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Let’s Talk About Skin Pigmentation

17 December 2021

Melanin is the pigment that provides colour to the skin. However, it is not always distributed evenly; for example, when melanin collects in patches, it can create spots or darker areas known as Hyperpigmentation. Changes in skin tone can occur due to sun exposure, injury, medical conditions and medications, hormonal changes, as well as age. Skin pigmentation abundance, or loss, may present itself in various ways, let’s take a closer look at some common types of hyper/hypopigmentation.

Birthmarks
As their name suggests, these pigmentations are present from birth. They can be caused by clusters of pigmented cells or malformed blood vessels. Birthmarks may go away without treatment, stay the same, or change over time. They may be present in different colours or contain different types of tissue.

Types of Birthmarks
Mongolian Spots - These birthmarks appear bruised or bluish in colour and usually develop on the back or buttocks of babies. This discolouration usually disappears by Age 4 and does not need to be treated.

Café-au-Lait Spots - These are light brown-to-dark brown flat spots with smooth or irregular borders. About 10% of the general population has 1 or 2 of these spots, and do not have another form of pigmentation that is related to it. These birthmarks may be treated with a laser for cosmetic purposes.

Nevi (moles)These spots may be flesh-coloured to light-to-dark brown. They may be flat or raised. Although most moles are benign (non-cancerous) and will not cause any problems, some may change and be at risk of becoming cancerous (known as Melanomas). For this reason, moles should be watched for bleeding, pain, itch, colour, shape, symmetry, even borders, and size changes. 

The ABCDE Guideline for Mole Checks
A common rule of thumb that most Dermatologists will advise is to follow the ABCDE guideline for checking moles.
A for Asymmetry. If you divide your mole in half, both sides should look the same.
B for Border. The border of your mole should be even.
C for Colour. Your mole should be one colour. Your mole should not have a variety of colours, especially colours like red or blue.
D for Diameter. Moles less than 0.6 cm in diameter are usually benign. If your mole increases in size, especially if it is greater than 0.6 cm, you should have it checked.
E for Evolving or Elevation. If your mole was flat but is now elevated (raised), or if you notice bleeding, crusting, pain, or itching, this should be checked out.

If you notice that any of these features change or you have a personal or family history of melanoma, please have your moles examined by a Dermatologist.

Vascular Birthmarks
Macular Stains appear anywhere on the body as mild red marks, but they are not elevated. They are the most common type of vascular birthmark. They can come in two forms: “angel kisses,” which may appear on the forehead and eyelids and usually disappear after age two; or “stork bites,” which will appear on the back of the neck and can last into the adult years. Because these marks are often mild and always harmless, they do not need to be treated.

Hemangioma are growths that are made up of many tiny blood vessels bunched together. Some Hemangiomas are more serious. They are more common in females and premature babies. This birthmark is usually just a small mark on the face, trunk, or extremities (arms and legs). However, in some children, Hemangiomas can be large and grow rapidly through the first year of life.

Port Wine Stains appear as a flat pink, red, or purple mark on the face, trunk, arms, or legs, and lasts a lifetime. Port Wine Stains are caused by abnormal development of blood vessels (capillaries). Over time, the port wine stain may become raised and thickened. 

Albinism, a hereditary condition, is caused by the absence of melanin, and results in no pigmentation in the skin, hair, or eyes. Albinos have a particular gene that restricts the production of melanin and thus, there is no treatment for this skin type. Individuals who have this skintype must use sun protection at all times as they are much more likely to have sun damage and in more severe cases, Skin Cancers. Albinism can occur in any ethnic skintype, however is most common in individuals with Type I-II (very fair to fair) skintypes. 

Melasma is the darkening of the skin due to hormonal changes, often seen during or after pregnancy. Patches of Melasma are often gray-brown and occur on the cheeks, forehead, bridge of the nose, chin, and upper lip. Melasma may also occur as a side-effect of taking birth control pills or other hormone therapy treatment. Individuals must be very cautious of the sun and use daily sun protection as sun exposure often makes Melasma worse.

Rosacea often misdiagnosed as acne or severe irritation, is patchy areas of redness that occur for no apparent reason. These often flare up for weeks or months and then go away. Common on the cheeks, chin, nose, or forehead, rosacea can be exacerbated by sunlight, temperature extremes, food and alcohol, and an increase in blood flow to the skin. Rosacea can resemble blushing but more advanced stages are characterized by visible blood vessels, and an enlarged nose, chin, and oil glands.

Photoageing, also known as age spots, liver spots, and solar lentigines, photoageing often results from years of prolonged sun exposure. Clusters of dark spots may appear in one’s late thirties or early forties. 

Post-Inflammatory Hyperpigmentation (PIH) is often associated with acne; once a pimple heals, a dark spot may be left behind. PIH can happen due to any trauma to the skin. Even if you get a scratch or an insect bite, melanocytes, or pigment cells, can create more pigment in response to the injury. 

Vitiligo is a condition where the body’s immune system attacks pigment cells (melanocytes), causing pigment loss. Vitiligo causes smooth, white skin patches, usually around the mouth and eyes, or on the back of the hands. In some people, these patches can appear all over the body. There is no current solution to even out Vitiligo pigmentation, however, some treatments including topical, light or laser are providing some evidence of evening out pigment. 

Remember, skin pigmentation is not a disease or illness, it is a skin characteristic that arises due to the irregular deposition of melanin in the skin. These factors may be genetic or may be influenced by extrinsic factors. Dermatologists have identified more than 70 different types of skin pigmentation characteristics, and while UV is often an aggravating factor, so is vitamin D deficiency, certain medications, reactions to chemical exposure and as well, hormonal changes often seen during pregnancy (or hormonal therapies).