When the human body is exposed to an injury or accident, the skin begins a natural healing process to repair itself, quickly forming a new skin to protect the body against germs and bacteria, and by doing so often results to a scar. As the body’s natural way of responding to inflammation, most scars are red in color initially but as the healing process continues, the tissues sometimes turns to white which is known as hypopigmentation.
Changes in one’s skin color can be concerning from either a medical or cosmetic point of view, or both. The human skin obtains its coloration from biological pigments called melanin. Once the production of melanin becomes significantly high, it results to a pigmentation disorder called melanism. On the other hand, small amounts or no melanin at all causes the skin to become lighter, which is called hypopigmentation.
In simple terms, Hypopigmentation in the skin is as a result of a decrease in melanin production.
What Causes Hypopigmentation?
There are two vital components to the production of melanin: melanocytes and tyrosine.
The melanocyte cells are responsible for the production of melanin. Skin damages caused by injuries can harm the skin cells, and if these injuries go deep enough it damages the melanocyte cells which causes them not to function properly, and in turn reduces the amount of melanin produced. This results in a lighter patch of skin or white skin.
The degree of hypopigmentation varies from partial hypopigmentation as in case of skin injury to complete hypopigmentation as seen in vitiligo. It is usually a temporary sign of some disease process except in situations like albinism.
Common causes for hypopigmentation of the skin are:
- Pityriasis alba
Some conditions of hypopigmentation resolve when the underlying cause is identified and treated accordingly while there is no cure for conditions like the albinism as it is a genetic condition.
Another common sign of hypopigmentation is vitiligo. This is a chronic dermatologic disorder that occurs when the cells responsible for skin pigmentation called “melanocytes” are destroyed which in turn causes de-pigmentation of patches of skin. These de-pigmented patches of skin vary differently in size and location from one person to another. Vitiligo are mostly common in areas the skin is exposed to the sun. Common affected areas include:
- Around the nose
- Around the eyes
- Around the mouth
- Armpits and groins
Statistics has shown that between 35 and 70 million people worldwide live with vitiligo.
Generally, signs of vitiligo begin to appear before the age of 20, but they can show up at any time.
Beneath the skin, vitiligo can be associated with a greater risk of certain medical issues like celiac diseases, Type 1 diabetes and rheumatoid arthritis.
Causes of Vitiligo
The exact cause of vitiligo is still unknown. Scientists and doctors have theories about causes of this disorder. The most common form being an autoimmune disease, which means that a person’s own immune system accidentally attacks the skin pigment cells also known as melanocytes. And as a result can no longer produce pigments in normal amount, which then causes the skin to turn white (de-pigmentation).
Heredity may also be a factor as there are increased incidents of vitiligo in some families. Some believe single events such as sunburn or emotional distress triggers this condition. However, none of these theories has been proved to be a definite cause of vitiligo.
Signs and Symptoms of Vitiligo
Vitiligo usually occurs in childhood or early adulthood. It looks white, flat and does not have scaly spots. It starts with a spot which is slightly paler than the rest of the skin, as time passes it becomes paler until it turns white. Usually in children, it occasionally comes in form of a segmental pattern.
The effects of the disease varies. Some may experience little white dots that develop no further, while others develop larger white patches joining together to affect larger areas of skin.
It is difficult to tell how fast or how slow the patches will spread, and by how much. The spread might take weeks, or might remain stable for months or years.
Usually, the signs first shows on body parts that are exposed to the sun, such as the hands, feet, arms, face and lips.
Some of its signs include:
- Whitening of the hair on your scalp, eyebrows or beard
- Patchy loss of skin color
However, it does not cause any irritation, soreness, dryness or discomfort in the skin.
Treatments for Vilitigo
A number of remedies can help decrease the visibility of vitiligo.
Phototherapy with UVB light
If the white spots are present across large areas of the body, UVB phototherapy may be used. It involves full-body treatment and should be done in a hospital.
Combination of UVB phototherapy with other treatments can result to a positive effect on vitiligo. However, it should be clear the results are not totally predictable, and there is still no treatment that will fully re-pigment the skin.
A person with mild vitiligo can easily camouflage some of the white patches with colored, cosmetic creams and makeup. It is imperative that they select tones that best match their skin features.
Phototherapy with UVA light
Another form of treatment is UVA phototherapy. The patient will need to take a drug that increases the skin’s sensitivity to UV light. After which he follows series of treatments, with the affected areas exposed to high doses of UVA light.
Depigmentation is achieved by applying topicals such as mequinol, hydroquinone or monobenzone. This reduces the color of the skin in unaffected parts to match the whiter areas.
Long exposure to the sun must be avoided as this type of treatment can make the skin even more fragile. Depigmentation can last as much 12 to 14 months, depending on factors such as the depth of the original skin tone.
There are several other ways to treat vitiligo and they include:
- Skin grafts
- Topical corticosteroids
- Using sunscreen
Re-pigmentation may take weeks, months or years, plus the results are usually partial rather than complete. After successful treatment, there is a chance the vitiligo may return in the future.
Other Causes of Hypopigmentation
The waardenburg syndrome disease was named after Petrus Johannes Waardenburg, a Dutch ophthalmologist. It is an uncommon genetic condition with different symptoms but generally involves hearing loss, characteristic facial abnormalities and changes in skin, hair and eye pigmentation.
This type of disease is caused by error in gene or sometimes in the much larger groups of genes called chromosomes.
A rare genetic disorder characterized by patches of lack of pigmentation that involves the skin and the hair.
Tuberous sclerosis is a hereditary disorder with presence of benign, tumor-like nodules of the brain or mental retardation.