Alternate Names: Hyperpigmentation; Hypermelanosis; Melanosis
Considerations: Normal skin contains cells called melanocytes that produce the brown skin-coloring pigment melanin. There are several conditions in which melanocytes are either abnormal or abnormally distributed. Most skin conditions that cause discoloration are harmless.
A pale area of the skin is the result of fewer or less active melanocytes than usual, whereas, a darker area (or area that tans more easily) indicates more numerous or more active melanocytes.
Sometimes mistaken for a suntan, bronzing of the skin often develops gradually starting at pressure points such as the elbows, knuckles, and knees and spreading from there. It is also seen in the creases of 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 intensity often a function of the underlying cause.
There are several types of benign hyperpigmentation that occur normally; however, any persistent hyperpigmentation that has not been medically explained ought to be seen by a dermatologist.
Common Causes:
- exposure to the sun or sun lamp
- inherited skin condition
- phenothiazine drug use
- chronic nutritional deficiency
Home Care: Nonprescription depigmenting creams are available for lightening the skin. If used, 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 in covering a discoloration.
For bronzing caused by malnutrition, a well-balanced diet is recommended.
Avoid too much sun exposure (use sunscreens or blockers).
Hyperpigmentation may persist even after treatment, so emotional support is recommended.
Follow prescribed therapy to treat the underlying cause and for use of corrective cosmetics (over-the-counter bleaching creams are generally not effective).
Call If:
- a skin discoloration causes significant concern or lifestyle impairment.
- there is persistent, unexplained darkening of the skin.
- any hyperpigmented area (like a mole) changes shape, size, or color (this may be a sign of malignancy).
What To Expect: The medical history will be obtained and a physical examination performed.
Medical history questions documenting abnormally dark or light skin in detail may include:
- time pattern
- When did the discoloration develop?
- Did it develop suddenly?
- Is it getting worse? How fast?
- quality
- Describe the change.
- Is the skin turning darker or lighter?
- location
- Exactly where is the discoloration?
- Has it spread to other parts of the body? In what pattern?
- aggravating factors
- What medications are used?
- Is there anyone else in your family that has had a similar problem?
- Are you often in the sun or exposed to a sun lamp?
- What is your diet like?
- other
The physical examination may include emphasis on evaluating the skin.
Diagnostic tests that may be performed include:Some skin conditions can be treated. Vitiligo may be treated using ultraviolet lamp treatment combined with drug therapy, which is effective in about 50% of cases. Pityriasis versicolor is usually treated using anti-fungal ointment. Moles that have changed color are usually surgically removed and a biopsy is taken.
Some pigment changes spontaneously return to normal skin color (unless there is scarring of the skin).
After seeing your health care provider:
If a diagnosis was made by your health care provider related to abnormally dark or light skin, you may want to note that diagnosis in your personal medical record.
