Hypopigmentation: Causes, Treatment & Help

Hypopigmentation is a specific symptom of human skin or hair. Hypopigmentation is usually characterized by the fact that the number of melanocytes is greatly reduced. The symptom can also occur when the formation of the skin pigment melanin is decreased. Basically, hypopigmentation can be both congenital and acquired.

What is hypopigmentation?

Symptoms of hypopigmentation can appear in different parts of the human body. In most cases, the hair, iris as well as the skin are affected. In dermatological science, hypopigmentation belongs to the so-called secondary efflorescences. Secondary efflorescences are changes in the skin that occur as a consequence of primary abnormalities. Examples of typical secondary efflorescences include dandruff or ulcers. Pigmentary abnormalities typical of hypopigmentation may occur in a single skin site and with local limitation or in multiple sites. There are also pigmentary disorders that affect the entire skin. Depending on the form of hypopigmentation, a variety of symptoms may be manifested. The light skin patches vary in size, color, expression, and symmetry depending on the cause and stage.

Causes

The causes for the appearance of hypopigmentation can vary. Basically, both congenital and acquired causes exist for the formation of the typical symptoms. Congenital hypopigmentation can manifest itself in a variety of syndromes. These include albinism, poliosis, vitiligo, nevus achromicus, Waardenburg syndrome, Angelman syndrome or Piebaldism. On the other hand, typical syndromes of acquired hypopigmentation are for example Sheehan syndrome, canities, Simmond cachexia, Progeria aldultorum, Sutton nevus or Leucoderma syphilicum. Acquired hypopigmentation also includes psoriasis, scars or leprosy. Common pigmentary disorders in the form of hypopigmentation occur, for example, in white spot disease (vitiligo) as well as in albinism. In the case of albinism, the pigment disorder appears on the whole body. Not only the skin color is significantly lighter, but also the iris and the hair of the affected persons. White or light patches on the skin are typical for white spot disease. These are completely depigmented and have a sharp border. In most cases, these light patches appear on the skin in the area of the face and neck, on the backs of the hands, elbows and knees, as well as on the navel and genital area. Only very rarely is almost the entire surface of the skin affected by the spots.

Diseases with this symptom

  • Pigment disorder
  • White spot disease
  • Leprosy
  • Albinism
  • Waardenburg syndrome
  • Psoriasis
  • Angelman syndrome
  • Piebaldism
  • Sheehan syndrome

Diagnosis and course

Numerous methods are available for the diagnosis of hypopigmentation. These are primarily dependent on the type or syndrome of hypopigmentation in question. In many hypopigmentations, melanin deficiency is the underlying cause for the appearance of the skin change. The reasons for this deficiency of the skin pigment melanin can be very different. They have not yet been sufficiently researched. For the time being, the number of melanocytes in the epidermis is decisive. The fewer melanocytes there are in the skin, the less melanin the body can produce. Accordingly, the appearance of the skin is pale. In the context of white spot disease, a localized deficiency of melanin is seen, probably as a result of an autoimmune reaction. Several steps are required to diagnose melanin deficiency associated with hypopigmentation. First, a thorough history of the affected patient is taken. This includes discussion of any hereditary diseases or other potential causes, such as medical therapies or specific medications that may trigger melanin deficiency. In certain circumstances, it may be necessary to take a sample of the area of the skin affected by hypopigmentation and perform a biopsy. This makes it possible to learn more about the background and possible causes of the melanin deficiency as well as the hypopigmentation.In the majority of cases, hypopigmentation is a relatively harmless disease. In addition, it usually progresses only slowly. Thus, the bright spots in a white spot disease with increasing age and become more, but this is from a medical point of view no reason for concern.

Complications

Hypopigmentation, a lack of pigment in the skin and thus a lightening, is usually the result of a lack of melanin. Hypopigmentation is usually a symptom of an underlying disease that destroys melanocytes, the melanin-producing cells in the skin. Depending on the disease, different complications present themselves. One cause can be, for example, an inflammation which, if left untreated, can spread systemically in the rarest cases (sepsis); this can be fatal. A typical disease of a lack of pigmentation is albinism. Here, the affected person has no melanocytes, the skin is completely pale and accordingly susceptible to UV radiation. Short exposure to the sun leads to severe skin irritation and even sunburn in people with albinism. In addition, the risk of developing skin cancer is increased in those affected. In addition to the skin, the eyes are also usually affected, as melanin may also be missing there. The result is impaired vision, which can even lead to blindness. In addition, especially at school age, there is discrimination from classmates, so that the affected person is exposed to a high stress factor, which can lead to depression. A similar condition, but only localized and causing the same complications, is white spot disease (vitiligo). Phenylketonuria can also cause hypopigmentation. If left untreated, this can lead to mental developmental disorders in the newborn, which can result in disabilities. Epileptic seizures and muscle spasms are also the result.

When should you go to the doctor?

Hypopigmentation must be distinguished between a congenital and an acquired form. Skin and hair are much lighter than usual in hypopigmentation. The cause is a severe reduction in melanocytes, which are responsible for the formation of skin pigment. Typical examples of congenital hypopigmentation are albinism with total light coloring of skin and hair and vitiligo with partially light colored skin in the form of differently sized and irregularly bordered patches. In the case of the congenital form of hypopigmentation, a visit to the doctor is not necessary. The situation is different with acquired hypopigmentation. The cause here is, for example, skin diseases such as psoriasis. Scars also often appear significantly lighter than their surroundings. In addition, chemical substances acting on the skin, including components of cosmetics, the intake of certain medications and mechanical influences can lead to discoloration of the skin. For medical clarification, the first visit should be to the family doctor, who will decide on the further course of treatment after taking a medical history. He often refers his patients to a dermatologist, i.e. dermatologist.

Treatment and therapy

The therapy of hypopigmentation is basically carried out depending on the underlying cause in each case. If a deficiency of melanin caused by medication is responsible for the development of hypopigmentation, the corresponding medication must be discontinued and a replacement prescribed. Similarly, cosmetics that have caused hypopigmentation should be discontinued. Since most hypopigmentation is predominantly harmless from a medical point of view, in many cases no therapy is required. From an aesthetic point of view, however, hypopigmentation is perceived as a blemish by many of those affected and can cause serious psychological problems as a result. In such a case, psychotherapy is recommended. Otherwise, cosmetic treatment is also an option.

Outlook and prognosis

In most cases, hypopigmentation is a harmless symptom. It can either be congenital and occur throughout life. However, patients with hypopigmentation should protect themselves from the sun and never spend long periods of time in direct sunlight without sunscreen. This can cause severe skin burns and irritation. The eyes can also be damaged by strong sunlight in hypopigmentation, so that blindness can occur. The affected person usually has very light skin and very light hair.If the symptom is congenital, usually no treatment takes place. By using cosmetics, the symptom can be relatively easily made over. However, there is actually no reason to hide the hypopigmentation. If it is due to a chronic cause or medication, the first step is to determine the cause of the disease and treat it. Newborns and young children with hypopigmentation need special treatment. In adolescents, bullying and teasing may also occur due to hypopigmentation. In this case, it is advisable to see a psychologist in case of psychological problems.

Prevention

Concrete measures for the prevention of hypopigmentation do not exist, since the symptoms are either congenital or occur relatively spontaneously. Sometimes hormonally active drugs such as the contraceptive pill are responsible for the symptoms, so that the instructions in the package insert should always be followed. Inflammations of the skin should be clarified by a doctor in order to avoid the development of hypopigmentation. Cosmetic products with a skin-lightening effect should also always be used responsibly and only after consulting a doctor.

What you can do yourself

If hypopigmentation is inherited, there is no effective method of treatment or self-therapy. However, the symptom itself is harmless and does not lead to any other medical problems on the body. If the hypopigmentation is triggered by a medication, this medication must be discontinued or replaced by another one. In this case, a doctor should be consulted for advice. The same applies to cosmetics. If hypopigmentation occurs after using a certain skin care product, it should be discontinued and replaced by another product. In any case, the affected areas can be made over so that they are not particularly noticeable. If the patient does not feel satisfied with his own skin, simple conversations with friends or with his own partner often help. In many cases, the birth control pill is also responsible for hypopigmentation. In this case, those affected should pay close attention to the package insert and possibly switch to a different pill. However, there is no self-help option for this symptom. If the patient feels uncomfortable with the hypopigmentation, triggering a lowered self-esteem, a visit to a beautician or psychologist is necessary.