Melasma

It is a skin pigmentation disorder that results from functional problems with cells that produce and contain the melanin pigment. This dysfunction results in the appearance of irregular brown or grayish-brown marks on facial skin. In melasma, the dark spots and patches usually affect the nose, cheeks, forehead, upper lip and chin in three different patterns.

Melasma can occur in all skin types and in people of all racial and ethnic groups, but is most common in women with brown skin who are between the ages of 21 and 40. It is sometimes referred to as the "mask of pregnancy" because it occurs commonly during pregnancy and in women who take oral contraceptive pills. Furthermore, people living in areas of intense and prolonged sunlight (Asia, Africa, Latin America and the Carribean) are more susceptible to developing melasma.

When melasma affects women due to pregnancy, it may resolve within a few months after delivery and treatment may not be necessary. There are, however, many cases in which the disorder persists indefinitely. Even when treated successfully, melasma often recurs, especially when the skin is exposed to the sunlight.

For all individuals with melasma, it's imperative to wear a broad-spectrum (UVA plus UVB) sunscreen daily. Avoid the sun when possible, and wear protective eyewear, caps, hats and clothing. When melasma develops in response to hormone treatment, either oral contraceptives or hormone replacement therapy, patients should consult with their physicians to discuss discontinuation of the hormones.

Treatment Options

• Hydroquine
• Tretinoin (Retin-A)
• Azelaic acid
• Glycolic acid
• Chemical peels and microdermabrasion

Post-Inflammatory Hyperpigmentation

It is a condition that affects people of Asian, African, Latin or Native American background.

Post-inflammatory hyperpigmentation (PIH) causes skin darkening and discoloration that appears as spots, or as large patches on a person's body. This is because cells that normally produce brown pigment evenly across your skin go into overdrive and produce too much melanin.

The root cause of hyperpigmentation is an inflammatory response in the skin. If the excess melanin is produced in the upper layer of skin (epidermis), the pigmentation color is a darker shade of brown. If the excess melanin is produced in the lower layer of skin (the dermis), a gray or blue discoloration becomes visible.

Although PIH can occur in all skin types, it is more common in people of Africa, Asia, Latin, and indigenous Indian background, and can affect men and women equally. Areas of the skin affected by PIH correspond with areas of previous inflammation. When dark changes in your skin's color remain after the underlying problem has gone away, you have PIH.

The most common causes are injuries such as scratches, burns, cuts or bruises. Rashes of any type can cause PIH (examples of which include eczema, psoriasis, pityriasis rosea, lichen planus, and fungal infections). Ordinary conditions such as acne or pimples are a very common cause of PIH in individuals with brown skin. PIH can also be caused by injury to the skin resulting from sunburns, surgery or cosmetic procedures such as chemical peels, dermabrasion, lasers and cryotherapy (liquid nitrogen treatments).

It is also important to know that PIH will in many cases fade over time on its own. However, there are treatments available that can speed up the process

Treatment Options

• Hydroquine
• Tretinoin (Retin-A)
• Azelaic acid
• Glycolic acid
• Chemical peels and microdermabrasion

Drug-Induced Pigmentation

A condition that is especially prevalent among women of African and Latino descent, who have a high incidence of hypertension, diabetes and heart disease and consequently take medications for those medical problems that can cause various types of allergic reactions that frequently lead to hyper-pigmentation and dark spots or patches.

Women with brown skin, particularly those of African and Latino descent, have a high incidence of hypertension, diabetes and heart disease and consequently take medications for those medical problems.

These medications can cause various types of allergic reactions that frequently lead to hyperpigmentation and dark spots or patches on the skin. There are four primary types of medication reactions that can lead to hyperpigmentation: fixed drug eruptions, photosensitivity reactions, drug-induced hyperpigmentation and drug eruptions with secondary post-inflammatory hyperpigmentation.

• A fixed drug eruption is a round, dark patch or eruption that results from a reaction to a drug (usually a prescription medication). This type of reaction leaves a grey-blue, round patch on the skin. The round patch is usually fixed to one spot will appear in this same location within 24 hours of each dose taken.


• Photosensitivity reactions occur as a result of a direct interaction between the sun and a medication that you are taking. In the case of a photosensitive reaction, brown or blue-grey patches will develop in areas of the skin exposed to the sun, including the face, tops of the ears, V of the neck, and outside of the arms.


• Drug-induced hyperpigmentation is hyperpigmentation (dark patches) caused by a reaction between a component of the medication and your skin. The pigmentation often occurs on the face, especially around the mouth. Other parts of the body may be affected as well.


• Secondary post-inflammatory hyperpigmentation occurs when dark marks remain in an area after a primary allergic rash has been resolved.

In the case of fixed drug eruptions, and photosensitivity reactions, the pigmentation is often in the lower layers of the skin (dermis). This makes treatment difficult if not impossible since currently available treatments are unable to penetrate the lower layers of the skin. This makes early detection and immediate discontinuation of the medication extremely important. If you notice that your skin is getting darker, especially after sun exposure, call your medical doctor immediately and ask if the medication can be discontinued and a substitute provided. Also, when you are taking any medication, the use of SPF 15 or higher sunscreen becomes even more important.

Vitiligo

It is a skin disorder in which the cells that make melanin pigment (melanocytes) are destroyed. The destruction results in the loss of pigment and the appearance of irregular white patches on the skin.

Vitiligo is a skin disorder in which the cells that make melanin pigment (melanocytes) are destroyed. The destruction results in the appearance of white patches on the skin. Vitiligo can occur at any age, but usually occurs before the age of 20 in about 50% of patients. Vitiligo affects approximately 1% to 2% of the world's population. It is believed to be a hereditary disorder with 30% of patients having a first-degree relative with vitiligo.

There are five main types of vitiligo, which are based upon the location of the white patches and the pattern of involvement: focal, generalized, acrofacial, segmental and universal.

• Focal vitiligo: minimal involvement with only one or a very few white patches scattered on the skin


• Generalized vitiligo: the most common type with symmetrical patches on any location on the skin including the trunk and/or extremities


• Acrofacial vitiligo: white patches limited to the fingers and around the mouth and eyes


• Segmental vitiligo: white patches on one side of the body and in a linear or line-like distribution (dermatome)


• Universal vitiligo: Widespread patches involving almost the entire body

The cause of vitiligo is not well understood. It is believed to be an autoimmune, disorder which means that certain blood cells in your body, lymphocytes, turn against and attack the melanocytes. Another theory is that vitiligo is caused by an interaction between the body's nerve cells and melanocytes.

Vitiligo may be associated with other immune disorders. They include Addison disease (an adrenal gland disorder), alopecia areata, diabetes mellitus, thyroid disease, parathyroid disease, melanoma, chronic mucocutaneous candidiasis (yeast infection), pernicious anemia, and uveitis (eye disorder). If you are affected with vitiligo, ask your doctor if you should also be evaluated for these immune disorders.

Treatment Options

• Camouflage cosmetics
• Topical creams: corticosteroids, tacrolimus
• Injections: corticosteroid
• Phototherapy: PUVA (oral or topical), narrow-band UVB
• Laser: 308-nm excimer laser
• Surgical: skin grafts
• Depigmentation: Monobenzylether of hydroquinone