Skin pigmentation conditions are characterised by a discolouration of the skin, i.e. certain areas are either lighter or darker than the rest, leading to an uneven tone. This happens as a result of an imbalance in the production of melanin — the pigment responsible for giving our skin its colour — by cells known as melanocytes.
These conditions can be divided into two categories: hypopigmentation and hyperpigmentation. Hypopigmentation is a result of melanocytes producing too little melanin, thus resulting in lighter patches of skin. This may be caused by two factors: a decrease in the amount of melanocytes in the body or a decline in melanin itself. There are three types of hypopigmentation:
- Loss of pigmentation due to skin damage
In contrast, hyperpigmentation is characterised by darker patches of skin due to an excess of melanin production. The overproduction of melanin by melanocytes can be triggered by a variety of factors such as sun exposure and hormonal imbalance. Hyperpigmentation can be categorised into four different types:
- Birthmarks (pigmented and vascular)
- Post-inflammatory hyperpigmentation
In this article, we will take a closer look at hyperpigmentation and dive deeper on each type of hyperpigmentation disorder. Read on to find out more!
Pigmented Birthmarks: The Different Types and Their Causes
As the name suggests, birthmarks are discoloured marks on the body that appear at birth or a few weeks after birth. These marks can range from flat spots to raised bumps, and they can vary in size and colour. Birthmarks can be divided into two categories: pigmented and vascular.
Pigmented birthmarks are a result of an excess amount of melanocytes — the cells responsible for forming melanin — in a particular area of the skin. They can be further categorised into three types, and can usually be distinguished by their colour and/or shape.
- Café au lait spots
- Mongolian blue spots
Moles are usually round in shape, either flat or raised, and are typically only in one colour ranging from pink to brown to black. The size and colour of the moles that appear in childhood or adolescence may change as you age. These changes are completely normal and are rarely a sign of melanoma, which is the most serious form of skin cancer. However, do pay attention to new moles that appear in adulthood as they have a higher risk of being malignant. To find out if a mole warrants a visit to the doctor, check the mole if it has one or more of the following five traits:
- Asymmetry: one half of the mole is unlike the other
- Border: has an irregular border
- Colour: has no uniform colour
- Diameter: greater than 6mm in size
- Evolving: changes in shape, size or colour
2. Café au Lait Spots
Café au lait spots are so named due to their colour resembling that of coffee with milk (café au lait means “coffee with milk” in French). Realistically, they can darken in colour either with age or when exposed to the sun. These spots tend to be flat with an irregular border and they could vary in size as well. Although café au lait spots are usually benign, having at least six of these spots that are accompanied with freckles on the underarm or around the groin may signal an underlying genetic medical condition known as neurofibromatosis type 1. This condition may affect the eyes, skin and nerves, as well as lead to speech difficulties and bone abnormalities. Therefore, if you notice coloured patches on your skin together with lumps, in addition to speech issues, be sure to consult a doctor as soon as possible.
3. Mongolian Blue Spots
Also known as congenital dermal melanocytosis, Mongolian blue spots are flat, grey-blue patches that usually appear on the back or buttocks. They are of an irregular shape and are about two to eight centimetres large. These spots are typically benign and will fade completely by the time one reaches teenhood, therefore no medical intervention is required.
Vascular Birthmarks: The Different Types and Their Causes
Vascular birthmarks develop due to an abnormal growth of capillaries — blood vessels that connect the arteries and veins together — in the body. There are three types of vascular birthmarks:
- Salmon patches
- Port-wine stains
1. Salmon Patches
Salmon patches are pink or red flat marks that either appear on the eyelids and forehead, back of the neck, nose bridge or upper lip. These marks will usually fade during infancy, however, those on the back of the neck might remain all the way into adulthood.
Hemangiomas can be found anywhere on the body, though most are located on the face and neck. There are two types of hemangiomas: capillary and cavernous. Capillary hemangiomas — also known as strawberry hemangiomas — are bright red, raised benign bumps that appear on the outer layer of the skin. If located around the eye area, these bumps can interfere with one’s vision development, in which case medical intervention is necessary. Meanwhile, cavernous hemangiomas are located deeper within the layers of the skin. They form when one’s capillaries become swollen, creating a reddish-blue mass.
3. Port-Wine Stains
Finally, port-wine stains are pink, purple or red flat marks that usually appear on the face, though they can appear on other parts of the body as well. They form when one’s capillaries swell and slowly expand, creating discolouration on the body. Port-wine stains will remain throughout one’s life, and if left untreated, the stains will gradually darken over time. They can even develop into a raised bump as well as form small lumps.
The Causes of Melasma
The next type of skin pigmentation is melasma, a condition characterised by brown or greyish-brown patches on the face, more specifically the forehead, nose bridge, cheeks, the strip above the upper lip, and chin. These patches develop due to overactive melanocytes producing more melanin than average, thus resulting in dark patches. This is why melasma tends to affect people with a darker skin tone as their body naturally has more active melanocytes compared to those with fairer skin.
There are mainly two factors that can stimulate melanocytes in the body to be more active: hormonal fluctuations and excessive sun exposure. Let us take a closer look at each of these factors:
1. Hormonal Fluctuations
Melasma affects a higher percentage of women than men. While any female can develop melasma, those who are pregnant are more likely to be affected due to the increase in the level of hormones such as oestrogen and progesterone during pregnancy. It is thought that the elevated levels of these hormones trigger the production of melanin, thus leading to discoloured patches. This is why melasma is sometimes called “the mask of pregnancy”. Fortunately, pregnancy-induced melasma will usually begin fading after birth. This could take place over the course of a few months, however, the patches might not completely disappear for some women.
2. Excessive Sun Exposure
Melasma may also appear on areas of the body that have been exposed to the sun like the neck and forearms, though this is less common. The sun’s ultraviolet rays trigger the melanocytes to produce melanin. In addition, excessive sun exposure can worsen existing melasma, which is why sun protection is extremely important to prevent the patches from darkening. Too much exposure to the sun is also why some people may develop melasma repeatedly, even if their previous patches have already faded.
The Causes of Post-Inflammatory Hyperpigmentation
From its name, it can be understood that post-inflammatory hyperpigmentation (PIH) is a type of skin pigmentation that results from inflammation as a result of skin conditions such as acne and eczema, or procedures that cause trauma to the skin like the incorrect application of chemical peels and microdermabrasion. This discolouration can be in the form of reddish-pink, brown or black spots that develop on any area of the body.
1.Inflammation of the Skin
When the skin becomes inflamed, the melanocytes respond by producing a higher amount of melanin. The excess melanin will darken the wounded area of the skin, thus leading to discolouration and it could even remain even after the wound has recovered. If the inflammation is severe, the first layer of the skin can be compromised and this allows the melanin to penetrate to the second layer, leading to a deeper discolouration that would be more resistant to treatment.
2. Overstaying Your Time in the Sun
Being exposed to the sun’s ultraviolet (UV) rays does not cause PIH, but it has been found to worsen your hyperpigmentation woes. This is so since the UV rays from the sun can cause the skin cells to start overproducing melanin in excess. From the elevated levels of melanin, there is a strong chance that this would cause the existing dark spots to intensify in colour. That’s how your extended time in the sun can prolong the time it takes for the PIH to fade completely.
Freckles: The Different Types and Their Causes
These small brown spots develop on areas of the body that have endured prolonged exposure to the sun. As with the other types of pigmentation that have been discussed above, freckles occur due to an excess of melanin, which in turn causes discolouration. Freckles can be categorised into two parts:
While both types of freckles appear as flat macules, they can be distinguished by a number of factors:
- Affected demographic
- Age when the freckles first appeared
Let us find out more about these two types of freckles!
While ephelides form due to sun exposure, there is a genetic component to these spots as well, i.e. these freckles are known to run in the family. To identify them, ephelides are characterised by flat spots that are one to two millimetres in size. They are red to light brown in colour, are usually located on the face, neck, chest and arms, and will become more prominent during the hotter months. In particular, children who are two to three years of age are likely to be affected by ephelides, especially if they find themselves under prolonged exposure to the sun. The number of spots will increase during adolescence and then fade with age.
Unlike ephelides, lentigines are freckles that form solely as a result of excessive sun exposure. The spots, which are larger in size than ephelides (0.2 to 2 centimetres), are light yellow to dark brown in colour. They appear on areas of the body that have experienced sunburn or sun damage and will persist regardless of the season. Lentigines tend to affect the older demographic, particularly those aged 50 and above.
How Can You Eliminate These Pigmentation Concerns?
While most of the hyperpigmentation types we have discussed above do not pose any health risk, some might be concerned with the appearance of their pigmentation disorder. This is especially so if the marks are significantly larger in size and located on a visible part of their body such as the facial area. In these cases, there are a number of treatment options to consider to have the marks removed.
For mild to moderate discolouration, it is possible to turn to products with skin lightening ingredients that can be easily obtained in most pharmacies. However, the downside to using these products is the longer length of time it will take for the discolouration to fade completely.
For a treatment option that will remove the marks at a much faster rate, consider the micro-needling procedure. This is a minimally invasive procedure that uses tiny needles to create microscopic tears on the skin’s surface. These tears will trigger the skin’s recovery process, ridding the old layer of skin and stimulating the production of collagen to create a new layer that is free of discoloured marks. Because of how popular the treatment is, the procedure is offered at many aesthetic centres such as Geo Aesthetics.
With the range of treatment options available, it can get particularly confusing. If you are after a stress-free experience, speaking to a knowledgeable specialist might help understand your unique pigmentation condition and you can seek advice on the best treatment for your aesthetic concerns. The specialists at Geo Aesthetics have years of experience under their belt and will have the know-how to help you achieve the flawless appearance you desire.