From birthmarks to conditions such as melasma that we develop later in life as adults, skin discolorations occur in many forms. Skin pigmentation depends on a variety of factors and can suggest different issues linked to our health. Such disorders can pop up as patches on the skin or affect the entire body. While most pigmentation issues are harmless, they can be bothersome and cause a person to become self-conscious. Some discoloration can be treated with a simple treatment, though more severe cases require intense ongoing care.
To be clear, pigmentation means coloring, so it’s a disorder that affects your skin color. There are individual cells that make melanin, the pigment responsible for giving our skin its color. However, when these cells become damaged or in poor health, melanin production is adversely affected. While we’re about to dive into some of the most common causes of skin discoloration, it’s interesting to note that COVID-19 has caused experts to pick up on a new skin discoloration issue related to the virus. Dermatologists have started to notice red or purple toes, bumps on the fingers, itchy hives, and a red lacy rash across the arms and legs.
To determine if these skin conditions were genuinely linked to the Coronavirus, a study was conducted. The research revealed that the skin discoloration could indicate partial or full blockage (clotting) of the blood vessels, which could cause rashes and skin discoloration. While researchers could not confirm the timing of these skin issues for each patient, they did conclude that there could be some “potential manifestations” that cause these skin discolorations.
While we may not know what the future holds in terms of ongoing skin discoloration conditions, we can gain a deeper understanding of issues that have been plaguing humans for decades — if not centuries.
Tinea Versicolor
The name may sound new to you, but tinea versicolor (also known as pityriasis versicolor or PV) is a common fungal infection of the skin. The fungus disrupts normal skin pigmentation, which causes small, discolored patches (which could be lighter or darker) to develop — typically on the chest, neck, shoulders, and parts of the face. Still, studies show it can manifest on a hairy scalp, too. These patches are also accompanied by mild itching and scaling. While it’s not a contagious skin condition, it can prompt emotional distress due to its appearance.
Cause
The fungus that sparks this skin condition can be found on healthy skin. It’s when the fungus overgrows that tinea versicolor gets out of control. Triggers include oily skin, hot and humid weather, a weakened immune system, and fluctuating hormones.
Treatment
Though antifungal lotions, creams, and shampoos, and oral medication can help treat versicolor, there may still be uneven discoloration for anywhere between a few weeks to several months. To prevent versicolor from returning, you may need to reintroduce a treatment product during warm and humid months. Common medications include:
- Selenium sulfide (Selsun) lotion or shampoo.
- Ketoconazole (Ketoconazole, Nizoral, others) cream, gel or shampoo.
- Itraconazole (Onmel, Sporanox) tablets, capsules or oral solution.
- Fluconazole (Diflucan) tablets or oral solution.
Vitiligo
Vitiligo is a chronic skin condition distinguished by patches of the skin that are in the process of losing their pigment. Perhaps you’ve seen famous vitiligo model Winnie Harlow walking the catwalk, embracing her uniqueness. Eventually, these patches turn entirely white and typically have sharp edges. Skin hair, nose, and the inside of the mouth can also become affected. Researchers have identified several forms of vitiligo, including:
- Generalized vitiligo is the most common form and involves patchy loss of pigment all over the body. Target areas typically include the face, neck, and scalp, as well as the mouth (like the lips) and genitals. Pigment loss becomes exasperated in regions that frequently experience rubbing or touch, such as the hands and arms.
- A more rare form of vitiligo called segmental vitiligo (affect only about 10% of adults) is characterized by smaller patches of depigmented skin that appear on one side of the body, typically in a concentrated area.
Cause
Vitiligo is an autoimmune disorder, which happens when the immune system attacks the body’s organs and tissues. Those with vitiligo have an immune system that assaults melanocytes (pigment cells in the skin.) Research suggests that approximately 15 to 25% of people with vitiligo are also affected by at least one other autoimmune disorder. Examples include psoriasis, autoimmune thyroid disease, rheumatoid arthritis, type 1 diabetes, pernicious anemia, Addison disease, or systemic lupus erythematosus.
Treatment
As this is a skin condition that tends to spread, vitiligo treatment is crafted based on the changing appearance of the skin in an effort to restore color. A doctor may suggest one or more of the following:
- Topical steroids such as fluticasone propionate, betamethasone valerate, or hydrocortisone butyrate.
- Pimecrolimus and tacrolimus are types of topical medicine known as calcineurin inhibitors. While they have similar side effects to steroids (increased sun sensitivity, redness, etc.), they don’t cause skin thinning.
- If topical treatments haven’t worked, phototherapy may be a more effective form of therapy — primarily when used in conjunction with other remedies.
- On the more severe side, a skin graft can be used to treat vitiligo by removing skin from an unaffected area and covering in areas where white patches are present. Another option is to remove melanocytes from healthy skin so they can be transferred to whitened vitiligo patches.
- Those who have vitiligo on more than 50% of their body are candidates for depigmentation, which means normal skin is “bleached” with a hydroquinone-based medicine so that it matches other white patches of skin.
Hyperpigmentation
Hyperpigmentation is a common and typically harmless skin condition identified by patches of the skin that become darker than the normal skin.
Cause
As the name suggests, hyperpigmentation is precipitated by an overproduction of melanin. By now, you know melanin is the natural pigment that gives our skin, hair, and eyes their hue. The main factors for increasing melanin include sun exposure, age, fluctuating hormones, inflammation, and skin injuries. There are three main types of hyperpigmentation:
- Sun (or Age) Spots: Sunspots — small, darkened patches of skin — occur from an overabundance of sun exposure that was likely unprotected. With that said, these spots tend to pop up on exposed areas such as the face, neck, décolleté, hands, and arms.
- Melasma: Though harmless, melasma (otherwise known as chloasma) can make people (especially women) feel self-conscious. Melasma is a skin condition where large patches — typically light and dark brown and/or blue-gray in color — of hyperpigmentation develop on the face. They can pop up as larger flat patches or smaller freckle-like spots. Melasma is typically referred to as the “mask of pregnancy” because it tends to affect pregnant women — 15%-50% of pregnant women get it. The condition typically worsens in the summer (again, the sun) and improves in the winter. According to the Mayo Clinic, this is a common skin disorder. Between 1.5% and 33% of the population may get melasma, typically starting between 20 and 40 years of age.
- Post-Inflammatory Hyperpigmentation: This type of hyperpigmentation occurs when there is trauma or injury to the skin, which causes a flat discolored patch of skin. Those with chronic acne or who regularly receive cosmetic procedures like dermabrasion are susceptible to this condition.
Treatment
As with other skin conditions such as wrinkles, crepey skin, and under-eye circles and bags, prevention is critical. Wearing sun protection every day (even when it’s cloudy) is one of your best measures of defense. If you’re late to the game and already have discoloration, you should still wear a broad-spectrum sunscreen to prevent future damage. Treatment options for hyperpigmentation include:
- Consider prescription-strength and over-the-counter lightening products with ingredients such as hydroquinone, licorice extract, niacinamide, or N-acetylglucosamine. If you need a few options to get you started, check out DOCTOR BABOR BRIGHTENING Intense Skin Tone Corrector Ampoule Treatment, Topicals Faded Brightening and Clearing Gel (a melasma miracle worker), Murad Rapid Age Spot and Pigment Lightening Serum, and SkinCeuticals Phyto Corrective Gel.
- Laser resurfacing is a non-invasive treatment that uses lasers to remove layers of your skin. Depending on the severity of your hyperpigmentation, either an ablative or non-ablative laser tool will be used.
- Retinoids are another ingredient that can either be prescribed by your doctor or found in OTC products. They’re an excellent option for treating hyperpigmentation because they reduce epidermal melanin. However, as they make the skin more sun-sensitive, you must be wearing sunscreen to prevent a counterproductive result.
- Chemical peels are applied to the skin by a dermatologist or esthetician to reduce the appearance of age spots via chemical exfoliation. There are various peel grades depending on whether you’re looking for a light, medium, or extreme exfoliation. Some peels just target the epidermis (outer layer of skin) while penetrating deep into the dermis, the middle layer of skin.
- Flat patches of skin are caused by post-inflammatory hyperpigmentation tend to respond well to IPL therapy — otherwise known as a photofacial — as it stimulates collagen production within the dermis.
Birthmarks
Clearly, birthmarks are present at birth or even a few weeks before. Most birthmarks are harmless, but there are a few you have to keep an eye on.
- Port-wine stains: This type of birthmark, caused by abnormal development of blood vessels, appears as a flat pink, red, or purple mark on the face, torso, arms, or legs, and it doesn’t fade with time. The spot may become raised and thickened.
- Moles: Otherwise known as nevi, moles range in color from flesh to light and dark brown and may be raised or flat. While most moles are non-cancerous (benign), they should be watched for changes using the ABCDE method: asymmetry, border, color, diameter, evolving. If you notice any changes to your mole(s), get it checked out by a doctor right away — especially if you have a family history of melanoma.
- Hemangioma: These types of moles are growths comprised of tiny blood vessels clustered together — some are more serious than others. They typically appear as a small mark on the face, torso, arms, or legs, but younger children can have large hemangiomas that get larger for the first year after they’re born. There are two different types of hemangiomas: strawberry (or superficial), which are slightly raised, red, and can appear anywhere on the body. Cavernous hemangiomas are deeper birthmarks with a bluish color. Most hemangiomas will go away on their own: 50% get better by age five, 70% by age seven, and 90% by age nine.
- Mongolian spots: These bluish birthmarks (they look similar to a bruise) typically develop on babies’ behind or back. There’s no need for treatment because the discoloration usually goes away by the age of four.
- Café-au-lait spots: Approximately 10% of the population have these light-to-dark brown flat spots. If only one or two is present, it’s a random marking — but if there are six or more, the skin condition may be linked to the genetic disorder neurofibromatosis.
Cause
Vascular birthmarks like port wine stains are formed when blood vessels don’t form correctly, whereas pigmented birthmarks such as moles are caused by an overgrowth of the cells that create excess skin color.
Treatment
Most birthmarks can be left alone (unless they’re jeopardizing one’s health), but for those who feel self-conscious about the discoloration (especially if it winds up on the face), there are some possible treatments.
- Your doctor can prescribe an oral prescription medication such as Propranolol, which can reduce the size while lightening the color of hemangiomas. There’s also a topical medication called Timolol that has a similar action.
- Laser treatment uses highly focused beams of light to reduce the size and lessen the color of birthmarks such as hemangiomas, port wine stains, and café au lait spots.
- Mole removal via surgery may be possible (and necessary if it appears as though there’s a cancer threat), but keep in mind this procedure can leave scarring behind on the skin.
Albinism
According to the National Organization for Albinism and Hypopigmentation, “Albinism occurs in all racial and ethnic groups worldwide. In the U.S., approximately one in 18,000 to 20,000 people have some type of albinism. In other parts of the world, the occurrence can be as high as one in 3,000. Most children with albinism are born to parents whose hair and eye color are typical for their ethnic backgrounds.”
Cause
Albinism is an inherited skin disorder caused by the absence of pigment (due to an atypical gene that prohibits melanin production) in the skin, hair, or eyes. However, it’s a common myth that albinos have red eyes. What’s really happening is that certain lighting conditions can make it easier to see the blood vessels at the back of the eyes, which gives them a reddish or violet cast. Unfortunately, those with albinism often have vision problems.
Treatment
There is no treatment, but it’s crucial individuals with this skin condition swear sunscreen at all times as they are highly susceptible to sun damage and skin cancer due to the loss of pigment.
Rosacea
Rosacea is a common skin condition that causes excessive redness (almost like a bad sunburn) and visible blood vessels in your face. Small, red, pus-filled bumps may also be present. While this disorder will be more evident in those with a lighter skin tone, according to the American Academy of Dermatology Association, people of color can get rosacea, too. The difference is that the redness is more of a dusky brown hue and the bumps are more of a yellowish-brown color. There are four different types of rosacea (though one affects the eyes, so we’ll skip talking about that one for the sake of staying on track), each of which contributes to skin discoloration in its own way.
- Erythematotelangiectatic Rosacea: Chronic redness and visible and enlarged blood vessels worsen when there’s a flare-up.
- Papulopustular Rosacea: Along with facial redness and flushing, there’s also the appearance of pus-filled blemishes and red, swollen nodules. This type of rosacea is often mistaken for acne, as there can be many imperfections present at once — including on the neck, chest, and scalp.
- Phymatous Rosacea: Thicken skin that’s prone to scarring, resulting in a swollen, bumpy, and often discolored appearance. It’s a rare form of rosacea that mainly affects the nose (aka rosacea nose) and is more predominant in men than women.
Cause
Unfortunately, the cause of rosacea is unknown, but it’s exasperated by triggers such as sunlight, stress, spicy foods, excessive heat, and even hairspray.
Treatment
Along with avoiding the aforementioned rosacea triggers, this skin condition can be treated with:
- Talk to a doctor about topical products that reduce redness, such as prescription-strength Brimonidine (Mirvaso) and oxymetazoline (Rhofade) that work to reduce redness by constricting blood vessels.
- Develop a soothing skincare routine with products like Vaniclear Free and Clear Liquid Cleanser, Bioderma Sensibio Anti-Redness Cream, Avène Antirougeurs Calm Soothing Repair Mask, and Neutrogena Sheer Zinc Dry-Touch Sunscreen SPF 30.
- A doctor may suggest an oral antibiotic such as Doxycycline for moderate to severe rosacea with bumps and pimples.
- Suppose you have severe rosacea that doesn’t respond to other therapies. In that case, your doctor may prescribe isotretinoin (Accutane, Claravis, etc.), an extremely potent oral acne drug that also helps clear up acne-like lesions associated with rosacea.
- Laser therapy and other light-based therapies such as Erbium Yag, Pulsed Dye, and CO2 (lasers) and Intense Pulsed Light Therapy (IPL) may help reduce the redness of enlarged blood vessels — but keep in mind that the treatments will likely need to be repeated to maintain results.
Eczema
Eczema is the all-encompassing name for a group of skin conditions that cause dry, itchy skin patches, redness, and irritation. There are seven different types of eczema, including:
- Atopic Dermatitis: The most common form of eczema, the skin becomes extremely dry and cracked.
- Contact Dermatitis: Occurs when the body comes in contact with a particular substance such as a harsh detergent.
- Neurodermatitis: Raised, rough patches of scaly skin that are incredibly itchy.
- Dyshidrotic Eczema: Small blisters on the palms of the hands.
- Nummular Eczema: A chronic form of eczema that causes itchy, cracked, and swollen circular or oval patches.
- Seborrheic Dermatitis: Red, scaly patches on scalp, ears, eyebrows, and the sides of the nose.
- Stasis Dermatitis: A chronic form of eczema that causes itchy skin, inflammation, and ulcers, on the lower legs.
Cause
The specific cause is unknown, but experts agree it’s likely due to a combination of environmental and genetic factors. Low humidity, heat, harsh detergents, materials like wool, and certain foods, and emotional stress can cause an eczema flare-up.
Treatment
First and foremost, try to avoid eczema triggers whenever possible. Heed this critical piece of advice because currently, there’s no cure for this skin condition. You can, however, manage it with the following treatment options.
- Topical anti-inflammatory medications such as corticosteroid creams and ointments can alleviate the main symptoms of eczema.
- If topical treatments don’t work, ask your doctor about systemic (oral or injectable) corticosteroids. Note this is not a permanent treatment and should only be used for a short period.
- Phototherapy has been known to treat mild forms of eczema by exposing the affected areas with UVB/UVA waves.
- Opt for over-the-counter topicals such as Aveeno Eczema Therapy Moisturizing Cream, Neosporin Eczema Essentials Daily Moisturizing Cream, and Eucerin Eczema Relief Body Cream.
Psoriasis
Psoriasis is a condition that occurs when the immune system causes certain areas of the skin to produce new cells more quickly than usual. Along with itching, burning, dry, cracked skin that’s prone to bleeding, people with psoriasis also experience skin discoloration due to red patches of skin covered with thick, silvery scales.
Cause
The cause of psoriasis is not clear, but scientists believe that most people with psoriasis inherit one or more specific genes that can affect the immune system to make them prone to psoriasis. According to these experts, the most common cause of a flare-up is stress. As with eczema, mental stress causes the body to release chemicals that boost the inflammatory response.
Treatment
If psoriasis is severe, prescription-strength topicals or oral medication can be more effective than over-the-counter creams.
- Of course, it wouldn’t hurt to incorporate a few gentle, dermatologist-approved formulas into your routine. Consider CeraVe Psoriasis Moisturizing Cream, Dermarest Psoriasis Medicated Treatment Gel (salicylic acid is the star ingredient in these two products), or Eucerin Skin Calming Itch Relief Treatment.
- A doctor can provide topical prescription treatments such as retinoids, corticosteroids, vitamin D analogs, and calcineurin inhibitors, such as Protopic and Elidel. Anthralin (a coal tar product used to slow cell growth, remove scales, and smooth out the skin) treats widespread patches and reduces inflammation and is typically more effective than OTC treatments.
- Light therapy is best for moderate to severe psoriasis and can be combined with other medications. It requires exposing the skin to controlled amounts of artificial or natural light. Several different methods exist (and repeated treatments are a must), so speak with your doctor about which one is best for you.
- If other treatment methods haven’t been working effectively, you may want to consider speaking with your doctor about prescription oral or injected systemic medication. Be warned that some of these medications have severe side effects, so they should only be used for a short period between other treatments. Some options include steroids, cyclosporine (Neoral), retinoids (Soriatane), methotrexate (Trexall), and injectable biologics such as Enbrel and Cosentyx.
Sunburn
At some point in most people’s lives, they get a bad sunburn. Between the chills, fire-engine red skin, barely touchable skin, sunburn blisters, and the snake-like peeling process, you’d think you’d learn better after the first time it happened. On top of the discomfort and lobster-like appearance, a sunburn leads to sunspots (hyperpigmentation as mentioned above), premature aging (read: wrinkles), and at its worst, skin cancer.
Cause
A sunburn is an inflammatory reaction to dangerous UV (ultraviolet) radiation, which damages the skin. Melanin is working overtime to protect against the sun’s harmful rays, which is why the pigment darkens when it’s exposed to the sun. However, the amount of melanin you produce all comes down to genetics. Some people tan while others burn. Either way, the skin is experiencing cellular damage at this point. For those who are more susceptible to burning, the skin becomes red, swelled, and painful — it may even blister. The peeling process is an indicator that the body is trying to get rid of damaged cells. Never peel this skin; let nature take its course, or you run the risk of scarring.
Treatment
Unlike some of the other aforementioned skin conditions, a sunburn is entirely preventable if you limit sun exposure, wear a broad-spectrum SPF with UVA/UVB protection of at least 30, and sport protective gear such as a hat, visor, and sunglasses. Experts also suggest you stay out of the sun during the most dangerous period between 10 a.m. and 4 p.m. However, if you do wind up getting burned, you should:
- Cool yourself down right away, whether that’s a pool, the sea, or the shower. After that, stay out of the sun and continue to apply cold compresses — but not direct ice. Avoid harsh, chemical-laden soaps as that will only dry the skin out further.
- Keep moisturizing the skin with a fragrance and petroleum or oil-free lotion — even natural aloe (not a formula with artificial colors or additives) can do the trick. Repeat several times a day over the next few days.
- Check with your doctor first, but an over-the-counter anti-inflammatory drug such as ibuprofen or aspirin can help alleviate pain, discomfort, or inflammation. Non-prescription cortisone cream can also help reduce redness and swelling.
Conclusion
There are many different reasons why the skin experiences discoloration, but in most cases, it all comes down to melanin issues — sometimes our skin produces more, sometimes less. While most pigmentation issues are harmless, it’s always a good idea to keep an eye on any noticeable changes such as size, shape, color, texture, reaction to current treatments, etc., in case there’s an underlying condition. Even a severe sunburn is a reason to call your dermatologist or another healthcare provider. From prescription topicals and dermatological treatments to over-the-counter healers to simply embracing skin discoloration, there are copious options, so work with a dermatologist to find the best treatments for you.
Sources:
“A Visual Guide to the Six Conditions That Cause Skin Discoloration,” National Library of Medicine.
“Livedoid and Purpuric Skin Eruptions Associated With Coagulopathy in Severe COVID-19,” JAMA Dermatology, August 2020.
“Tinea Versicolor Confined to the Hairy Scalp,” JAMA Dermatology.
“Tinea Versicolor,” Mayo Clinic.
“People With Skin of Color Can Get Rosacea,” American Academy of Dermatology Association.
“Vitiligo,” U.S. National Library of Medicine.
“Melasma,”Cleveland Clinic.
“Pigmentation: Abnormal Pigmentation,” Cleveland Clinic.
“A Deeper Look at Psoriasis,” Harvard Health Publishing, November 2018.
