restricts the body from producing melanin. There is no cure for albinism. People with albinism should regularly apply sunscreen because they are much more likely to develop sun-damage and skin cancer.
What Causes It?
Inflammation (such as eczema, dandruff) and trauma to the skin (such as post-liquid nitrogen application and superficial abrasions) may cause a temporary lightening of the skin and decrease in pigmentation by affecting the way the melanocytes (pigment cells) work.
What is the Clinical Presentation?
Flat, non-scaly and lighter than normal areas of skin may be seen on any body area.
How is Post-Inflammatory Hypopigmentation Diagnosed?
The condition is diagnosed by means of clinical examination carried out by your specialist dermatologist. It may be necessary for a skin biopsy to be performed to distinguish this condition from other skin conditions that may have a similar appearance.
How is Post-Inflammatory Hypopigmentation Treated?
Cosmetic camouflage techniques such as cosmetic foundations and concealers can be used to blend the normal and affected skin until the condition resolves. It is also important to sun-protect as tanning may increase the visibility of the affected areas.
How is it Treated?
What is It?
Vitiligo is a chronic dermatologic disorder that causes de-pigmentation of patches of skin. It occurs when the melanocytes (the cells responsible for skin pigmentation) are destroyed. The vitiligo lesions may appear nearly anywhere, but are more common in areas where the skin is exposed to the sun. Common areas to be affected include:
Armpits and groin
Around the mouth
Men and women are equally affected and it usually presents before the age of thirty.
What Causes Vitiligo?
The cause of vitiligo is not known but the most common form of vitiligo is thought to be an “autoimmune” disease, meaning that the person’s own immune system accidentally attacks the skin pigment cells (melanocytes). When attacked, they can no longer make pigment in normal amounts, which causes the skin to turn white (de-pigmentation).
Vitiligo affects approximately 1% of the population, both genders equally. Around 30 – 40% of patients have a family history of vitiligo and the disease has occurred in monozygotic twins.
What Other Problems Can Occur with Vitiligo?
Some people with vitiligo also have autoimmune conditions such as thyroid disease (30% of patients have Graves’ disease or hypothyroidism), and less so pernicious anaemia, diabetes mellitus and alopecia areata.
What are the Signs and Symptoms?
Vitiligo looks white, flat and does not have scaly spots. The disease usually occurs in childhood or early adulthood. The de-pigmented patches are often sharply delineated, surrounded by normal or darker skin and are usually symmetrical. A segmental pattern occasionally occurs, usually in children. Vitiligo often follows trauma, with the disease common on extensor sites, such as the hands, elbows and knees. Another pattern is orofacial, with de-pigmented areas surrounding orifices (nostrils, mouth, vagina and anus).
How is Vitiligo Treated?
Treatment options will be aimed at restoring colour to the white patches of skin, and the choice of treatment will depend on:
How widespread the patches are
The number of white patches
The treatment the person prefers
Specific medical treatment includes:
Topical steroid creams and ointment
Topical calcineurin inhibitors (Pimecrolimus, Tacrolimus)
Photo-therapy – narrow-band UVB light treatment. This can be administered two to three times per week until pigmentation returns. While this therapy treats large lesions of the body, an Excimer laser may be used to target specific, localized areas of vitiligo.
Excimer laser treatment can be used for small, localized areas of treatment (involving less than 10% of the body) in conjunction with strong topical steroid creams. The treatment regime with the Excimer laser is twice a week, and up to twenty treatments are required, with around 80% successful re-pigmentation on the face and neck. This laser uses a carefully focused beam of narrow-band UVB light delivered through fibreoptics and allows higher doses of narrow-band UVB light, with minimal exposure of nearby, healthy skin. Patches of vitiligo are easily sun-burned, hence patients should wear a sunscreen with an SPF of 50+ on all areas of vitiligo not covered by clothing. Avoid the sun when it is most intense to avoid burns.
Epidermal grafting can help some patients with stable disease
The treatment aim is to stop progression and induce re-pigmentation. The return of pigmentation may take many months to years and is usually partial rather than complete. After maximal re-pigmentation has occurred, the frequency of treatments is gradually tapered to avoid recurrence. It needs to be kept in mind that even after successful treatment, there is a risk that the vitiligo may return in the future.
The amount of re-pigmentation depends on many factors – consistent use of the prescribed treatments is critical. The sites affected also determine the likely success of treatment. Areas with high numbers of hair follicles are likely to re-pigment more easily and more rapidly, so areas like the face, chest and neck respond better than areas like hands, feet, ankles and wrists.
What’s the next step?
If you already have an appointment booked at The Skin Specialist Centre, you can easily add a Skin Pigmentation treatment consultation to your booking by calling our friendly team on (09) 524 5011. If you have never been to The Skin Specialist Centre, you can either give us a call on (09) 524 5011 or make an enquiry by clicking on the Enquire Now option below.