So often when looking at skin damage or skin disorders, hyperpigmentation, dark spots, age spots, sun damage, and excessive melanin production is a main focus. Let’s look at the opposite of hyperpigmentation: hypopigmentation.
WHAT IS HYPOPIGMENTATION?
Hypopigmentation, or depigmentation of the skin, manifests as patches of skin that are lighter than the overall skin tone. Melanin is a chemical that the body produces to give skin its coloring. When the skin is not producing enough melanin, white patches form. Understanding what is causing this condition is important when determining treatment.
In most cases, the loss of melanin is partial, although some can experience a total loss of melanin. Hypopigmentation is typically caused by trauma to the skin. Genetic conditions, as well as severe environmental conditions, can cause a disruption in melanin production. Not all cases of hypopigmentation result from trauma, but most do. Anyone can be affected by this skin condition, though it is more common in darker complexions.
TRAUMA-INDUCED HYPOPIGMENTATION
Again, hypopigmentation is usually the result of some sort of trauma. Examples include acne, cuts, scrapes, lesions, infections (like chickenpox), burns, and blisters. Procedure related trauma could cause hypopigmentation. If chemical peels, cryotherapthy, microdermabrasion, dermabrasion, or laser treatments are administered incorrectly, they can cause trauma, resulting in white patches.
INFLAMMATORY DISEASE-RELATED HYPOPIGMENTATION
Inflammatory skin diseases can be a culprit of hypopigmentation. Seborrheic dermatitis is a skin disease where the skin is covered in red scaly patches. The skin tends to be oilier with this condition. Irritant contact dermatitis is when the skin is injured by friction, overexposure to water, environmental factors like cold, or chemicals such as detergents and solvents. It is typically confined to the area that was directly exposed to the irritant, but with prolonged exposure it can spread. Allergic contact dermatitis is just that, an allergic reaction. It is not commonly caused by an internal source, like food.
Atopic dermatitis is a form of eczema that causes dry, scaly rashes that can be uncomfortable and itchy. Chronic cases of atopic dermatitis can create changes in skin color.
Vitiligo is a disease where melanocytes are actually destroyed. The cause of vitiligo is unknown, making treatment of this condition difficult. Experts believe it is an autoimmune disorder, where the body’s immune system mistakenly attacks certain cells within the body. Most people develop the disease before the age of 40. It has a genetic component and has been linked to thyroid dysfunction. There is no known way to prevent or cure vitiligo.
Albinism is a disorder that is caused by an absence of the enzyme tyrosinase, which produces melanin. In place of this enzyme is a gene that inhibits the production of melanin. Due to the total lack of melanin, people with this disease are more prone to contract skin cancer. Albinism is inherited and genetic. In some people, melanin production can increase with age. Albinism not only affects the skin in a dramatic way but can also affect a person’s vision. One in 70 people are thought to carry this gene. Because this disease is genetic, there is no cure.
Pityriasis alba is a common skin condition in children. It can create ill-defined scaly patches. When these lesions subside, it leaves a hypopigmented area that will slowly return to normal. It commonly occurs on the face, most notably the cheeks.
Tinea versicolor is caused by yeast living on the skin. When this yeast (sometimes labeled as a fungal infection) gets out of control, it will cause tinea versicolor. It is very common in subtropical and tropical areas of the world. People who live in tropical areas may have this condition year round. The spots can be lighter than the surrounding skin and appear anywhere on the body. They are much more noticeable when a person is tan. They tend to disappear when the temperature drops and reappear in spring and summer, when the air is humid and hot. Some causes of the yeast overgrowth are excessive sweating, hot, humid air, oily skin, and a weakened immune system.
Other skin conditions that can cause hypopigmentation include leprosy, leucism, Angelman syndrome, and idiopathic guttate hypomelanosis.
REDUCING THE RISK
Unfortunately, there is no way to completely prevent hypopigmentation. But, through preventative measures, the risk can be reduced. Clients should be encouraged to take good care of their skin on a daily basis, by cleansing, exfoliating, and moisturizing. Bruises, cuts, and scrapes should always be treated with care. Leaving acne to heal properly will diminish the chance of any type of scarring. Emphasize that clients must not pick. An SPF of 30 or higher should be used daily. If there is a risk of genetic hypopigmentation, clients should seek proper treatment at first sight.
DIAGNOSING
While there are many types of hypopigmentation, recognizing it can be tricky. When doing a client consultation, ask detailed questions beyond the intake form. For example, when the client writes what they would like to improve about their skin, if light or white spots are bothersome, ask more questions. Do they sunbath regularly? When did the light patches first appear? Have they ever seen a doctor for this specific condition? And, what types of deep peels or laser treatments have they had in the past? Knowing more will help determine the best treatment options. If unsure, say so. Some forms of hypopigmentation are incurable; if you misdiagnose what a client may have, you could make it worse.
TREATMENT
Now, there are treatment options for some of the skin disorders that cause hypopigmentation. Corticosteroid creams are the first try at treating vitiligo. Since vitiligo is not well understood, the results can be unpredictable. It may or may not work, but under close supervision it can improve the condition. Skin lighteners have also been used to unify the lighter skin. If the client has this as a goal, using products with ingredients such as kojic acid, azelaic acid, or bearberry extract can be effective. Ultraviolet therapy and phototherapy are effective against vitiligo. It treats the depigmented areas with a narrowband UVB light. Laser treatments can cause hypopigmentation, but have cured it, as well. The type of laser treatment needed will depend on the cause. Antifungal creams can be effective against tinea versicolor. There have been suggestions that those experiencing hypopigmentation should discontinue the use of benzoyl peroxide and any type of strong cortisone.
Hypopigmentation is very common and widely accepted. Many clients learn to just live with it. There is beauty in all of us and our flaws make us unique. Still, understanding what hypopigmentation is, its causes, how to identify it, and methods for treatment and reducing the risk of developing it can all be instrumental in interacting with clients who may suffer from the condition.
Courtney La Marine has been a licensed aesthetician since 2006 and continues to grow and learn in the skin care industry every day. She is based in Denver, Colorado and owns Clove Studios. She has worked with many skin care and wax lines as head of education. Working with top resort spas and destination hotels has allowed her create a unique approach to how skin care is presented to clients. Not only does La Marine have a skin care studio in Denver, she also takes clients in Uvita, Costa Rica, and researches new ingredients for a fresh take on skin care. La Marine is a result-driven professional who loves what she does, creates unique treatments for each client, and wants to give clients the skin they deserve. Staying current with new trends, innovative ingredients, and the latest technologies are of the upmost importance to her.