Pigmentation – melasma

PIGMENTATION – hyperpigmentation or dark patches
There are numerous factors that can lead to hyperpigmentation, or excess pigment that results in dark areas on the skin. Preliminary consultation is necessary because a diagnosis is necessary so that treatment can be properly targeted at the underlying problem.
The common conditions are briefly described below 

  1. MELASMA

What is melasma?
Melasma, which typically manifests as dark spots on both sides of the face, primarily on the cheeks but also on the forehead, bridge of the nose, upper lip, and chin, is the most prevalent cause of hyperpigmentation in people with skin of colour. 

What is the cause of melasma?
It is more common if there is an affected family member. Other triggers for it include pregnancy, birth control medications, and, most crucially, sun exposure (both UV and visible light from the sun or lightbulbs).  

What is the treatment of melasma?
An initial consultation is required to assess the skin, make the diagnosis (most cases clinically, rarely requires a biopsy) and discuss treatments. 

Medical and cosmetic treatment options include: 

  1. i) Depigmenting creams – treatment for 3 – 6 months is required to reach maximal results
  2. ii) Sunscreen – UVA/UVB sunscreens alone are not sufficient; specialised sunscreens that effectively prevent pigmentation are required. Also, specific quantities (will be discussed in detail during the consultation) should be applied regularly which 

iii) Chemical peels – Can be advantageous in some carefully chosen patients but have hazards, should only be carried out by dermatologists with expertise in treating skin of colour. It can take more than one session. 

  1. iv) Laser – some types of laser can be used with varying results and benefits on selected patients, however, it should be performed by specialised dermatologists only. Multiple sessions may be required.
  2. v) Tranexamic acid – One of the most recent and efficient treatments, it comes in oral, topical, and injectable varieties. Treatment programmes can be completed in two to six months. 
  3. POST-INFLAMMATORY HYPERPIGMENTATION

What is post-inflammatory hyperpigmentation (PIH)?
In people with skin of colour, PIH refers to the brown to purple patches that remain following skin irritation or damage. 

What are the causes of PIH?
Any source of skin irritation, such as physical trauma (burns, grazes), skin conditions (acne, eczema, psoriasis, seborrheic dermatitis, lichen planus, etc.), or skin disorders (acne, eczema, psoriasis, etc.), can heal with black stains. 

What is the treatment of PIH?
An initial consultation is required to establish the diagnosis and cause (clinical or with the help of biopsy) and discuss treatments. 

Treatment is aimed at:
i) Treating the underlying cause of skin irritation
ii) Methods to lighten the pigmentation 

  1. LICHEN PLANUS PIGMENTOSUS

What is lichen planus pigmentosus (LPP)?
LPP is a diffuse grey to brown pigmentation that affects the neck, upper limbs, and face (temples, forehead, or entire face). Additionally, skin creases like the groins and underarms may be affected. 

What is the cause of LPP?
The exact cause is not known, but there is inflammation in the skin. 

What is the treatment of LPP?
At the consultation, a diagnosis is made initially, followed by a detailed discussion of the treatment. 

Treatment options include:
i) Reduction of inflammation
ii) Lightening the pigmentation. 

  1. ACANTHOSIS NIGRICANS

What is acanthosis nigricans (AN)?
Acanthosis nigricans manifests as thick, velvety, dark skin that affects the groins, underarms, and back of the neck. It affects the upper cheekbones and forehead on the face as well. 

What is the cause of AN?
It has been linked to heart disease, high cholesterol, obesity, and high blood pressure. 

What is the treatment of AN?
After the diagnosis is made, further tests may be recommended. Treatment includes depigmenting or skin-lightening agents. 

PIGMENTATION- hypopigmentation or light patches
There are many causes of light patches on the skin, which require expert assessment by a dermatologist to make a diagnosis.