Hyperpigmentation is adecrease in skin pigmentation and is a condition where the body does not produce sufficient melanin.

What are the causes of hyperpigmentation?

Vitiligo - An autoimmune disease (sometimes also linked to hyperthyroidism and Addison’s Disease that affects the adrenal glands), where de pigmented patches can be seen on any part of the body. This disease affects nearly 2% of the population and is more evident in those with darker skin.To darken those spots affected by vitiligo, doctors may prescribe photosensitive medications, such as trimethylpsoralen, and ultraviolet light therapy.

Pityriasis Alba - Hyperpigmented patch can be usually seen on the face in young children. It is common in winter and amongst those, with history of atopy. It can be treated with a mild topical steroid.

Pityriasis Versicolor - A superficial fungal infection caused by a yeast “pityrosporum orbiculare”. These very clearly distinct hypo or hyperpigmented lesions come with fine scales and can be normally detected on the chest, back, neck and sometimes on the face areas. This condition is treated with topical and oral anti fungal drugs.

Secondary Leucoderma – hyperpigmentation caused by the contact with certain chemicals (phenol derivatives, glue of 'bindi', rubber slippers, plastic watch straps, photograph developing solutions or burns). Secondary leucoderma can be treated by spot dermabrasion or skin grafting.

Post inflammatory hyperpigmentation - Occurs after the healing phase of certain dermatoses such as eczemas, psoriasis, candidiasis etc.

Leprosy - A chronic disease caused by 'mycobacterium leprae', affects mainly skin and nerves. Hyperpigmented patches can be detected with absent or decreased sensation -tuberculoid type of leprosy (good immune response) or sensations may be normal if it is a lepromatous type (low immune response) of leprosy. It can be cured with the help of drugs.

Nevus depigmentosus - A congenital, clearly defined, hyperpigmented patch, present since birth. It can be treated with spot dermabrasion or ablation with Co2 laser followed by ultra thin skin grafting.

Albinism – Condition when a person has light skin, white or pale yellow hair and gray eyes. Albinism is usually an inherited trait. There is no cure for albinism. People with albinism should use sunscreen at all times to avoid skin damage and skin cancer.

Hyperpigmentation (increase in skin pigmentation)

Hyperpigmentation is a condition when body produces too much melanin causing certain areas of skin to become darker than usual. Hyperpigmentation can be caused excessive sun bathing or medicine reactions. Deep wounds and scars leave a darker patch of skin after healing. Moles, birthmarks and aging spots are also indications of hyperpigmentation. It is important to keep an eye on moles and birthmarks for any change in size, color or texture to avoid skin cancer.

What are the causes of hyperpigmentation?

Melasma – This hyperpigmentation condition seen as brown patches on the face; it is more commonly seen in females and as a rule during the pregnancy. A dark mask appears over the cheeks, bridge of the nose and the neck, which usually disappears after the birth of the child. Melasma pigmentation condition is also known as chloasma and can be treated with creams by prescription or over-the-counter.

Lichen Simplex Chronicus – The skin pigmentation disorder characterized by dark patches of skin accompanied with severe itching. This condition can lead to permanent scarring and infection if untreated.

Freckles and Lentigenes - Tiny black spots on the face and are genetic in origin.

Birthmarks – Skin pigmentation appearing at birth but may also appear at a later age.

These birthmarks do not generally present any health risks.

Peri-orbital Melanosis - Also known as “dark” circles. This type of pigmentation can be hereditary, or can occur due to stress or eye strain

Port-Wine Stains – Skin pigmentation spots caused by abnormal development of capillaries and appear as a red or purple mark on the body.

Photomelanosis - Increased pigmentation due to sun exposure, occurs on exposed skin, commonly on the face, neck and the back. The appearance of this type of pigmentation may be patchy or as diffused darkening area of the exposed skin.

Sun Burn (tan) - Commonly encountered in fair skinned people caused by the lack of sun protection or sun over exposure.

Post inflammatory hyperpigmentation skin pigmentation, occurring:

* after healing acne, eczemas, contact dermatitis etc.

* in drug induced pigmentation

* due to the use of cosmetics especially those containing fragrance

Tattoos - are pigments inserted into the skin for decorative purpose or as a tradition. Tatoos’ pigments are inserted deep into the dermis which makes them permanent and stubborn.

Treatment for hyperpigmentation disorders

Melasma, Photomelanosis and Post Inflammatory hyperpigmentation can be treated with topical creams such as hydroxy quinone, tretinoin, topical steroids, alpha hydroxy acid creams or kojic , ascorbic and azelic acids.

If the state of pigmented area doesn’t improve with these medicines, other treatments can be advised, such as: chemical peeling with tri-chloro acetic acid or glycolic acid, electrical stimulation of the skin, iontophoresis, intense pulse light treatment, laser surgery.

Peri-orbital melanosis may be treated with spot glycolic acid peel or electrical stimulation of the skin. Intense pulse light therapy can be suggested.

Iron supplements and anti oxidants help to decrease hyperpigmentation on this stage.

Freckles and Lentigens can be treated with a number of methods:

* spot peel with 88% phenol or glycolic acid

* cryo-spray with liquid nitrogen

* fulguration with Radiofrequency.

* lasers

In curing Lichen Simplex Chronicus hyperpigmentation following remedies procedures are normally prescribed:

* topical tretinoin or steroids

* oral vitamin A, Etretinate or Colchicine may be taken

* cryo-spray with liquid nitrogen

* carbon dioxide laser treatment or treatment with Q switched NdYag laser.

* spot dermabrasion in case of lichen amyloidosis

Birthmarks can be removed by pigmented laser

Tattoos may be removed by dermabrasion or laser surgery