Thursday, December 30

Reddened skin - Causes of reddened skin

› › Reddened skin - Causes
Reddened skin can be due to thin epidermal layer and lack of pigment as in the case of lips or can be due to conditions like Hemangioma.

Why the skin on the lips is reddened?

Lips appeared reddened because there are plenty of blood vessels in the area. Further the skin of the lip is very thin and made of three to five cellular layers whereas it is several layers in other areas. Due to thinness of epidermis in lips the deeper blood vessels give reddened appearance. Further lips have lesser melanin pigment cells.

Hemangioma

In infants in the first weeks of life, in some instances, endothelial cells involute to form benign growths (swellings or tumors). These benign tumors of infancy are called hemangioma and they usually resolve by the age of ten years.

Hemangiomas have blood supply through circulatory system and when they are on the surface of the skin they appear as reddened ripe strawberry. Hemangiomas are more common in Caucasians and almost ten percent of the population have them. Further the incidence is three to four times more in female babies when compared to male babies.

The real cause of hemangioma is not known and it is presumed that increased levels of circulating estrogen after childbirth may be the stimulus. Mostly hemangiomas are uncomplicated and resolve by adolescence. However they may have a psychological impact on the sufferer, especially when they form on the face.

Rosacea and reddened skin

Rosacea is usually chronic and is characterised by reddened erythema of the face. Rosacea is a harmless cosmetic concern and to some extent can be treated with anti-inflammatory medicines. Like hemangioma, rosacea is also affects more women than men.

Rosacea is more common in fair people, especially Caucasians of North and Western European descent. The usual onset period of rosacea is between thirty to sixty years of age. Rosacea forming on the face spreads to forehead, nose and cheeks.

Rosacea can also affect to a lesser extent scalp, ears and chest. Certain conditions like extremes of temperatures, intake of spicy foods and some skin lotions can be triggers and avoiding these triggers and use of sunscreen and anti-inflammatory applications can alleviate the disorder.

Nevus flammeus

Port-wine stain (nevus flammeus) is a birthmark due to superficial and deeper capillaries getting dilated. Nevus flammeus produces reddened skin discoloration resembling port wine and hence called port-wine stain. Nevus flammeus is present at birth and usually persists throughout the life of the affected person.

Nevus flammeus are caused by the absence or deficiency of nerve supply in the affected regions causing the blood vessels to dilate and allowing blood to collect in the affected region. Nevus flammeus, over a period of time, become thickened and develop ridges and bumps and last for the life. Port-wine stains appear equally on men and women and about 0.3% of the population may be affected by them.

elangiectatic nevus

Telangiectatic nevus, also called as stork bite, salmon patch or angel's kiss, is birthmark having irregular shapes with pink or reddened coloration. This is a highly prevalent birthmark appearing on the forehead, eyelids, knees, on lips or back of neck. In telangiectatic nevus, the epidermis is not thickened and feels level with rest of the epidermis. Stork bite is due to dilation of blood vessels and resolves by itself as the child grows.

Acute urticaria and reddened skin

Hives or urticaria is a type of raised, itchy rash caused usually by allergic reactions.Urticaria may also be caused by viral infection, excess sunlight, extreme temperature, pressure or friction.

In many instances, urticaria is idiopathic and the reasons are unknown. Urticaria due to allergy usually resolves by about six months and idiopathic urticaria many become chronic.

Palmar erythema and reddened skin

Reddened palms, especially at hypothenar and thenar eminences is called Palmar erythema. Many diseases and disorders are associated with this condition and notable among them are high blood pressure, liver diseases, thyrotoxicosis, rheumatoid arthritis, eczema and psoriasis.


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Wednesday, December 15

Yellow skin discoloration - Causes of yellow skin color

› › Skin discoloration - Yellow skin color
There are many causes for yellow skin color and discoloration and the condition has to be evaluated immediately as some are harmless changes, whereas some are due to serious disorders which can be life threatening, requiring immediate treatment.

Causes of yellow skin color

Certain pigments in the food like carotene get deposited in the epidermal layers when in excess and their presence causes yellow skin color change which is harmless. However, certain disorders of the body systems can interfere with the metabolism of carotene.

These disorders induce carotene deposition and discoloration even though serum levels of carotene are normal, requiring investigation. The excretion of certain medicines through epidermal layers shows up as yellow skin color. The buildup of bilirubin in the blood and the onset of jaundice is due to many diseases and disorders leading to yellow coloration.

Jaundice caused yellow skin discoloration

Jaundice (aka icterus) is yellow pigmentation of the dermal and epidermal layers, sclerae (white of eyes) and mucous membranes. The increased levels of bilirubin in blood plasma (1.5 mg/dL), also known as hyperbilirubinemia, causes jaundice. Hyperbilirubinemia can be due to various factors and categorized into pre-hepatic, hepatocellular and post-hepatic types.

Any of the causes of increased rate of breakdown of red blood cells (hemolysis) leads to pre-hepatic jaundice. Tropical diseases like malaria, genetic diseases like thalassemia, organ disorders like hemolytic uremic syndrome affecting kidney, bilirubin metabolism disorders and high fevers as in leptospirosis (rat fever) causes jaundice and dermal color change.

In hepatocellular jaundice there is usually cholestasis (bile not flowing to duodenum) and the causes are hepatitis of any origin, liver toxicity, genetic disorders like Gilbert's syndrome, alcoholic liver disease and Crigler-Najjar syndrome. Post-hepatic jaundice is usually due to interruption to the flow of bile inside liver as well as to duodenum.

The causes can be gallstones in the bile duct, cancer of pancreas, obstruction by liver flukes, biliary atresia (passage closed or absent), ductal carcinoma (tumor in the duct), pancreatitis (inflammation of the pancreas) and pancreatic pseudocysts (circumscribed collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue). Jaundice discoloration conditions require a combination of liver function tests to arrive at the exact causes and diagnosis.

Newborn and yellow skin color

Mild jaundice is observed in many newborns and this neonatal jaundice is usually harmless. This condition may be seen from second day to eighth day in normal birth and for about two weeks in premature births. It is presumed that apart from higher turnover of red blood cells, physiological and metabolic adjustments after birth, causes this increase in serum bilirubin in newborn.

This increased levels of bilirubin gets lowered with regular urination and bowel movement; hence regular and proper feeding of the baby are very important. However in a few rare cases, neonatal hyperbilirubinemia causes kernicterus, a brain-damaging condition, resulting in lifelong disability.

To avoid this risk it is better to treat the neonatal jaundice by exposing the baby to intense photo-therapy. Inadequate feed, infections, internal bleeding or liver disorder or malfunction or incompatible Rh blood factors of mother and child can also lead to skin discoloration requiring proper treatment.

Primary carotenoderma

Ingesting food containing high levels of carotenoids leads increased serum levels of carotene and its deposit in the skin. Carotenoids are deposited in the intercellular lipid containing spaces in stratum corneum.

Thick epidermal layers and regions of increased sweating like nasolabial folds, palms, knees and soles bear increased deposits and show greater color change. Carotenoderma differs from yellow color due to bilirubin in not showing coloration of white of eyes. Primary carotenoderma yellow color usually disappears after the reduction in intake of carotenoids.

Secondary carotenoderma

Usually a underlying disease condition causes increase in serum levels of carotene and secondary carotenoderma discoloration, though the carotene intake is normal. Kidney malfunction or dysfunction is usually associated with decreased excretion of carotenoids and hypercarotenemia and color change.

Impaired conversion of carotenoids to retinol is seen in diabetes mellitus and hypothyroidism. The associated increase in serum lipids as seen in diabetes mellitus, nephrotic syndrome and hypothyroidism causes yellow skin color and secondary carotenoderma. In Anorexia nervosa, a self-imposed starvation, diets may be rich in carotene. Liver disease also leads to yellow color change due to poor utilization and breakdown of carotene resulting in its increased serum levels.

Yellow skin color due to medicines

The use of certain medicines in the treatment of diseases causes yellow coloration. Tyrosine kinase inhibitors (TKIs) are used in the treatment of various cancers. Sunitinib (a TKI) used in the cancer therapy is associated with many adverse events and yellow color changes of the epidermal layers. Color changes start after a week of treatment and with the continuation of the treatment, color intensification has been noticed.

The sclerae and mucous membranes are spared of the color change and on the discontinuation of medicine resolves the coloration. Probably the excretion of the chemical via the epidermis causes this coloration. Another TKI, sorafenib also causes a diffuse yellow discoloration of the skin.

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Tuesday, December 7

Bluish discoloration of skin

› › Bluish skin discoloration
Bluish discoloration of skin can be due to cyanosis, Raynaud's Syndrome, methemoglobinemia, Mongolian spot or argyria. The skin color is determined by epidermal pigments and the colors of blood and pigments carried by the blood.
Oxygen saturated blood is bright red in color and oxygen depleted blood appears dark red. The optical properties of epidermal skin distort the color of the oxygen-depleted blood to appear bluish.

Bluish skin discoloration and cyanosis

Deoxygenated hemoglobin equal to 2.5 g/dL or greater in blood causes bluish coloration called cyanosis. Though the deoxygenated blood appears dark red, there are certain optical principles involved in its giving of different coloration. Tissues are low in oxygen in cyanosis and are filled up with dark red deoxygenated blood in place of oxygenated bright red blood.

Darker blood generates shift in optical effects leading to bluish skin discoloration. Cyanosis can be due to many health problems and notable among them are all types of blood circulatory problems, all types of ventilatory problems and extreme cold. Toxins such as cyanide interfere with oxygenation of blood and cause cyanosis.

In cyanosis two types of conditions are observed namely central and peripheral cyanosis. Circulatory or breathing problems cause reduced oxygenation of blood in the lungs and slowing down the oxygen circulation and the skin turns bluish. This is a serious situation can lead to lung or heart failure. In the peripheral cyanosis only the extremities become bluish due to inadequate blood oxygen supply. This can be corrected by increasing the oxygenated blood supply.

Raynaud's Phenomenon

Raynaud's Phenomenon is a vasospastic disorder in which blood vessels in fingers and toes spasm, leading to vasoconstriction. Raynaud's Phenomenon causes bluish color changes in the toes and fingers and their necrosis if unattended. Raynaud's Phenomenon occurs in sensitized persons as an exaggeration of vasomotor response to emotion or cold leading to bluish discoloration of skin.

In Raynaud's Phenomenon the sympathetic nervous system is hyperactivated affecting the peripheral blood vessels and their extreme vasoconstriction leading to tissue hypoxia. Recurrent attacks can cause tissue damage, ulceration, gangrene and necrosis. Shifting to a warm room and keeping fingers in warm water may relieve the symptoms and restore blood circulation. Persons prone to attacks of Raynaud's Phenomenon are advised to keep themselves warm and if necessary use vasodilatory drugs under the advice of physician.

Methemoglobinemia

Methemoglobinemia is a blood disorder wherein, methemoglobin, an oxidised form of hemoglobin is present in levels above normal condition. In methemoglobinemia, due to oxidative stress the oxygen carrying ferrous ion of hemoglobin molecule is oxidized to ferric state. This is results in conversion of hemoglobin to methemoglobin which does not bind oxygen. If the levels of methemoglobin are high in blood bluish chocolate-brown color is imparted to blood.

Methemoglobinemia impedes normal oxygen transport resulting in tissue hypoxia and bluish skin. Methemoglobinemia may be congenital with autosomal recessive inheritance pattern. Since congenital methemoglobinemia is recessive, there is a chance of inheritance in the offspring only if both the parents carry the gene. Patients with impaired production of NADH (the essential cofactor for diaphorase I) with the resultant pyruvate kinase deficiency have risk of getting methemoglobinemia and bluish skin.

Methemoglobinemia is acquired in people exposed to exogenous oxidizing drugs and chemicals. Antibiotics like dapsone, sulphonamides and trimethoprim can give rise to increased methemoglobin levels and methemoglobinemia. Certain local anaesthetics (prilocaine and articaine), chlorates, bromates, metoclopramide, nitrates and aniline dyes can also cause methemoglobinemia. Methemoglobinemia disorder can be treated with oxygen supplementation and administration of intravenous methylene blue 1% solution.

Mongolian spot

Mongolian spot is a congenital birthmark, which is flat, benign and harmless; it is sometimes mistaken as an injury or bruise during childbirth. Mongolian spot exclusively involves skin and is due to melanocytes (melanin producing cells) embedded deep in the dermis. Mongolian spot results from melanocytes entrapment in the dermis during their embryonic development.

Mongolian spot is usually a bluish skin and with irregular shape and wavy borders. Mongolian spot can appear as multiple skin discoloration spots usually on the shoulders, flanks, lower back and the buttocks. Mongolian spot is highly prevalent in East Asians, East Africans, Polynesians and Turkic people. As the child with Mongolian spot grows, the spot fades and disappears by puberty.

Argyria

Argyria is condition wherein irreversible bluish or bluish-grey skin discoloration is caused by exposure to silver dust, silver compound and elemental silver. Silver gets accumulated in the body and the dermis on chronic exposure. On exposure to sunlight these particles in the skin darken giving a dark discoloration. Generalized argyria occurs when silver containing compounds are ingested and the whole body gives bluish discoloration.

Localized argyria occurs due to continuous contact with silver and its compounds. Argyria is a harmless cosmetic problem which can be socially debilitating and mildly disfiguring. Though generally believed to be irreversible, avoidance of sun exposure and laser therapy appears to give good results.

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Sunday, December 5

Reddish skin discoloration

› › Reddish skin discoloration
Reddish skin discoloration (Erythema) is the result of increased blood flow (hyperemia) of the capillaries in the lower dermal layers.
Bruises, certain infections and injuries can give rise to purpura, a reddish coloration due to bleeding underneath the epidermis.

Erythema - reddish skin discoloration

Erythema is hyperaemia of the dermis, wherein there is increased blood flow in capillaries in the lower layers. Erythema usually has medical implications and occurs with any inflammation, injury or infection.

Erythema can be caused by dermatitis and rash, dermal and body infections, toxic insect bites, massage and friction, acne and acne medication, physical exercises, UV radiation and sunburn, radiation therapy, allergic reactions and hypersensitivity and dermabrasion. Dermatitis can result due to a wide varieties of conditions like fungal infections, eczema, psoriasis, parasitic infections, measles, Lyme disease, rubella, acne, meningitis, drug abuse, stress and anxiety.

The cause of erythema in 30-50% of incidences can be unclear and unknown. There is usually temperature elevation at the site of erythema due to engorgement of blood vessels with oxygenated blood. On finger pressure, erythema disappears whereas in purpura the reddish color persists. Fall in atmospheric pressure can also induce erythema.

Purpura and purple or reddish discoloration

Purpura is the appearance of purple or reddish color caused by bleeding underneath. Purpura does not blanch on applying finger pressure while erythema disappears. Purpura can result due to injuries and bruises, infections, cutaneous small-vessel vasculitis, foods, hereditary disorders and drug reactions. In bruise the capillaries and sometimes venules are damaged due to injury allowing blood to seep beneath the dermis and into surrounding interstitial tissues.

Disseminated intravascular coagulation is a pathological activation of blood clotting (coagulation) induced by certain infections. In typhus infection dull reddish rash appears on the middle of body and spreads. Meningitis caused by meningococcal bacteria may be accompanied by a characteristic rash. Inflammation of small blood vessels (cutaneous small-vessel vasculitis) is clinically characterized by purpura. Food-induced purpura may result from ingestion of food containing Escherichia coli, benzoates or tartrazine dye.

Allergic reactions to certain drugs can cause extensive purpura. Purpura can occur due to hereditary blood coagulation disorders as in the case of hemophilia or von Willebrand's disease. In most cases of purpura there is initially crimson coloration, which turns purple and then blue due to breakdown of blood cells.

Reddish skin coloration and carbon monoxide poisoning

Carbon monoxide is a poisonous gas formed by burning of carbon materials under low oxygen conditions when there is not sufficient oxygen to produce carbon dioxide. This gas may get produced in running car engine in a closed garage or by burning wood or operating stove in a small closed room. When this gas is inhaled in larger quantities carbon monoxide poisoning occurs which is highly visible on the victims as Reddish coloration.

Carbon monoxide is highly reactive with blood hemoglobin and forms carboxyhemoglobin. Carboxyhemoglobin at concentrations above 30% appears bright crimson and the color intensifies with increase in concentrations. Though at these concentrations it can be fatal, many survivors of lower exposure show apart from many debilitating effects show reddish coloration.

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Tuesday, November 30

Kinds of skin discoloration

› › › Pictures of skin discoloration

Patchy irregular skin discoloration can be caused by various reasons.

The skin discoloration pictures and their brief description gives us a clear idea about the conditions and the ways to tackle them.
Changes in melanin pigmentation, diet, pregnancy, inflammation, growth of foreign organisms, diseases, hypercarotenemia, hypervascularization, cyanosis, mineral overload, medicines and jaundice can cause these various hues of discoloration.

Skin discoloration can be different and versicolor like white, brown, dark, red, pink, black, blue, orangish, yellowish, bronze and slate colors.

Skin discoloration and hyperpigmentation in Addison disease

Addison's disease, which is a disorder of adrenal gland insufficiency, increased tanning can be noted.
The manifestation of Addison disease in the skin primarily by hyperpigmentation.

Sunburn

Sunburn is a burn to skin tissue due to over exposure to sun light. There is malady and pain with hot, red or reddish skin and associated fatigue and mild dizziness.

Tanning

Tanning is a process by which skin color is darkened due to exposure to ultraviolet rays.
Moderate exposure to sun light has benefits like enhancing the vitamin D production by the dermis.

Freckles

Freckles are often visible in people with fair complexion and are concentrated clusters of melanin deposits.
Freckles contrast from moles and lentigines in that there is no increase in the number of melanin producing cells.

Lentigo

Lentigo (plural lentigines) is a benign hyperplasia (proliferation of cells) of melanocytes.
Regardless of sun exposure lentigo is stable in color and differ from moles in its linear spread, whereas moles are multi-layer nests of melanocytes.

Acanthosis nigricans

Acanthosis nigricans is brown to black, velvety, poorly defined skin discoloration.
Acanthosis nigricans dark brown coloration is usually found in the body folds like groins, armpits, neck folds etc.

Scleroderma diabeticorum

Scleroderma diabeticorum is a rare disorder affecting people with type 2 diabetes.
Scleroderma diabeticorum causes thickening of epidermis on the upper back and the back of the neck with excess black or dark brown melanin deposits.

Albinism

(achromia) is a hypopigmentary disorder which is congenital.
Albinism results from defect in production of melanin pigment due to dysfunction of melanocytes (melanin producing cells) in the skin, hair and eyes.

Leucism

Leucism, white skin coloration, is a result of defects in neural crest pigment cell differentiation.
Unlike albinism wherein the melanocytes are very much present but they fail to produce melanin pigment only, here the discoloration is caused due to defect in the embryonic development and there is partial or complete absence of pigment cells.

Vitiligo

In , a chronic disorder, loss of pigment (depigmentation) occurs in patches leading aesthetic disfigurement of the affected individual.
These depigmentation patches occur usually on the extremities and around body orifices like umbilicus, mouth, genitalia, nostrils and eyes.

Tinea versicolor

is caused by yeasts (fungi) Malassezia globosa and .
The first signs of tinea versicolor infection are small spots of pale discoloration, usually lighter than the surrounding area, developing on the oily areas of the body, such as back, upper arms and shoulder giving rise to itching.
Nevus depigmentosus are harmless non-progressive hypopigmented stable localised patches.
Nevus depigmentosus patches result from localised abnormalities in the function of melanocytes which fail to produce pigments.

Mongolian spot

, also known as "Mongolian blue spot," is a benign, flat, congenital birthmark with wavy borders and irregular shape.
The blue discoloration is caused by melanocytes, melanin containing cells, that are deep under the skin.


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Monday, November 29

Black, dark discoloration of skin - Brown spots and patches

› › Black, dark brown skin discoloration spots and patches

Dark brown discoloration of skin and patches is due to hyperpigmentation.

Brown discoloration of skin and formation of pigmented patches in most of the cases is caused by excessive production of the melanin pigment.

Sun damage, diseases, inflammation, hormonal imbalances, injuries etc. can cause excess pigmentation leading to skin discoloration and the incidence of dark brown skin patches. People with dark skin tones as with Mediterranean, African or Asian origins are more prone for excess pigmentation.

Sun exposure

Sun exposure, which has ultraviolet A and ultraviolet B radiation, brings about color changes in two different ways. Initially the Ultraviolet A (UVA) radiation which is usually in the range of 320 to 400 nm., by oxidative stress, causes the release of melanin from the melanocytes and causes its oxidation by combining with oxygen leading to rapid darkening discoloration patches of melanin.

Secondly, melanogenesis, which is skin reaction to photo-damage from UV radiation (CPD-DNA damage or direct DNA damage), increases the production of melanin pigment. The tanning or darkening by melanogenesis is a delayed reaction and the brown patches become visible only about three days after exposure. Sunscreens, umbrellas and hats can go a long way in protection from sun damage.

Freckles, age or liver patches and lentigines

Freckles (aka ephelis) are brown discoloration often visible in people with fair complexion and are concentrated clusters of melanin deposits.
Though many people have freckles, their origin is genetic in nature and freckles are triggered by exposure to sun.

Freckles contrast from moles and lentigines in that there is no increase in the number of melanin producing cells. Lentigo (plural lentigines) is a benign hyperplasia (proliferation of cells) of melanocytes. Regardless of sun exposure lentigo is stable in color and differ from moles in its linear spread, whereas moles are multilayer nests of melanocytes.

Liver patches are associated with aging and are blemishes on the skin associated with exposure to UV radiation from the sun. These dark brown liver patches particularly form on the face, hands, neck, shoulders and head. Freckles, lentigines and liver patches are benign and harmless and if required can be treated with skin whitening treatments

Melasma - brown patches

Chloasma or melasma are dark hyperpigmentation patches particularly common in women. Melasma are irregular dark, brown patches of excess pigment found on the nose, upper cheek, lips and forehead causing cosmetic discoloration. Melasma is usually prevalent in pregnant women (mask of pregnancy), women using contraceptives or women under HRT (hormone replacement therapy) medications.

Melasma patches also prevalent in men and women of Jewish descent, Russian descent, German descent and Native American descent. Genetic predisposition, thyroid diseases and female hormones (estrogen and progesterone) are the determining factors of developing melasma.

Melanocytic nevus (mole) skin discoloration

Melanocytic nevus is a common dark brown growth of the epidermis which are known as birth mark. Melanocytic nevus may form subdermal under the skin or form a pigmented growth on the dermis. Melanocytic nevi present at the time of birth or around the time of birth are called congenital nevi.

Melanocytic nevi may also appear in the childhood or later stages of life and their discoloration may range fromlight to very dark brown. Though in most of the cases Melanocytic nevi are harmless, any mole which changes color, shape, size or hurts may have to be investigated as some can turn into melanoma (a type of skin cancer).

Addison's disease

Addison's disease, a chronic adrenal insufficiency disease, is a rare endocrine disorder wherein adrenal glands malfunction or show functional insufficiency. Apart from the symptoms like weight loss, weakness, nausea, fever, diarrhea, muscle pains and headache, the Addison's disease affected person suffers from dark brown skin discoloration patches. It can give rise to brown freckles on the face, neck and shoulders and also dark brown skin discoloration patches on the knees, elbows, toes, knuckles and forehead.

Alkaptonuria

Alkaptonuria or dark urine disease is a rare inherited disorder leading to degradation of tyrosine and production and accumulation of homogentisic acid. Alkaptonuria causes damage to cartilage and heart valves and precipitates formation of kidney stones. Alkaptonuria disorder leads to dark brown patches of skin in sun exposed areas and around sweat glands.

Acanthosis nigricans is brown to dark, velvety, poorly defined skin discoloration. Acanthosis nigricans dark brown skin discoloration patches usually found in the body folds like groins, armpits, neck folds etc. Acanthosis nigricans, typically occurs in persons below 40 years and it is associated with obesity, hormonal anamallies and insulin resistance. Control of blood sugar and obesity improves the symptoms.

Scleroderma diabeticorum and dark brown patches

Scleroderma diabeticorum is a rare disorder affecting people with type 2 diabetes. Scleroderma diabeticorum causes thickening of epidermis on the upper back and the back of the neck with excess of dark brown patches melanin deposits. Scleroderma diabeticorum can be treated by bringing blood sugar under control and using moisturizers for softening the epidermis.

Dark, brown skin discoloration between thighs and in armpits

In some persons, especially in obese persons, the skin between the thighs and also in the armpits gets dark brown discoloration patches due excess melanocyte deposit as a result of excessive sweating and dead cells build-up leading to dermatitis and related fungal infections. Use of antifungal preparations followed by exfoliation and dermabrasion, if necessary, can remove the excess skin pigmentation and the dark brown patches to a great extent.


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Saturday, November 27

White discoloration on skin - Pale skin discoloration

› › White skin discoloration
White or pale discoloration on skin occurs due to hypopigmentation (diminished pigmentation). The epidermis layer of skin has melanin pigment which gives different hues ranging right from white to dark black.
The amount of melanin to be produced by the skin and the color of a person are decided by the genetic factors.

There are also conditions wherein white hypopigmentation occurs due to some other factors like lack of vitamins, congenital conditions, autoimmune diseases, injuries, infections etc.

White discoloration on skin due to albinism

Albinism (achromia) is a hypopigmentary disorder which is congenital. Albinism results from defect in production of melanin pigment due to dysfunction of melanocytes (melanin producing cells) in the skin, hair and eyes. Albinism can be complete or partial leading to degrees of absence of melanin pigment in the hair, epidermis and eyes.

Two main clinical phenotype categories of albinism are ocular albinism and oculocutaneous albinism which are further categorized into subtypes based on specific genetic mutations. This genetic white color occurs due to mutations to the tyrosinase gene and several different types of mutations can occur. Certain mutations can lead to completely inactive tyrosine enzyme production resulting in total albinism.

In some mutations tyrosine enzyme may have reduced activity (leaky mutations) and partial albinism may result. Mutations to P protein gene and human gene coding for TRP-1 also produce varying degrees of albinism.

Leucism

This type of white discoloration on the skin is a result of defects in neural crest pigment cell differentiation. Unlike albinism wherein the melanocytes are very much present but they fail to produce melanin pigment only, here the discoloration is caused due to defect in the embryonic development. There is partial or complete absence of pigment cells.

In partial absence of skin pigment cells 'piebald' effect is seen with varying degree of pigment absence leading to spotted pigmentation. Another difference between albinism and leucism is that albinos lack skin pigment in both iris and the retinal pigmented epithelium (RPE) leading to red color of the internal blood vessels showing up as red eyes.

However the formation of iris and the retinal pigmented epithelium is by the outpouching of the neural tube during development and is not affected by the neural crest aberration. Hence the eye color is not affected and has normal pigmentation in leucism.

White discoloration on skin due to vitiligo

In this chronic disorder loss of pigment (depigmentation) occurs in patches leading aesthetic disfigurement of the affected individual. Though the very exact cause of this white hypopigmentation - hypomelanosis is not known, most of the researchers agree that autoimmunity, neural, oxidative stress, genetic or viral causes precipitate the death and destruction of melanocytes.

These depigmentation patches affecting the normal human skin color, occur usually on the extremities and around body orifices like umbilicus, mouth, genitalia, nostrils and eyes.There are different types of vitiligo and now various treatments are available for eradication or camouflage of the white patches.

Leprosy and white discoloration on skin

Leprosy or Hansen's disease (HD), which is now on the verge of eradication from the world population, is a chronic disease caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis. Dermal lesions are the initial external signs, characterized by one or more hypopigmented macules or patches.

These white patches are anaesthetic in nature where sensations are lost. This is due to damage caused by human immune cells on the peripheral nerves. Leprosy can be cured completely and if detected early damages to nerves, dermis, eyes and limbs can be prevented.

White discoloration on skin due to tinea versicolor

Tinea versicolor is caused by yeasts (fungi) Malassezia globosa and Malassezia furfur. Tinea versicolor, though a common microbe living on the skin, sometimes over grows in some people and the exact reason is not clear. However, tinea versicolor is found to affect people with oily epidermis and in tropical and humid climates.

The first signs of tinea versicolor infection are small hypopigmented spots, usually lighter than the surrounding area, developing on the oily areas of the body, such as back, upper arms and shoulder giving rise to itching. The white coloration caused by tinea versicolor can be effectively treated and cured with anti-fungal lotions.

Idiopathic guttate hypomelanosis

Idiopathic guttate hypomelanosis is a non-infectious common benign acquired disorder of the skin affecting women more frequently than men. Idiopathic guttate hypomelanosis white discoloration appears to affect the exposed areas of the body, more particularly forearms and legs, in late twenties.

Idiopathic guttate hypomelanosis appears as small drops-like spots of white discoloration, the exact cause of which is not clear. However, as they appear on the exposed parts of the body, exposure to sun may have some role on the melanocytes making them effete.

Nevus depigmentosus

Nevus depigmentosus are harmless non-progressive hypopigmented stable localized skin patches. Nevus depigmentosus patches result from localized abnormalities in the function of melanocytes which fail to produce pigments. Most of the nevus depigmentosus patches are usually present right from birth.

Pityriasis alba

Pityriasis alba is a common and highly prevalent facial condition occurring in children. Pityriasis alba appears as dry, fine-scaled, white patches especially on the face. Pityriasis alba is a non-contagious condition and resolves by itself after sometime. Use of moisturizers improves the scaly condition especially in winter.

Avitaminosis and white skin discoloration

The chronic lack of certain vitamins, especially vitamins of the B complex group in the diet can cause hypopigmentation.
This white skin hypopigmentation can be corrected by improving the quality of diet and taking vitamin supplements.
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Monday, November 22

Skin discoloration - Types of skin discoloration

› › Types of skin discoloration
Skin discoloration can indicate mild to severe medical conditions. Changes in skin color and patchy irregular types of discoloration can be caused due to various reasons.
Skin discoloration can be with different hues like white, dark, brown, red, pink, blue, yellow, orange, bronze and slate colors.

Changes in melanin pigmentation, hypervascularization, pregnancy, inflammation, diet, growth of foreign organisms, diseases, cyanosis, hypercarotenemia, mineral overload, medicines and jaundice can cause these various hues of coloration.

Skin coloration with white or pale spots and patches

White patches and lightening of epidermis occurs due to hypopigmentation, wherein the melanin pigmentation gets reduced. This situation can be due to self destruction of melanin producing cells (melanocytes) in diseases like vitiligo.

Certain infections like tinea versicolor can affect the melanocytes and white patches can appear. Conditions like nevus depigmentosus, idiopathic guttate hypomelanosis, fordyce spots can also give rise to harmless white spots and patches.

Skin discoloration with dark/brown spots and patches

Dark/brown type of spots are due to hyperpigmentation caused by excessive production and deposition of melanin pigment by melanocytes (pigment producing cells).
Prolonged sun exposure, hormonal imbalances, diabetes, melasma, pregnancy and old age may be some of the reasons for this condition.

Reddish type of discoloration

Reddening of the epidermis may be caused by infections, inflammation, rash, eczema, sunburn and dermatitis. Hypervascularization of the certain areas of the dermis also can cause reddening.

Blue type of skin coloration

The dermis becomes bluish when the blood is low in oxygen (cyanosis). This type of coloration can be observed in young children when the weather gets very cold. This is due to slowing down of circulation in the blood vessels in the dermis. In case of lung infections and impaired heart functions the oxygen level may go down resulting in blueness of epidermis.

Yellow type of skin

In case of jaundice, mucus membranes, eyes and epidermis become yellow due to the presence of bilirubin.
Bilirubin is the yellow pigment (a product of RBC breakdown) present in bile and when the bile is obstructed from reaching the gastrointestinal canal, it gets into circulation.

Bronze or slate-grey skin pigmentation

When there is iron overload or iron poisoning the epidermis may appear slate-grey or bronze in color. This type of coloration is a grave situation and necessary medical treatments must be given to avoid greater damages.

Orange skin coloration

When epidermis accumulates carotenoids, it appears yellowish orange in color. Carotenoderma occurs when fruits and vegetables containing carotene is consumed in excess. This is a harmless condition resolving by itself when the carotene consumption is brought down.



Current topic: Types of skin discolorations.
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Thursday, November 4

Permanent skin lightening - Lasting skin lightening

Permanent skin lightening → Olive oil for skin → Causes of oily skin
Permanent skin lightening can only be achieved by destruction of melanin-pigment producing melanocyte cells. Skin fairness and lightening is possible now as so much of research work is focused on getting permanent fair complexion.
However, most of the skin lightening and fairness methods are semi-permanent and fairer complexion lasts as long as you keep using the products or keep undergoing the maintenance treatments.
Once you stop the products or the treatment, you are back to square one, as genetically controlled melanin production takes over.
There are two aspects of skin pigmentation and one of them is hereditary factor which is a permanent program.
Genes have the permanent instructions about the amount of melanin our skin should produce leading to its darkening or lightening.
Another pigmentation process is by various biological reactions of the body to exogenous and endogenous factors.
Factors like sun exposure (tanning), chemical exposure (hypo and hyper-pigmentation), free radicals (melasma and dark spots), aging (freckles, liver spots or age spots) and idiopathic (with unknown reason) permanent skin lightening or darkening cause blemishes to appear on our skin spoiling the evenness in complexion.
Various homemade as well as chemical remedies are available to achieve fairness and lightening and protect skin from permanent damage due to prolonged neglect of the adverse conditions.
However continuous treatment, protection from sun exposure and sunscreen are essential for extending the skin lightening effects achieved.

Can homemade recipes give permanent skin lightening?

Many of the homemade skin lightening recipes no doubt improve fairness and make you look a few shades fairer.
Many traditional tips for fair complexion are effective with years of experience and experimentation behind them.
Many of the recipes are scientifically tested and are scientifically explainable.
However, if permanent skin lightening is claimed, we have to take with a pinch of salt.
Enhancing exfoliation and free-radical control are the two main actions of most of the remedies.
Skin growth is a continuous process and the outer dead epidermis is shed by desquamation.
This dead debris holds lots of melanin pigment and if it is removed by exfoliating ingredients the inner layers of epidermis show up with lightening in color.
Melanin pigment production itself is an oxidative process. When there is higher presence of free radicals, as during sun exposure, the melanin production is speeded up, which darkens the skin.
Most of the skin lightening ingredients have antioxidant properties.
Because of their antioxidant properties the oxidative processes in the skin are reduced, cutting down the pigment production.
Many ingredients like lemon juice, tomato juice, honey, vitamin C, vitamin A, vitamin E, oatmeal and yogurt show either antioxidant property or exfoliation property; many have both the properties.

Are results of skin lightening treatments permanent?

There are many chemicals available for fairness and lightening and except for one or two of them permanent results cannot be realized.
Hydroquinone, glutathione, arbutin, tretinoin, glycolic acid and kojic acid are some of them.
They show good results and are especially useful for treating acne scars, freckles, liver spots etc.
They are the main ingredients in most of the cosmetic products.
Many of these cosmetic procedures inhibit the production of the enzyme tryosinase, which in turn inhibits the production of melanin pigment.
After these treatments, maintenance application must be carried on to retain the skin lightening achieved.
However, monobenzone which should be used under the advice of a doctor gives permanent lightening.

Monobenzone in permanent skin lightening (only for vitiligo)

Monobenzone (C13H12O2) is the monobenzyl ether of hydroquinone which is a tasteless, white crystalline powder and goes by the popular brand name Benoquin (20% monobenzone).
Monobenzone has been in use for permanent skin lightening in treatment of vitiligo (an autoimmune disease wherein the body's own immune system kills the melanocytes).
The exact way monobenzone works in still not clear and in some cases its action may not be predictable.
Monobenzone appears to cause permanent destruction of melanocytes and give depigmentation.
When monobenzone treated skin is studied under microscope it shows, very similar to vitiligo affected one, being devoid of melanocytes.
Monobenzone is a potent depigmenting agent and is medically contraindicated in all conditions except in extensive disseminated vitiligo (leukoderma) wherein more than 50% area suffered pigment loss.
Monobenzone, being called monobenzyl ether of hydroquinone, should not be taken as a substitute to hydroquinone as both the drugs have fundamentally different ways of actions in depigmenting.
NEVER repeat NEVER use monobenzone as fairness cream or to remove scars and age spots as the application will have irreversible permanent devastating effects on the system.

Side effects in monobenzone permanent skin lightening

Normal areas, which are distant from areas of application, may get depigmented (satellite depigmentation) in a irregular manner and the depigmentation may be permanent.
In some persons monobenzone has been found to cause dermatitis and burning sensation.
In some cases vesicular dermatitis was seen only on the normal pigmented skin.
In some cases monobenzone was found to cause acquired conjunctival melanosis.
Family members coming into contact with treated area of skin soon after monozone application have the risk of getting their normal skin depigmented.
The treated area acquires permanent reddish pink color similar to albinism and becomes photo-sensitive.
In some persons, follicular melanocytes may survive and produce resistant pigment spots

Precautions in monobenzone permanent skin lightening

Monobenzone cream is only for external use and it should be kept out of reach of children.
A physician or Poison Control Center must be immediately contacted in case of accidental application or ingestion.
Great caution must be taken when used on pregnant women and nursing mothers as its effects on fetus and newborn is not known.
Long term studies on permanent impairment of fertility, mutagenesis and carcinogenesis are yet to be concluded.
Its safety in young children is yet to be established.
Prolonged sun-exposure of areas of skin treated with monobenzone can get sunburnt and sufficient protective precaution with sunscreen must be taken

Related topics on permanent skin lightening:
Glutathione for bleaching and fairness
pros and cons of bleeching
Discoloration and hyper-pigmentation problems
Treatments and methods
Homemade tips
Permanent skin lightening (current topic)
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