Hypopigmentation

Common Causes Of Hypopigmentation:

1. Vitiligo
2. Albinism
3. Pityriasis Versicolour
4. Pityriasis Alba

1. Vitiligo

This is a skin disorder where one sees a complete pigment loss in the affected areas. This occurs due to the damage of the pigment producing cells (melanocyte). Vitiligo is clinically identified by the development of chalky white macular (flat) patches, which when viewed microscopically are completely devoid of melanocyte.

• Vitiligo starts as small white patches, first affecting an area with pigment loss, and then spreading with time.
• The goal of treatment is to stop or slow down the progression of pigment loss.

Signs And Symptoms:

• Pigment loss produces milky white patches on conducting a Wood’s light examination.
• Flat areas of normal-feeling skin without any pigment appear suddenly or gradually. These areas have a darker border. The edges are well-defined but irregular.
• Vitiligo most often affects the face, elbows, knees, hands, feet and genitals. But can affect any part of the body.
• Vitiligo is more noticeable in darker-skinned people because of the contrast of white patches against dark skin.
• No other skin changes occur.
• In some cases, a skin biopsy may be needed to rule out other causes of pigment loss. Your doctor may also perform blood tests to check the levels of Thyroid or other hormones, and Vitamin B12.

Causes:

• Immune system disorder
• Hereditary
• Sunburn or emotional stress
• Unknown in certain cases

Management

• Topical corticosteroids: Corticosteroid creams or ointments
• Immunomodulators: Immunosuppressant creams or ointments, such as Pimecrolimus, are (Elidel) and Tacrolimus (Protopic).
• Phototherapy: Phototherapy is a medical procedure in which your skin is carefully exposed to ultraviolet light. This therapy can be done by itself or after taking a drug that sensitizes your skin to light.
• Autologous skin graft: Skin may be moved (grafted) from normally pigmented areas and placed onto areas where there is pigment loss.
• Cover-up make-up: Several cover-up make-up or skin dyes can mask vitiligo.
• Using sunscreen: It is important to remember that skin without pigment is at greater risk for sun damage. Be sure to apply a broad-spectrum (UVA and UVB), high SPF sunscreen or sun block and use appropriate safeguards against sun exposure.

2. 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 or 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.

3. Pityriasis Versicolour

This is a common fungal infection of the skin caused by the fungus Pityrosporum Ovale, a type of yeast normally found on human skin. It only causes problems under certain circumstances; for instance, when the fungus interferes with the normal pigmentation of the skin resulting in small discoloured patches. These patches can be lighter or darker in colour than the surrounding skin and mostly affect the trunk and the shoulders.

The condition is most common in adolescent and young adult males. It typically occurs in hot climates and can recur in warm humid weather.

Symptoms

• Patches could be coloured white, pink, tan or dark brown
• The patches are slow growing, scaly and mildly itchy.
• They are more noticeable after sun exposure.
• They are generally located on the back, chest, neck and upper arm.

Causes

• Hot humid weather
• Excess sweating
• Oily skin
• Hormonal changes
• Weakened immune system

Treatment

• Antifungal creams, gel, lotion and shampoos can be used.
• But skin colour may continue to remain uneven even after weeks or months of successful treatment.

4. Pityriasis Alba

It is characterised by multiple partially hypo pigmented patches seen commonly on the face, especially on the cheeks. The condition is named for its fine scaly appearance that one sees initially. The patches are not totally depigmented.

Causes

• Use of public swimming pools
• Excessive use of corticosteroids
• Common in children between 3-16 years

Symptoms

• Dry scaling is more noticeable during winter.
• Raised red or raised pale or smooth flat and pale patches can be seen.
• Lesions could be round or oval 0.5 – 2 cms, mostly present on cheeks

Treatment

• Application of moisturisers
• Sometimes a weak steroid is used