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ormal skin color, an important part of everyone’s life, is dependent upon the amount and size of certain pigment granules in the upper layers of the skin. This basic skin color is determined at birth and cannot be altered.
All human skin contains three important pigments:
1. Melanin: this black pigment in your skin is produced by special pigment cells called melanocytes. All of us – black, yellow, red, and white people – have the same number of these melanocytes in our skin, approximately 60,000 per square inch. Then why aren’t we all black?
Racial and ethnic variations in skin color depend on the size and shape of these melanocytes, the amount of melanin they produce, the speed at which the pigment is formed, the manner in which this pigment is concentrated in the skin, and the color of the melanin, which can vary from light tan to black.
Melanin is produced in the skin as small, insoluble granules. Where there are no melanin granules, the skin is white; the more melanin granules, the darker the skin. The variations in your particular skin color – tan, brown, black – will depend upon the concentration of these granules in your epidermis.
In black people, melanin production is evenly distributed, producing uniform skin color. In redheads, and in some blonds with blue eyes, melanin is produced in clumps, resulting in splotchy pigmentation – freckles.
Freckles, probably the most common pigmentary alteration in the skin, first appears at about the age of six as flat, light- brown, pigmented spots over sun-exposed skin. During the summer, they have a tendency to increase in number, size, and darkness.
The depth of the melanin granules will also affect the color of your skin: the deeper the granules, the more your skin will take on a bluish cast.
2. Hemoglobin: this pigment is responsible for giving red blood cells their color. If you are anemic, your skin will be pale; if you have too much hemoglobin, your skin will take on a ruddy complexion.
3. Carotene: this pigment, which gives your skin a yellowish cast, comes from outside the body, and is dependent upon what you eat. A diet consisting of large amounts of oranges, carrots, and squash can be responsible for an orange-yellow staining of the skin.
Excessive Pigmentation
The most common cause of excessive pigmentation is an increased stimulation in the production of melanin due to certain hormonal changes, sun exposure, or a combination of both. This condition, called melasma, appears as a dark, splotchy, brownish pigmentation on the face that develops slowly and fades with time. It usually affects women but occasionally is seen in young men who use aftershave lotions, scented soaps, and other toiletries.
Melasma is especially common in young white women, who often develop this blotchiness on their foreheads, cheeks, and mustache areas. It occurs frequently during pregnancy and is more common in brunettes than in blonds. Often called “the mask of pregnancy,” melasma is more pronounced in summer due to sun exposure, and usually fades a few months after delivery. Repeated pregnancies, however, often increase the intensity of this pigmentation.
Melasma also occurs as a side effect of taking the higher- dose birth control pills. It may also be noted in apparently healthy, normal, nonpregnant women due to some mild and harmless hormonal imbalance.
Sun exposure, following the use of deodorant soaps, scented toiletries, and various cosmetics, can also produce this mottled pigmentation. This is what we call a phototoxic reaction; it is due to ultraviolet radiation being absorbed by the chemical substance (perfume, cologne, and other types of fragrance) on the skin. This pigmentation often extends down to the sun-exposed areas of the neck and may be more pronounced on the left side of the forehead, face, and neck due to sun exposure while driving a car.
Excess pigmentation can also be triggered by injury to the skin (burns, abrasions, bruises), by inflammatory disorders of the skin particularly in dark-skinned people (acne, eczema, contact dermatitis, pityriasis rosea, lichen planus), by X-rays, and by heat.
Treating Excessive Pigmentation
How can you treat excessive pigmentation of the skin?
With any local, over-the-counter product, you must remember to be patient; it may take months before you notice any appreciable fading. Occasionally, even without treatment, your dark areas may eventually fade away.
If you believe that your pigmentation is a result of taking birth control pills, try to switch to a lower-dose type with the approval of your doctor or, if possible, stop them altogether.
If none of these treatments work, your dermatologist can try a variety of methods to eliminate these pigmented areas:
If your condition does not respond to any type of treatment, or while waiting for the dark areas to disappear, you can mask them with a cover-up such as Covermark or Dermablend.
Above all, try to be patient . . . .
Liver Spots
The so-called “liver spots” are nothing more than flat patches of excess pigmentation associated with sun exposure and the aging process. (They have nothing to do with the liver.) They are often called “age spots.” The are extremely common in white people beginning in their sixties and occur over the backs of the hands, the face and forearms – the areas of the greatest amount of sun exposure. It is interesting to note that these pigment changes (as well as keratoses and skin cancers) occur in the United States more on the left side of sun-exposed areas. Particularly for those who drive automobiles, it’s the sun that shines in the window on the driver’s side that allows the longwave ultraviolet light to penetrate the glass that results in these sun-induced problems. (In the England and Australia and other countries, where the driver maneuvers the car from the right side, the reverse is true.)
Since these are benign lesions, no treatment is required. But for cosmetic reasons they can be eradicated with a variety of methods. Topical treatments include fresh lemon juice (see Home Remedies section), freezing them off with liquid nitrogen by a dermatologist, chemical peels, the topical application of bleaching or fading creams, or by applying some of the so-called, over-the-counter AHAs (alpha-hydroxy acids) or Retin-A.
To protect yourself from developing these sun-induced skin changes, avoid fragrances when in the sun, use a sunscreen at all times, and wear a hat.
Dark Circles Under Eyes
This, the number two problem for women (after wrinkles), is an age-old dilemma and an age-old question: Why do “bags” and dark circles occur in certain people? Truthfully, no one knows the answer! There are many theories and speculation why they develop. And here are a few of them, none of which have any valid basis or proof:
Treatments for the dark circles are concealers and, possibly, topical vitamin K. One thing that is certain: dark circles and bags do not indicate any illness in the body.
Treatment for bags is plastic surgery. No topical measures will work.
Vitiligo – Loss of Pigmentation
Vitiligo is a mysterious malady characterized by a gradual or rapid loss of pigment, or skin color. If affects about one out of every hundred people and is more common among younger individuals. Approximately half the people who develop this ailment suffer some pigment loss before the age of twenty.
No one knows what triggers this strange condition. The most fashionable theory claims that it is one of the autoimmune disorders in which the body attacks and destroys its own tissues – in this case the pigment producing cells. We do know that it results from a decrease or loss of the normal cells (melanocytes) that are responsible for the production of pigment (melanin) in the skin. If the melanocytes are unable to produce melanin, or if their number decreases, white, sharply-bordered patches of different shapes and sizes will develop on otherwise normal skin.
Vitiligo can occur on any portion of the skin surface where pigment cells are present, but more commonly involves the exposed parts – the face, neck, and backs of the hands. There is no way to predict how much pigment a person will lose. In severe cases the loss of pigment can extend over the entire body. The hairs in these depigmented patches also turn white. When the pigment returns, it returns first in and around these hairs.
The pattern of vitiligo is unclear, although the condition appears to run in families. Most of the people afflicted are in good health. Occasionally, however, vitiligo occurs in association with such conditions as pernicious anemia, thyroid disease, diabetes, and disorders of the adrenal glands. Some cases follow sunburn or severe emotional stress. If you do have this cosmetic blight called vitiligo, be assured that it is not a sign of cancer.
While this pigmentary failure can occur in all races, the cosmetic – as well as the psychological – implications are considerably greater for those with darker skins. Vitiligo is a dramatic process in dark-skinned people, often causing profound despair. In India, for example, vitiligo is considered by the populace to be a sure sign of leprosy. Nehru, realizing the myths and superstitions surrounding this perfectly benign condition, often remarked that a treatment for vitiligo was as important for his people as the treatment for leprosy and tuberculosis.
Vitiligo is usually a progressive and relentless disease, and rarely do people with the condition regain their color spontaneously. There may be a long period of time where the depigmented patches remain about the same and very often an emotional upset, infection, or illness may activate the process again with the old spots getting larger and new spots developing.
Unfortunately, there is no reliable method of regaining lost pigment. Current therapy consists of taking a special pill (a psoralen) and exposing the affected skin to sunlight or long-wave ultraviolet radiation (UVA). This form of therapy – commonly called the PUVA treatment (from Psoralen UltraViolet A) – is similar to the way dermatologists treat extensive psoriasis. But even this procedure may have to be carried out for a number of months or years before any noticeable repigmentation occurs.
Not everyone is a good candidate for repigmentation. Ideally, the person should meet the following criteria:
There are some physicians – I am one of them – who treat vitiligo with small doses of anti-inflammatory drugs such as aspirin or ibuprofen along with antibiotics (on the basis that some minor, hidden infection is causing some defect in the immune system). But before you embark on such a regimen, you should ask your general doctor or dermatologist about possible adverse side effects.
Some dermatologists have been using a “cocktail” of the following over-the-counter supplements along with directions for use, and have reported “good results”:
Day 1: Vitamin E – 600 I.U.
Day 2: Methionine – 500 milligrams
Day 3: Selenium – 200 ?cg
Repeat this cycle for a “long period.” And be patient!
The prognosis for vitiligo is discouraging at best. Whatever the treatment, only about one in five patients respond at all, and relapses are the rule. When the involved loss of pigment is in small patches, certain types of make-up (such as Covermark or Dermablend) and concealers can help camouflage the patches of vitiligo.
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For more information concerning vitiligo, write to: National Vitiligo Foundation P.O. Box 6337 – Tyler, Texas 75711 903-534-2925 or www.aad.org 1-888-462-DERM x22 |
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| TREATING EXCESSIVE PIGMENTATION |
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How can you treat excessive pigmentation of the skin?
Above all, protect those pigmented areas from sunlight by using a sunscreen with an SPF of over 30
Protect the areas from irritation: no strong soaps, no abrasive cleansers, no Buf-Pufs, no loofah pads. Use only a mild, gentle soap for washing.
Try one of the over-the-counter bleaching creams (Porcelana, Esoterica, Artra, Eldoquin) and use only as directed. Ironically, some of these can cause further pigmentation if they are too strong for your particular skin.
If these don't work, try Cort-Aid Cream 0.5% once or twice daily.
If your condition does not respond to any type of treatment, or while waiting for the dark areas to disappear, you can mask them with a cover-up such as Covermark or Dermablend.
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