Health A-Z

Pigmentation is the coloring of a person's skin. When a person is healthy, their skin color will appear normal. In the case of illness or injury, the person's skin may change color, becoming darker (hyperpigmentation) or lighter (hypopigmentation).

Hyperpigmentation and Skin

Hyperpigmentation in skin is caused by an increase in melanin, the substance in the body that is responsible for color (pigment). Certain conditions, such as pregnancy or Addison's disease (decreased function of the adrenal gland), may cause a greater production of melanin and hyperpigmentation. Exposure to sunlight is a major cause of hyperpigmentation, and will darken already hyperpigmented areas.

Hyperpigmentation can also be caused by various drugs, including some antibiotics, antiarrhythmics, and antimalarial drugs.

Melasma

An example of hyperpigmentation is melasma. This condition is characterized by tan or brown patches, most commonly on the face. Melasma can occur in pregnant women and is often called the "mask of pregnancy;" however, men can also develop this condition. Melasma sometimes goes away after pregnancy. It can also be treated with certain prescription creams (such as hydroquinone).

Melasma is often seen in women, but men can get it, too. Sunblock, either with clothing or strong sunscreen, can help.

If you have melasma, try to limit your exposure to daylight. Wear a broad-brimmed hat and use a sunscreen with an SPF of 30 or higher at all times, because sunlight will worsen your condition. Sunscreens containing the physical blockers zinc oxide or titanium dioxide are also helpful in blocking daylight’s UVA rays, which makes hyperpigmentation worse. People with darker skin are at higher risk for melasma. It will look like dark brown or greyish brown patches on darker skin. 

Hypopigmentation and Skin

Hypopigmentation in skin is the result of a reduction in melanin production. Examples of hypopigmentation include:

• Vitiligo: Vitiligo causes smooth, white patches on the skin. In some people, these patches can appear all over the body. It is an autoimmune disorder in which the pigment-producing cells are damaged. There is no cure for vitiligo, but there are several treatments, including cosmetic cover-ups, corticosteroid creams, calcineurin inhibitors (Elidel cream, Protopic ointment) or ultraviolet light treatments. The Janus Kinase inhibitor ruxolitinib (Opzelura) has been approved for the treatment of nonsegmental vitiligo in adult and pediatric patients 12 years of age and older.
• Albinism: Albinism 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 use a sunscreen at all times because they are much more likely to get sun damage and skin cancer. This disorder can occur in any race, but is most common among whites.
• Pigmentation loss as a result of skin damage: If you've had a skin infection, blisters, burns, or other trauma to your skin, you may have a loss of pigmentation in the affected area. The good news with this type of pigment loss is that it's frequently not permanent, but it may take a long time to re-pigment. Cosmetics can be used to cover the area, while the body regenerates the pigment.

Diagnosis

Diagnosis of albinism is based on:

• A physical exam that includes checking skin and hair pigmentation.
• A thorough eye exam.
• Comparison of your child's pigmentation to that of other family members.
• Review of your child's medical history, including whether there has been bleeding that doesn't stop, frequent or large bruises, or unexpected infections.

A specialist in vision and eye disorders called an ophthalmologist usually should do your child's eye exam. The exam includes an assessment using tools to look at the retina and determine if there are signs of problems with eye development or function.

Genetic testing can help determine the type of albinism and the risk of passing down the gene change to children.

Treatment

Albinism is a genetic disorder, and there is currently no cure. Treatment focuses on getting proper eye care and monitoring skin for problems. Your care team may include your primary care provider, a specialist in eye care called an ophthalmologist and a specialist in skin care called a dermatologist.

A specialist in genetics can help identify the specific type of albinism. This information can help guide care, identify possible complications and determine the risk of the condition in future children.

Treatment usually includes:

• Eye care. This includes receiving an eye exam at least every year by an ophthalmologist. You'll likely need prescription lenses to help with visions problems. Although surgery is rarely part of treatment for eye problems related to albinism, your ophthalmologist may recommend surgery on eye muscles to reduce nystagmus. Surgery to correct strabismus may make the condition less noticeable.
• Skin care and prevention of skin cancer. This includes receiving a skin exam at least every year to screen for skin cancer or spots that can lead to cancer. An aggressive form of skin cancer called melanoma can appear as pink or red moles or growths. Moles or growths, with or without color — especially ones that are pink or red and keep changing — should be checked by a skin specialist right away.

People with Hermansky-Pudlak or Chediak-Higashi syndromes usually need regular specialized care for medical problems and to prevent complications.

Lifestyle and home remedies

You can help your child learn self-care practices that should continue into adulthood:

• Use low vision aids, such as a hand-held magnifying glass, a telescope or a magnifier that attaches to glasses. Another aid is a tablet connected to a digital whiteboard in the classroom. This is an interactive electronic board with a touch screen.
• Always use sunscreen with a sun protection factor (SPF) of 30 or greater that protects against both UVA and UVB light.
• Strictly avoid high-risk or lengthy sun exposure. Examples include being outside for long periods of time or in the middle of the day, at high altitudes, on or near water, and on sunny days with thin cloud cover.
• Wear protective clothing, including clothes with color. Examples include long-sleeve, collared shirts, long pants and socks; broad-brimmed hats; and special UV-protection clothing.
• Protect eyes by wearing dark, UV-blocking sunglasses. Another option is transition lenses called photochromic lenses, which darken in bright light.

Albinism Diagnosis

Albinism is often obvious in newborns. A genetic test can confirm it. Your doctor probably will compare your baby’s skin and hair to those of family members. An eye doctor, or ophthalmologist, may run a test called an electroretinography to check for vision problems linked to albinism.