What is hypopigmentation?
Hypopigmentation is when the skin lacks color. It may affect the whole body or only a small area.
To understand hypopigmentation, it is helpful to know how skin usually gets its color. Melanocytes are pigment cells that produce melanin. Melanin is the protein that gives skin, hair, and eyes their pigment or color.
The amount of pigment in the skin usually varies depending on sun exposure and genetics. But pigmentation disorders can also affect the skin's darkness or lightness.
Hypopigmentation is the loss of skin pigment or color. It may occur all over the body or be localized.
In localized hypopigmentation, there may be multiple patches or areas on the skin that appear white. The size and shape of the patches can vary widely.
In people with hypopigmentation, there is either a decrease in melanocytes or melanin itself.
A decrease in the amino acid tyrosine can also lead to hypopigmentation. Melanocytes use tyrosine to make melanin.
Hypopigmentation can occur in people of all races, but it may be more noticeable in people with darker skin because of the contrast between the natural skin color and the white patches.
There are several different causes of hypopigmentation. The condition most commonly develops as a result of injury or trauma to the skin.
Blisters, burns, and infections can all damage the skin and lead to hypopigmentation. Cosmetic skin treatments, such as chemical and laser peels, may also cause hypopigmentation if the procedure is done incorrectly.
Certain chronic conditions can also cause hypopigmentation. In instances where hypopigmentation is due to a chronic condition, the condition is usually present from birth.
The types of hypopigmentation include:
Albinism is considered a rare inherited disorder. According to the National Organization for Albinism and Hypopigmentation, about 1 in 20,000 people have some type of albinism in the United States.
Albinism occurs because of a defect in the gene that affects melanin production. The result is a reduction in melanin.
Since people with albinism cannot produce melanin, they have a lack of skin pigmentation. Their skin and hair appear white, and they may have less pigment in the irises of their eyes.
The exact cause of vitiligo is not fully understood, but researchers believe it may be due to an autoimmune disease that damages the cells that produce melanin.
Vitiligo causes smooth, white patches on the skin, which may occur over the entire body or specific areas, such as the arms or face.
In addition to the skin, white patches can also develop on the inside of the mouth and in the hair.
Pityriasis alba most commonly occurs in children with dark skin and involves white, slightly raised patches on the face.
The cause of pityriasis alba is not known, but it may be associated with eczema.
Young boy with albinism, next to young girl with normal skin pigmentation.
Vitiligo on the hands.
Pityriasis alba on a child's face. Image credit: DermNet New Zealand.
Vitiligo on the feet.
Vitiligo on the skin around the eye, with poliosis causing white eyelashes and eyebrows.
Treatment for hypopigmentation depends on the cause. Many people choose not to treat hypopigmentation if it is not causing any bothersome symptoms.
There is no cure for albinism. However, people with albinism are at a higher risk of developing skin cancer. They should be careful about sun exposure and always use sunscreen.
People with albinism also have an increased risk of vision problems, so they should try to wear sunglasses and a wide-brimmed hat when necessary.
In other cases, treatment may not be needed. For example, people who develop hypopigmentation due to an injury may find that their skin returns to its normal color over time without treatment.
Hypopigmentation due to pityriasis alba may also not require treatment. In many cases, the white patches go away on their own.
A person may choose to use a topical steroid cream that may help decrease skin discoloration. A moisturizing lotion may also be useful to reduce dryness and itchiness that can occur with the condition.
Although there is no cure for vitiligo, certain treatments may help reduce white patches on the skin.
According to the American Academy of Dermatology, some topical corticosteroids and light therapy may be helpful.
Applying corticosteroids to the skin may help add color, but they can have side effects and may cause the skin to become dry and fragile.
Vitiligo may also be treated with a laser, which is used on the skin two to three times a week for several weeks. In some people, these results are only temporary, and the white patches return over time.
A combined therapy using the medication psoralen and light therapy may also be used to treat hypopigmentation. The medication is applied to the skin or taken by mouth before light therapy is used on the affected area.
This treatment usually needs to be repeated two to three times a week for up to a year. Psoralen combined with light therapy tends to be more effective than light therapy alone.
The conditions associated with hypopigmentation, such as albinism and vitiligo, do not shorten lifespan. A person with albinism will need to take steps to protect their skin and eyes from sun damage, but they can lead an otherwise normal and healthy life.
Although hypopigmentation is not life-threatening, it can be life-altering and lead to emotional issues, such as low self-confidence and a lack of self-esteem.
Education, peer support, and learning about treatment options can decrease social and emotional concerns and improve overall outcome.