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Abnormal Pigmentation

Abnormal skin pigmentation

Birthmarks and other pigmentation disorders affect many people. Some of the most common problems are listed below. If you think you have one of these skin pigmentation abnormalities, make sure to visit a physician or dermatologist to receive an official diagnosis.

Birthmarks

As might be expected, this abnormal skin coloration will appear at birth or in just a few weeks following birth. While it’s important to know that most birthmarks are non-cancerous, certain birthmarks, described below, can pose health risks.

  • Pigmented birthmarks
    • Nevus of Ota

      This birthmark is characterized by bluish or grayish discoloration of the facial skin and sometimes the white part of the eye (sclera). The discoloration is caused by increased amounts of the pigment melanin as well as the cells that produce this pigment (melanocytes) in and around the eyes. Patients with this type of birthmark are at a higher risk of developing a melanoma cancer of their eye or central nervous system. Additionally, they may develop glaucoma (increased pressures in their eyes). For this reason, they should have periodic examinations by a neurologist as well as an ophthalmologist. Potential treatments for the skin discoloration include topical bleaching agents, such as hydroquinone, and laser treatments.

    • Mongolian spots

      These birthmarks are bruised or bluish in color, typically appearing on the back or buttocks of babies. This discoloration usually disappears by age 4 and does not require treatment.

    • Café-au-lait spots (French for “coffee with milk”)

      These are light brown to dark brown flat spots with smooth or irregular borders. About 10% of the general population has 1-2 of these spots and do not have an associated disorder. However, six or more of these spots on the body that are greater than 0.5cm in diameter can be associated with the genetic disorder Neurofibromatosis. These birth marks may be treated with a laser for cosmetic purposes.

    • Nevi (moles)

      These spots may be flesh-colored to light to dark brown. They may be flat or raised. Although most moles are benign and will not cause any problems, some may change and become a skin cancer called a melanoma. For this reason, moles should be monitored for bleeding, pain, itch, color, shape, symmetry, even borders, and size changes. A good mnemonic to keep in mind is ABCDE: 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 color. Your mole should be one color. Your mole should not have a variety of colors, especially colors like red or blue. D for diameter. Moles less than 0.6cm in diameter are usually benign. If your mole increases in size, especially if it is greater than 0.6cm, you should have it evaluated. E for evolving or elevation. If your mole was flat but is now elevated or if you notice bleeding, crusting, pain or itch this should be evaluated. If any of these features change, you should have your moles examined. Regular examinations of your moles should also be performed by a dermatologist if you have a personal or family history of melanoma.

  • Vascular birthmarks (from blood vessels)
    • Macular stains

      Macular stains appear anywhere on the body, appearing as mild red marks, but they are not elevated. They are the most common type of vascular birthmark. These marks can come in two forms: angel kisses, which may appear on the forehead and eyelids and typically disappear after age two; or stork bites, which will appear on the back of the neck and can last into adult years. Because these marks are often mild and always harmless, no treatment is necessary.

    • Hemangioma

      Hemangiomas are growths composed of many tiny blood vessels bunched together and vary in severity. They are more common in females and premature babies. Typically, this birthmark is just a small mark on the skin of the face, trunk or extremities. However, in some children, hemangiomas can be large and grow rapidly through the first year of life. There are two types of hemangiomas: strawberry (or superficial) hemangiomas, which are slightly raised and can appear anywhere on the body; or cavernous (deep) hemangiomas, which are deeper birthmarks characterized by a bluish color. Fortunately, most hemangiomas will go away on their own: 50% resolve by age five, 70% by age seven and 90% by age nine. If the hemangioma is small and not causing any problems, it can be watched for resolution. Reasons to treat a hemangioma include problems with functions (such as sight, eating, hearing or defecation), ulceration, bleeding or pain. If medically indicated, hemangiomas can be treated in different ways, each of which carries its own risks. Corticosteroid medication can be injected or taken orally. Risks associated with corticosteroid medication include high blood pressure, high blood sugar, poor growth, or cataracts. Certain hemangiomas can also be treated with lasers to stop them from growing and facilitate resolution. Rare risks associated with that treatment include ulceration and scarring. Additionally both topical and oral beta blocker medication has been used for the treatment of these hemangiomas, but these medications also carry their own risks that should be carefully discussed with your dermatologist. In rare cases, a hemangioma can be removed with surgery.

    • Port wine stains

      Port wine stains are caused by abnormal development of blood vessels (capillaries) and last a lifetime. The port wine stain appears as a flat, pink, red, or purple mark, and occurs on the face, trunk, arms, or legs. Overtime it may become raised and thickened. Port wine stains present on eyelids are thought to pose an increased risk of glaucoma. Physicians have tried many ways to treat port wine stains, including radiation, tattooing, freezing, dermabrasion, or sclerotherapy. Laser therapy is currently the treatment of choice, as it is the only method that destroys capillaries in the skin without causing damage to the rest of the skin. Port wine stains may be seen in certain medical disorders, including Sturge-Weber Syndrome, whose symptoms include port wine stains on the face, vision problems, convulsions, mental retardation, and perhaps even paralysis; and Klippel-Trenaunay Syndrome in which a limb has a triad of port wine stains, varicose veins, and/or too much bone and soft tissue growth. Each of these syndromes is very rare.

Skin pigmentation disorders

  • Albinism

    Albinism, an inherited disorder, is caused by the absence of the pigment melanin and results in no pigmentation in skin, hair, or eyes. Albinos have an abnormal gene, which restricts melanin production. There is no cure for albinism, and individuals 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 in Caucasians. Additionally, almost all patients with albinism have problems with their eyes such as decreased vision or abnormal movements of their eyes and should be seen by an ophthalmologist.

  • Melasma

    Melasma (also known as chloasma) is characterized by tan or brown patches that may involve the forehead, cheeks, upper lip, nose, and chin. Although this condition is typically termed the "pregnancy mask," men can also develop it. It may also occur in women on birth control pills or postmenopausal estrogen. Melasma may go away after pregnancy, but persistent pigmentation can be treated with certain prescription creams and some over-the-counter skin care products. Additionally, certain lasers that target pigment can be helpful. Remember to consult your dermatologist for a proper diagnosis of this condition before you choose to treat it yourself. If you have melasma, use a sunscreen at all times because sunlight will worsen your condition.

  • Pigmentation alteration as a result of skin damage (postinflammatory hyper or hypopigmentation)

    If you’ve had a skin infection, blisters, burns or other trauma to your skin, you may have a decrease of increase of pigmentation in the affected area. The good news with this type of pigment alteration is that it’s frequently not permanent, and cosmetics can be used to cover the area.

  • Vitiligo

    Vitiligo is pigment loss due to the body’s immune system attacking pigment cells (melanocytes). Other associated immune system diseases include diabetes, pernicious anemia, thyroid disease, and Addison’s disease. 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 cure for vitiligo, but there are several treatments, including topical steroid preparations, topical immunomodulators, topical vitamin D analogs, dyes or psoralens (light-sensitive drugs) used in combination with ultraviolet A (UVA) light treatment, and more recently the excimer laser, which delivers UVB light. All treatments may take 6 or more months to be effective.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 12/21/2012...#11014


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