Dreaded Dark Spots

By Asmaa Chaudhry, MD

Dermatology Associates of NOVA

. http://www.dermdocs.com/

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Dreaded Dark Spots

Complaints of discoloration, particularly skin darkening, is a common concern of many dermatology patients. Skin darkening, or hyperpigmentation, can affect any skin type, any age, and can cause embarrassment and, in extreme cases, even social withdrawal. It is therefore important to identify, treat, and most importantly, prevent when possible.

Melanin is the brown pigment that gives color to skin. Hyperpigmentation results when there is excess melanin relative to normal skin. Several types of hyperpigmented lesions exist

Lentigines commonly referred to as “liver spots” or “sun spots”, these are often on sun-exposed skin of adults or those with significant sun exposure.

Melasma also referred to as the “mask of pregnancy”, these dark patches are primarily on the face and can affect both men and women, though there is a predilection for women. Women who take birth control pills or hormone replacement therapy can also develop melasma, as it is believed to be caused by hormonal fluctuations.

Post inflammatory hyperpigmentation (PIH) Among the most common causes of hyperpigmentation, PIH can result from any inflammatory process or injury to the skin acne, eczema, psoriasis, burns, friction, skin allergic reactions.

Birthmarks A variety of birthmarks are hyperpigmented. These include caf-au-lait macules, nevus of Ito, nevus of Ota, congenital melanocytic nevi, speckled lentiginous nevi.

Drug induced hyperpigmentation Certain drugs can discolor the skin, often in a dose-dependent manner. Further, some drugs can increase photosensitivity, making post inflammatory hyperpigmentation more likely. Some known culprits are minocycline, chloroquine, and NSAIDs.

Ephelides Ephelides, or freckles, can be seen in any skin type, though they tend to be more numerous in lighter skin. These tend to be more prominent in the summer months and may fade in the winter.

Treatment of hyperpigmentation is possible in most cases, and varies with the type of hyperpigmentation. Sun protection is crucial and must accompany all other treatments. Other treatment options include laser (particularly for lentigines and birthmarks like nevus of Ota/Ito), bleaching agents such as hydroquinone, azaleic acid, cryotherapy, camouflage makeup, chemical peels, dermabrasion, topical retinoids, and topical steroids. Often, a combination approach is required.

Consultation with a board certified dermatologist is of utmost importance, as the treatment modality, duration, and strength of treatment(s) vary based on severity of the hyperpigmentation, skin type, and medical history of the patient.