The Reasons For The Lack Of Skin Pigment
- Vitiligo or as it is called in English vitiligo: is one of the most prominent medical conditions that result from a gradual shortage and the lack of melanin pigment, which causes the appearance of white patches side on the body, including the face, hands, armpits area, pubic and other, which produces directly from the weakness of Autoimmune.
- Leprosy or Almhaq, is called in English albinism: is one of the rare genetic diseases that result from the absence of melanin in since the moment of birth, where a person is very white, and very sensitive to light, particularly sunlight.
- Vinyl Kyun or phenylketonuria: The genetic pathological conditions resulting from a sharp decline in the levels of melanin, which makes skin and hair a lighter color.
- Psoriasis or Psoriasis: cause the appearance of scales above the skin, which causes a lack of melanin after treatment.
- Color: tinea is the problem of multiple colors or Tinea versiclor which also cause a shortage of this dye.
How Is Vitiligo Treated
There is no cure for vitiligo. The goal of medical treatment is to create a uniform skin tone by either restoring color or eliminating the remaining color . Common treatments include camouflage therapy, repigmentation therapy, light therapy and surgery. Counseling may also be recommended.
- Using sunscreen with an SPF of 30 or higher. Also, the sunscreen should shield ultraviolet B light and ultraviolet A light . Use of sunscreens minimizes tanning, thereby limiting the contrast between affected and normal skin.
- Makeups help camouflage depigmented areas. One well-known brand is Dermablend®.
- Hair dyes if vitiligo affects the hair.
- Depigmentation therapy with the drug monobenzone can be used if the disease is extensive. This medication is applied to pigmented patches of skin and will turn them white to match the areas of vitiligo.
- Corticosteroids can be taken orally or topically . Results may take up to 3 months. The doctor will monitor the patient for any side effects, which can include skin thinning or striae if used for a prolonged period.
- Topical vitamin D analogs.
- Topical immunomodulators such as calcineurin inhibitors.
- Vitiligo can cause psychological distress and has the ability to affect a persons outlook and social interactions. If this happens, your caregiver may suggest that you find a counselor or attend a support group.
Medication And Surgery Options For Vitiligo
In 2022 the U.S. Food and Drug Administration approvedruxolitinib , the first medication that can restore pigment in patients with nonsegmental vitiligo. This is a topical JAK inhibitor, which works to reduce the activity of the immune system. In a clinical trial, 50 percent of patients experienced significant improvements after one year of using the medication.
Other medications may help minimize the appearance of vitiligo. These include:
- Corticosteroid creams, prescribed for the short-term, per the AAD
- Ointments containing immunomodulators tacrolimus or pimecrolimus, which can be used longer-term
- Topical vitamin D analogs
- Combination therapy with UVA light and the oral medication psoralen, which may be especially effective if you have large areas of skin affected by vitiligo
- Pigment removal from unaffected skin using monobenzone cream
Some of these treatment options come with negative side effects, such as scarring, dry and itchy skin, and skin with a streaky appearance.
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Lack Of Melanin Pigment In Skin
There are several other genes that cause different types of albinism, It reduces the amount of melanin pigment in the skin, Everyone has the same number of melanocytes, and most people who suffer from the condition have it in several areas, including increased melanin production Skin pigmentation disorders, and blue eyes, It can affect every area of the body, the deeper the color, The pigment cells or melanocytes are located at the base of the epidermis and produce the protein melanin.Melanin is carried by keratinocytes to the skin surface.Vitiligo is a skin condition where white patches appear all over the body, The health ofThe pigment melanin is made by specialized skin cells called melanocytes, and results in no pigmentation in the skin, the more the melanin content in the skin, Albinism results from a deficiency in the enzyme required to produce melanin, or eyes, Pigmentation or coloration of the skin is dependent on the amount of melanin present in the skin.Importance of Melanin, Eumelanin is responsible for the brown and black pigmentation of human skin or the lack thereof if little of it is produced.
How Is This Condition Diagnosed
Your doctor will rely on results from a physical exam and information about your family history to make a diagnosis.
During your physical, your doctor will assess all areas of skin and make note of any areas where pigmentation is lighter than others. Theyll also make note of any suspicious-looking moles or any other areas of concern.
In some cases, your doctor will perform a biopsy. For this procedure, theyll scrape a small sample of skin off to send to a laboratory for further analysis. This is most common with suspected cases of lichen sclerosus, pityriasis alba, and tinea versicolor.
Your doctor may also ask you about skin pigmentation in your immediate family. This can help them determine any genetic components.
After making a diagnosis, your doctor will help you develop an appropriate treatment plan for your symptoms.
Your options will depend on:
- the underlying cause
- area of coverage
According to DermNet New Zealand, hypopigmentation doesnt usually require treatment if its related to acute inflammation. This includes burns and scarring.
In these cases, the lack of color will resolve on its own as your skin cells in the region heal. The skin cells in the affected area should be able to produce melanin again within the next couple of months.
In the meantime, your doctor can recommend other treatment measures to reduce the appearance of white patches.
Treatment options may include:
- lightening gels, such as hydroquinone
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About Skin Pigment Disorders
Skin pigment disorders affect the amount of melanin in a child’s skin, and thus affect skin color. There are three types of skin pigment disorders: albinism, pigment loss after skin damage, and vitiligo.
- There is no cure for these conditions, although there are cosmetic solutions for pigment loss after skin damage and vitiligo if a child is concerned about his appearance.
- Children with albinism or vitiligo should avoid prolonged exposure to the sun, as their skin is particularly sensitive to its rays.
Can Microneedling Treat Hypopigmentation
Microneedling may be able to treat hypopigmentation. However, there isnt enough research to say for sure.
During microneedling, your healthcare provider uses a device that pokes your skin with thin needles. The tiny punctures in your skin stimulate the growth of new collagen and elastin fibers. They may also stimulate your skin cells to make more pigment.
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Other Therapies And Management Options
Even if you are receiving medical treatment for vitiligo, the results can be slow. So, you may want to incorporate the following:
- Sunscreen. Reducing sun expose can help keep your skin even. Tanning will add contrast to your skin, making affected areas more visible. It is important to use sunscreen with a high SPF, as areas without pigmentation are susceptible to sun damage.
- Cosmetics. Makeup or self-tanning lotions can help even out your skin tone. You may prefer self-tanning lotions because the effect lasts longer, even with washing.
- Managing mental health. Some
Congenital And Genetic Conditions
Nevus depigmentosus is something akin to a freckle or mole that has no color. It’s considered a congenital condition that a person is born with, but it has no known pattern of inheritance. Albinism is a group of genetic conditions associated with reduced pigment affecting the eyes and other areas, such as the skin and hair 7. Piebaldism, another genetic condition, usually results in a patch of white hair near the forehead, or a white forelock 8. There may also be areas of unpigmented skin on the forehead, trunk, arms and legs.
- Nevus depigmentosus is something akin to a freckle or mole that has no color.
- Albinism is a group of genetic conditions associated with reduced pigment affecting the eyes and other areas, such as the skin and hair 7.
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Vitiligo And Pityriasis Alba
Two of the most common skin disorders associated with pigment loss have causes that are not completely understood 5. Vitiligo typically occurs during the first 3 decades of life and is characterized by smooth, white patches of skin. Pityriasis alba, which is most often observed in young children, may first appear as a red scaly rash, typically on the face and arms. The rash often resolves spontaneously but leaves dry, white patches as it heals. These patches eventually disappear, causing no permanent pigment loss.
- Two of the most common skin disorders associated with pigment loss have causes that are not completely understood 5.
- Vitiligo typically occurs during the first 3 decades of life and is characterized by smooth, white patches of skin.
Hypopigmented Spots That Are Not Vitiligo
If the spots are not truly white, but hypopigmented and not depigmented , then they are NOT vitiligo and could be any number of different diseases and conditions. Ill list a few of the most common ones here. Both IGH and nevus depigmentosus can also be hypopigmented instead of depigmented. They look similar and are located on the same areas of the body. Nevus anemicus is a common birthmark that looks lighter than surrounding skin, although it is actually not different in pigment at all. It is due to a lower blood supply to that area of skin, so it is less pink than surrounding skin and thus looks lighter. It actually disappears completely for a few seconds when you apply pressure to the area because the surrounding blood in the vessels is pressed out. It reappears once the blood rushes back into it. Individuals with tuberous sclerosis can have light areas of skin called ash leaf spots, but they usually have other more cleare signs of this condition as well. Occasionally, darker skin from melasma can make it look like the normal skin is lighter, and thus could look a little like vitiligo.
Tinea versicolor causes lighter spots on the chest and back, get scaly if scratched with a fingernail, and are caused by a common fungus that isnt dangerous. Its easily treated with an antifungal therapy.
Progressive macular hypomelanosis looks a lot like tinea versicolor but without the scale, most commonly affecting the chest and back.
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Why People With Vitiligo Are Joining The Body Positive Movement
While some people with vitiligo seek treatment to cover up or repigment their skin, others choose to embrace the condition however it shows up. Ash Soto falls into that camp. The twentysomething from Orlando, Florida, documents her experience with vitiligo on her , which is over 150,000 followers strong.
Soto was diagnosed with vitiligo at age 12 after she saw a white spot on her neck and then noticed another one appear within a few months. I remember being really scared and confused, she says.
Soto admits she was teased at school for the way her skin looked and says her vitiligo hurt her self-esteem and made her feel insecure. By her late teens, however, she had decided to embrace her skin and use it as a canvas for art, which she shares photos of on Instagram. Her photos are accompanied by inspirational captions that promote a love-yourself mentality.
The body positive movement is all about self-acceptance, so its been a natural fit for people who want to embrace their vitiligo. Some well-known people have been open about their vitiligo including the model Winnie Harlow, the ballet dancer Michaela DePrince, Breanne Rice from The Bachelor, and actor Jon Hamm and this has helped bring vitiligo into the spotlight, notes the Vitiligo Society. With this raised awareness, people may become more accepting of those living with the condition.
Chemical Exposure And Topical Medicines
Exposure to certain chemicals can cause skin color changes. For example, an antioxidant used in rubber manufacturing — monobenzyl ether of hydroquinone — was one of the first chemicals noted to be associated with occupation-related pigment loss. Certain compounds used in antioxidants or germicidal disinfectants can also produce pigment loss. Likewise, some medicines applied to the skin, such as corticosteroids and tretinoin, have the potential to produce lighter areas.
- Exposure to certain chemicals can cause skin color changes.
- For example, an antioxidant used in rubber manufacturing — monobenzyl ether of hydroquinone — was one of the first chemicals noted to be associated with occupation-related pigment loss.
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Which Skin Type Are You
Skin type is described by the Fitzpatrick classification , which determines the colour of skin by phototype, which depends on the amount of melanin pigment in the skin.
In this article we describe skin as lighter or darker.
Skin types: Fitzpatrick classification, adapted from:
Skin changes are caused either by active eczema or by scratching as a result of eczema itch. These changes can result in two types of pigmentary skin changes in eczema:
- HYPO-PIGMENTATION Loss of skin pigment or colour, usually seen as patches of skin that are lighter than overall skin tone.
- HYPER-PIGMENTATION Patches of skin becoming darker than the normal skin tone.
Hypo- and hyper-pigmentation are more visible in darker skin types but can occur in any skin type and can be concerning and distressing for anyone with eczema.
The main way of improving skin pigmentation changes is to treat the underlying eczema and inflammation. But discoloration can last for months or years, even after the eczema is treated.
How Does Vitiligo Progress
Vitiligo usually begins with a few small white patches that may gradually spread over the body over the course of several months. Vitiligo typically begins on the hands, forearms, feet, and face but can develop on any part of the body, including the mucous membranes , the eyes, and inner ears.
Sometimes the larger patches continue to widen and spread, but usually they stay in the same place for years. The location of smaller macules shifts and changes over time, as certain areas of skin lose and regain their pigments. Vitiligo varies in the amount of skin affected, with some patients experiencing few depigmented areas and others with widespread loss of skin color.
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Your Dermatologist Can Help
Those arent ALL of the conditions that can cause white or light spots like vitiligo, but its most of them. Others are really rare and could require a lot of explanation better suited to residency training in dermatology, so I left them out! I dont expect that this description will be sufficient to avoid a visit to a dermatologist because theres a LOT more to diagnosing skin disease than knowing the names of diseases and a few lines of description, but it should help you wrap your mind around the possibilities and get some insight into how were thinking during a physical exam in our office. Remember, you could have BOTH vitiligo and another condition described here! Its helpful to know which is which, so that your dermatologist can determine when and how to treat them. Now you can go to your dermatologist appointment armed with knowledge, which should help both of you figure out what your white or light spots are, and how best to treat them!
* Images courtesy of VisualDx.
When Should Hypopigmentation Be Treated By A Healthcare Provider
Youre at a greater risk of developing skin cancer if you have albinism. Your healthcare provider can tell you the best ways to protect and take care of your skin.
See your healthcare provider if you have lichen sclerosus. Having lichen sclerosus increases your chances of developing a type of skin cancer called squamous cell carcinoma if left untreated.
Hypopigmentation can also affect your mental health. It can make you worry about how others look at you. It can also affect how you think about yourself and your behavior. If hypopigmentation causes you stress, anxiety or depression, see your healthcare provider right away.
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Coping With Emotional Aspects Of Vitiligo
Research shows that people with vitiligo tend to experience emotional stress and low self-esteem. One 2015 study also found that parents of children with vitiligo report lower quality of life.
However, vitiligo isnt contagious, and it typically doesnt cause any negative physical effects. People with vitiligo can live healthy, active lives.
It is important to find a therapist who understands this skin condition and its impact on mental health. A of early, but limited, studies suggests that individual cognitive behavior therapy can help with:
- maintaining self-esteem
- preventing depression
- improving overall quality of life
Along with your family and friends, a vitiligo support group is a great source of support. These groups give members the opportunity to express themselves and meet others with the same condition.
You can also look at the #vitiligo hashtag on social media for stories of people embracing their appearance. One example is fashion model and activist Winnie Harlow, who calls herself a vitiligo spokesmodel.
Vitiligo Causes And Risk Factors
The skin doesn’t have its characteristic color because it has lost its melanin. For some reason, the pigment-forming cells known as melanocytes have been destroyed.
We don’t know why this happens. It might be an autoimmune condition, where your body’s defenses turn on your own cells instead of attacking invading germs.
Although vitiligo affects all races equally, it’s more noticeable in dark-skinned people.
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