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Skin - abnormally dark or light

Hyperpigmentation; Hypopigmentation

 

Skin that has turned darker or lighter than normal is usually not a sign of a serious medical condition.

Considerations

 

Normal skin contains cells called melanocytes. These cells produce melanin, the substance that gives skin its color.

Skin with too much melanin is called hyperpigmented skin.

Skin with too little melanin is called hypopigmented skin.

Pale skin areas are due to too little melanin or underactive melanocytes. Darker areas of skin (or an area that tans more easily) occurs when you have more melanin or overactive melanocytes.

Bronzing of the skin may sometimes be mistaken for a suntan. This skin discoloration often develops slowly, starting at the elbows, knuckles, and knees and spreading from there. Bronzing may also be seen on the soles of the feet and the palms of the hands. The bronze color can range from light to dark (in fair-skinned people) with the degree of darkness due to the underlying cause.

 

Causes

 

Causes of hyperpigmentation include:

  • Skin inflammation (post-inflammatory hyperpigmentation)
  • Use of certain drugs (such as minocycline and birth control pills)
  • Endocrine diseases such as Addison disease
  • Hemochromatosis (iron overload)
  • Sun exposure
  • Pregnancy

Causes of hypopigmentation include:

  • Skin inflammation
  • Certain fungal infections (such as tinea versicolor)
  • Pityriasis alba
  • Vitiligo
  • Certain medicines
  • Skin condition called idiopathic guttate hyomelanosis

 

Home Care

 

Over-the-counter and prescription creams are available for lightening the skin. If you use these creams, follow instructions carefully, and don't use one for more than 3 weeks at a time. Darker skin requires greater care when using these preparations. Cosmetics may also help cover a discoloration.

Avoid too much sun exposure. Always use sunscreen with an SPF of 30 or higher.

Abnormally dark skin may continue even after treatment.

 

When to Contact a Medical Professional

 

Call your health care provider for an appointment if you have:

  • Skin discoloration that causes significant concern
  • Persistent, unexplained darkening or lightening of the skin
  • Any skin sore or lesion that changes shape, size, or color may be a sign of skin cancer

 

What to Expect at Your Office Visit

 

Your provider will perform a physical exam and ask about your symptoms, including:

  • When did the discoloration develop?
  • Did it develop suddenly?
  • Is it getting worse? How fast?
  • Has it spread to other parts of the body?
  • What medicines do you take?
  • Has anyone else in your family had a similar problem?
  • How often are you in the sun? Do you use a sun lamp or go to tanning salons?
  • What is your diet like?
  • What other symptoms do you have? For example, are there any rashes or skin lesions?

Tests that may be done include:

  • Adrenocorticotropin hormone stimulation test
  • Skin biopsy
  • Thyroid function studies
  • Wood lamp test
  • KOH test

Your provider may recommend creams, ointments, surgery, or phototherapy, depending on the type of skin condition you have. Bleaching creams can help lighten dark areas of skin.

Some skin color changes may return to normal without treatment.

 

 

References

Chang MW. Disorders of hyperpigmentation. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 67.

Ortonne JP, Passeron T. Vitiligo and other disorders of hypopigmentation. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 66.

 
  • Vitiligo, drug induced

    Vitiligo, drug induced - illustration

    The white spots on this person's face have resulted from drug-induced vitiligo. Loss of melanin, the primary skin pigment, occasionally occurs as a result of medicines, as is the case with this individual. The typical vitiligo lesion is flat and depigmented, but maintains the normal skin texture.

    Vitiligo, drug induced

    illustration

  • Vitiligo on the face

    Vitiligo on the face - illustration

    This is a picture of vitiligo on the face. Complete loss of melanin, the primary skin pigment, occurs for unknown reasons. The resulting lesions are white in comparison to the surrounding skin. Vitiligo may occur in the same areas on both sides of the face -- symmetrically -- or it may be patchy -- asymmetrical. The typical vitiligo lesion is flat (macular) and depigmented, but maintains the normal skin texture. The dark areas around the eyes are this person's normal skin color.

    Vitiligo on the face

    illustration

  • Incontinentia pigmenti on the leg

    Incontinentia pigmenti on the leg - illustration

    Incontinentia pigmenti produces darkly-pigmented swirling marks on the skin. It occurs more frequently in females. The skin lesions are divided into three stages: blisters (vesicles and bullae) are present at birth or within the first 6 to 7 weeks, followed by a rough wart-like (verrucous) stage, and lastly, swirled and bizarre patterns of dark pigmentation (hyperpigmentation) appear.

    Incontinentia pigmenti on the leg

    illustration

  • Incontinentia pigmenti on the leg

    Incontinentia pigmenti on the leg - illustration

    Incontinentia pigmenti produces darkly-pigmented swirling marks on the skin. It occurs more frequently in females. The skin lesions are divided into three stages: blisters (vesicles and bullae) are present at birth or within the first 6 to 7 weeks, followed by a rough wart-like (verrucous) stage, and lastly, swirled and bizarre patterns of dark pigmentation (hyperpigmentation) appear.

    Incontinentia pigmenti on the leg

    illustration

  • Hyperpigmentation 2

    Hyperpigmentation 2 - illustration

    Hyperpigmentation refers to skin that has turned darker than normal where the change that has occurred is unrelated to sun exposure. Cells called melanocytes located in the skin, produce melanin. Melanin gives the skin its color. In certain conditions melanocytes can become abnormal and cause an excessive amount of darkening in the color of the skin.

    Hyperpigmentation 2

    illustration

  • Post-inflammatory hyperpigmentation - calf

    Post-inflammatory hyperpigmentation - calf - illustration

    Hyperpigmented concentric rings over the tibia are secondary to prior inflammation. Residual hemosiderin from broken down red blood cells in macrophages, left behind after inlammation pigments the skin.

    Post-inflammatory hyperpigmentation - calf

    illustration

  • Hyperpigmentation w/malignancy

    Hyperpigmentation w/malignancy - illustration

    Generalized hyperpigmentation, in addition to localized areas of even deeper pigmentation is sometimes found in patients with malignancy. Etiology of these pigmentary changes is varied.

    Hyperpigmentation w/malignancy

    illustration

  • Post-inflammatory hyperpigmentation 2

    Post-inflammatory hyperpigmentation 2 - illustration

    Post-inflammatory hyperpigmentation is seen here in a mottled pattern, over the posterior shoulder. Hemosiderin, left behind by degraded RBC's, creates the discoloration.

    Post-inflammatory hyperpigmentation 2

    illustration

    • Vitiligo, drug induced

      Vitiligo, drug induced - illustration

      The white spots on this person's face have resulted from drug-induced vitiligo. Loss of melanin, the primary skin pigment, occasionally occurs as a result of medicines, as is the case with this individual. The typical vitiligo lesion is flat and depigmented, but maintains the normal skin texture.

      Vitiligo, drug induced

      illustration

    • Vitiligo on the face

      Vitiligo on the face - illustration

      This is a picture of vitiligo on the face. Complete loss of melanin, the primary skin pigment, occurs for unknown reasons. The resulting lesions are white in comparison to the surrounding skin. Vitiligo may occur in the same areas on both sides of the face -- symmetrically -- or it may be patchy -- asymmetrical. The typical vitiligo lesion is flat (macular) and depigmented, but maintains the normal skin texture. The dark areas around the eyes are this person's normal skin color.

      Vitiligo on the face

      illustration

    • Incontinentia pigmenti on the leg

      Incontinentia pigmenti on the leg - illustration

      Incontinentia pigmenti produces darkly-pigmented swirling marks on the skin. It occurs more frequently in females. The skin lesions are divided into three stages: blisters (vesicles and bullae) are present at birth or within the first 6 to 7 weeks, followed by a rough wart-like (verrucous) stage, and lastly, swirled and bizarre patterns of dark pigmentation (hyperpigmentation) appear.

      Incontinentia pigmenti on the leg

      illustration

    • Incontinentia pigmenti on the leg

      Incontinentia pigmenti on the leg - illustration

      Incontinentia pigmenti produces darkly-pigmented swirling marks on the skin. It occurs more frequently in females. The skin lesions are divided into three stages: blisters (vesicles and bullae) are present at birth or within the first 6 to 7 weeks, followed by a rough wart-like (verrucous) stage, and lastly, swirled and bizarre patterns of dark pigmentation (hyperpigmentation) appear.

      Incontinentia pigmenti on the leg

      illustration

    • Hyperpigmentation 2

      Hyperpigmentation 2 - illustration

      Hyperpigmentation refers to skin that has turned darker than normal where the change that has occurred is unrelated to sun exposure. Cells called melanocytes located in the skin, produce melanin. Melanin gives the skin its color. In certain conditions melanocytes can become abnormal and cause an excessive amount of darkening in the color of the skin.

      Hyperpigmentation 2

      illustration

    • Post-inflammatory hyperpigmentation - calf

      Post-inflammatory hyperpigmentation - calf - illustration

      Hyperpigmented concentric rings over the tibia are secondary to prior inflammation. Residual hemosiderin from broken down red blood cells in macrophages, left behind after inlammation pigments the skin.

      Post-inflammatory hyperpigmentation - calf

      illustration

    • Hyperpigmentation w/malignancy

      Hyperpigmentation w/malignancy - illustration

      Generalized hyperpigmentation, in addition to localized areas of even deeper pigmentation is sometimes found in patients with malignancy. Etiology of these pigmentary changes is varied.

      Hyperpigmentation w/malignancy

      illustration

    • Post-inflammatory hyperpigmentation 2

      Post-inflammatory hyperpigmentation 2 - illustration

      Post-inflammatory hyperpigmentation is seen here in a mottled pattern, over the posterior shoulder. Hemosiderin, left behind by degraded RBC's, creates the discoloration.

      Post-inflammatory hyperpigmentation 2

      illustration

    A Closer Look

     

    Talking to your MD

     

      Self Care

       

        Tests for Skin - abnormally dark or light

         

           

          Review Date: 4/14/2015

          Reviewed By: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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