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Skin - abnormally dark or light

Hyperpigmentation; Hypopigmentation

 

Skin that has turned darker or lighter than normal is usually not a sign of a serious medical condition.

Considerations

 

Normal skin contains cells called melanocytes. These cells produce melanin, the substance that gives skin its color.

Skin with too much melanin is called hyperpigmented skin.

Skin with too little melanin is called hypopigmented skin.

Pale skin areas are due to too little melanin or underactive melanocytes. Darker areas of skin (or an area that tans more easily) occurs when you have more melanin or overactive melanocytes.

Bronzing of the skin may sometimes be mistaken for a suntan. This skin discoloration often develops slowly, starting at the elbows, knuckles, and knees and spreading from there. Bronzing may also be seen on 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 degree of darkness due to the underlying cause.

 

Causes

 

Causes of hyperpigmentation include:

  • Skin inflammation (post-inflammatory hyperpigmentation)
  • Use of certain drugs (such as minocycline and birth control pills)
  • Endocrine diseases such as Addison disease
  • Hemochromatosis (iron overload)
  • Sun exposure
  • Pregnancy

Causes of hypopigmentation include:

  • Skin inflammation
  • Certain fungal infections (such as tinea versicolor)
  • Pityriasis alba
  • Vitiligo
  • Certain medicines
  • Skin condition called idiopathic guttate hyomelanosis

 

Home Care

 

Over-the-counter and prescription creams are available for lightening the skin. If you use these creams, 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 cover a discoloration.

Avoid too much sun exposure. Always use sunscreen with an SPF of 30 or higher.

Abnormally dark skin may continue even after treatment.

 

When to Contact a Medical Professional

 

Call your health care provider for an appointment if you have:

  • Skin discoloration that causes significant concern
  • Persistent, unexplained darkening or lightening of the skin
  • Any skin sore or lesion that changes shape, size, or color may be a sign of skin cancer

 

What to Expect at Your Office Visit

 

Your provider will perform a physical exam and ask about your symptoms, including:

  • When did the discoloration develop?
  • Did it develop suddenly?
  • Is it getting worse? How fast?
  • Has it spread to other parts of the body?
  • What medicines do you take?
  • Has anyone else in your family had a similar problem?
  • How often are you in the sun? Do you use a sun lamp or go to tanning salons?
  • What is your diet like?
  • What other symptoms do you have? For example, are there any rashes or skin lesions?

Tests that may be done include:

  • Adrenocorticotropin hormone stimulation test
  • Skin biopsy
  • Thyroid function studies
  • Wood lamp test
  • KOH test

Your provider may recommend creams, ointments, surgery, or phototherapy, depending on the type of skin condition you have. Bleaching creams can help lighten dark areas of skin.

Some skin color changes may return to normal without treatment.

 

 

References

Chang MW. Disorders of hyperpigmentation. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 67.

Ortonne JP, Passeron T. Vitiligo and other disorders of hypopigmentation. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 66.

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    • Vitiligo, drug induced

      Vitiligo, drug induced

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    • Vitiligo on the face

      Vitiligo on the face

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    • Incontinentia pigmenti on the leg

      Incontinentia pigmenti o...

      illustration

    • Incontinentia pigmenti on the leg

      Incontinentia pigmenti o...

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    • Hyperpigmentation 2

      Hyperpigmentation 2

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    • Post-inflammatory hyperpigmentation - calf

      Post-inflammatory hyperp...

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    • Hyperpigmentation w/malignancy

      Hyperpigmentation w/mali...

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    A Closer Look

     

    Talking to your MD

     

      Self Care

       

        Tests for Skin - abnormally dark or light

         
           

          Review Date: 4/14/2015

          Reviewed By: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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