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Vitiligo – NHS

Vitiligo is a long-term condition where pale white patches develop on the skin. It’s caused by the lack of melanin, which is the pigment in skin.

Vitiligo can affect any area of skin, but it commonly happens on the face, neck and hands, and in skin creases.

The pale areas of skin are more vulnerable to sunburn, so it’s important to take extra care when in the sun and use a sunscreen with a high sun protection factor (SPF).

Symptoms of vitiligo

The areas of skin most commonly affected by vitiligo include:

• mouth and eyes
• fingers and wrists
• armpits
• groin
• genitals
• inside your mouth

It can also sometimes develop where there are hair roots, such as on your scalp. The lack of melanin in your skin can turn the hair in the affected area white or grey.

Vitiligo often starts as a pale patch of skin that gradually turns completely white. The centre of a patch may be white, with paler skin around it. If there are blood vessels under the skin, the patch may be slightly pink, rather than white.

The edges of the patch may be smooth or irregular. They’re sometimes red and inflamed, or there’s brownish discolouration (hyperpigmentation).

Vitiligo does not cause discomfort to your skin, such as dryness, but the patches may occasionally be itchy.

The condition varies from person to person. Some people only get a few small, white patches, but others get bigger white patches that join up across large areas of their skin.

There’s no way of predicting how much skin will be affected. The white patches are usually permanent.

Types of vitiligo

There are 2 main types of vitiligo:

• non-segmental vitiligo
• segmental vitiligo

In rare cases, it’s possible for vitiligo to affect your whole body. This is known as universal or complete vitiligo.

Non-segmental vitiligo

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In non-segmental vitiligo (also called bilateral or generalised vitiligo), the symptoms often appear on both sides of your body as symmetrical white patches.

Symmetrical patches can appear on the:

• backs of your hands
• arms
• skin around body openings, such as the eyes
• knees
• elbows
• feet

Non-segmental vitiligo is the most common type of vitiligo, affecting around 9 in 10 people with the condition.

Segmental vitiligo

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In segmental vitiligo (also known as unilateral or localised vitiligo), the white patches only affect one area of your body.

Segmental vitiligo is less common than non-segmental vitiligo, although it’s more common in children. It usually starts earlier and affects 3 in 10 children with vitiligo.

What causes vitiligo?

Vitiligo is caused by the lack of a pigment called melanin in the skin. Melanin is produced by skin cells called melanocytes, and it gives your skin its colour.

In vitiligo, there are not enough working melanocytes to produce enough melanin in your skin. This causes white patches to develop on your skin or hair. It’s not clear exactly why the melanocytes disappear from the affected areas of skin.

Autoimmune conditions

Non-segmental vitiligo (the most common type) is thought to be an autoimmune condition.

In autoimmune conditions, the immune system does not work properly. Instead of attacking foreign cells, such as viruses, your immune system attacks your body’s healthy cells and tissue.

If you have non-segmental vitiligo, your immune system destroys the melanocyte skin cells that make melanin.

Vitiligo is also associated with other autoimmune conditions, such as hyperthyroidism (an overactive thyroid gland), but not everyone with vitiligo will develop these conditions.

Risk factors

You may be at increased risk of developing non-segmental vitiligo if:

• other members of your family have it
• there’s a family history of other autoimmune conditions – for example, if one of your parents has pernicious anaemia (an autoimmune condition that affects the stomach)
• you have another autoimmune condition
• you have melanoma (a type of skin cancer) or non-Hodgkin lymphoma (cancer of the lymphatic system)
• you have particular changes in your genes that are known to be linked to non-segmental vitiligo

Neurochemicals

Segmental vitiligo (the less common type) is thought to be caused by chemicals released from the nerve endings in your skin. These chemicals are poisonous to the melanocyte skin cells.

Triggers

It’s possible that vitiligo may be triggered by particular events, such as:

• stressful events, such as childbirth
• skin damage, such as severe sunburn or cuts (this is known as the Koebner response)
• exposure to certain chemicals – for example, at work

Vitiligo is not caused by an infection and you cannot catch it from someone else who has it.

Diagnosing vitiligo

A GP will be able to diagnose vitiligo after examining the affected areas of skin.

They may ask you if:

• there’s a history of vitiligo in your family
• there’s a history of other autoimmune conditions in your family
• you’ve injured the affected areas of skin – for example, whether you’ve had sunburn or a severe rash there
• you tan easily in the sun, or whether you burn
• any areas of skin have got better without treatment, or whether they’re getting worse
• you’ve tried any treatments already

A GP may also ask you about the impact vitiligo has on your life. For example, how much it affects your confidence and self-esteem, and whether it affects your job.

Wood’s lamp

If available, the GP may use an ultraviolet (UV) lamp called a Wood’s lamp to look at your skin in more detail. You’ll need to be in a dark room and the lamp will be held 10 to 13cm away from your skin.

The patches of vitiligo will be easier to see under UV light, which will help the GP distinguish vitiligo from other skin conditions, such as pityriasis versicolor (where there’s a loss of pigment due to a fungal infection).

Other autoimmune conditions

As non-segmental vitiligo is closely associated with other autoimmune conditions, you may be assessed to see whether you have any symptoms that could suggest an autoimmune condition, such as:

• being tired and lacking energy, which may be a sign of Addison’s disease
• being thirsty and needing to urinate often, which may be a sign of diabetes

A blood test may also be needed to check how well your thyroid gland is working.

Treating vitiligo

If vitiligo is severe or making you unhappy, you may want to consider treatment.

The white patches caused by vitiligo are usually permanent, although treatment options are available to reduce their appearance.

If the patches are relatively small, skin camouflage cream can be used to cover them up.

Steroid creams can also be used on the skin to restore some pigment, however long-term use can cause stretch marks and thinning of the skin

If steroid creams do not work, phototherapy (treatment with light) may be used.

Although treatment may help restore colour to your skin, the effect does not usually last. Treatment cannot stop the condition spreading.

Find out more about treating vitiligo.

Complications of vitiligo

Vitiligo can sometimes cause other problems.

Because of a lack of melanin, your skin will be more vulnerable to the effects of the sun. Make sure you use a strong sunscreen to avoid sunburn.

Vitiligo may also be associated with eye problems, such as inflammation of the iris, inflammation of the middle layer of the eye (uveitis), and a partial loss of hearing (hypoacusis).

Problems with confidence and self-esteem are common in people with vitiligo, particularly if it affects areas of skin that are frequently exposed.

Help and support

Support groups can provide help and advice and may be able to put you in contact with other people with vitiligo. A GP may suggest a group in your local area.

The charity The Vitiligo Society is also offers advice and support.

Page last reviewed: 05 November 2019
Next review due: 05 November 2022

Pigmentation in vitamin B12 deficiency masquerading Addison’s pigmentation: A rare presentation

Indian J Endocrinol Metab. 2013 Oct; 17(Suppl1): S254–S256.

Ritesh Kumar Agrawala

Department of Endocrinology, Sriram Chandra Bhanj Medical College and Hospital, Cuttack, Odisha, India

Srikanta Kumar Sahoo

Department of Endocrinology, Sriram Chandra Bhanj Medical College and Hospital, Cuttack, Odisha, India

Arun Kumar Choudhury

Department of Endocrinology, Sriram Chandra Bhanj Medical College and Hospital, Cuttack, Odisha, India

Binoy Kumar Mohanty

Department of Endocrinology, Sriram Chandra Bhanj Medical College and Hospital, Cuttack, Odisha, India

Anoj Kumar Baliarsinha

Department of Endocrinology, Sriram Chandra Bhanj Medical College and Hospital, Cuttack, Odisha, India

Department of Endocrinology, Sriram Chandra Bhanj Medical College and Hospital, Cuttack, Odisha, India

Corresponding Author: Dr. Ritesh Kumar Agrawala, Department of Endocrinology, Sriram Chandra Bhanj Medical College and Hospital, Cuttack – 753 001, Odisha, India. E-mail: moc.liamg@rgahsetirrdCopyright : © Indian Journal of Endocrinology and Metabolism

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC.

Abstract

A 35-year-female presented with generalized weakness, weight loss, and progressive pigmentation was worked up for suspicion of Addisons disease. On examination hyper pigmentation was noted on both palmar and dorsal aspect of hands involving knuckles, creases, feet, tongue, oral mucosa and gluteal region. There was no evidence of hypocortisolemia as initially suspected, and literature search revealed a possibility of vitamin B12 deficiency. She had megaloblastic anemia with a low serum vitamin B12, mostly due to poor dietary intake. Her hyper pigmentation resolved with vitamin B12 supplementation. Skin biopsy showed increased pigmentation at stratum spinosum and basal-layer. The mechanism of hyper pigmentation in vitamin B12 deficiency was due to an increase in melanin synthesis.

Keywords: Addisons disease, B12 deficiency, hyper pigmentation, vitamin B12 deficiency

INTRODUCTION

Aetiology of acquired hyper pigmentation are many. In some patients it gives a clue to the diagnosis of systemic disorders. Pigmentation in vitamin B12 deficiency that simulates the pigmentation of Addison’s disease is a rare initial presentation and early management can prevent various neurological complications. Herein, we report a rare case of hyper pigmentation due to vitamin B12 deficiency.

CASE REPORT

A 35-year-female presented with generalized weakness, weight loss and nausea along with progressive pigmentation involving both palmar and dorsal aspect of hands including knuckles, creases, feet, tongue, oral mucosa and gluteal region over a period of one year []. There was no history of fever, loose motion or steatorrhea, diabetes mellitus, tuberculosis, seizure disorder or any drug intake. She was unmarried, vegetarian, non-smoker, non-alcoholic and working in a hospital as a HIV counsellor.

Hyperpigmentation before treatment

On systemic examination the only significant finding was pallor. Haematological and other investigation were done []. Her Serum Cortisol level at 8 A.M and 4 P.M was 14.1 μg/dl and 7.01 μg/dl respectively (normal 5-25 μg/dl), which ruled out hypocortisolemia. At this point, a literature search revealed pigmentation in vitamin B12 deficiency can masquerade as addisonian pigmentation. Skin biopsy taken from left great toe showed “Increase pigmentation at stratum spinosum and basal layer” []. Upper gastrointestinal endoscopy was normal and anti parietal cell antibody was weakly positive. Her serum vitamin B12 level was 67 pg/ml (normal 180-900 pg/ml) indicative of severe vitamin B₁₂ deficiency. After treatment improvement in subjective symptoms noticed within two weeks and skin pigmentation completely normalised within twelve weeks [].

Table 1

Biochemical profile of the patient before and 12 weeks after treatment

Skin Biopsy (Increased pigmentation in stratum spinosum and basal layer)

Post treatment reversal of hyper pigmentation after 12 weeks of vitamin B12 supplementation

DISCUSSION

Vitamin B12 deficiency was first described by Cook in 1944 and later by Baker et al., in 1963. Currently, vitamin B12 deficiency was defined as a plasma concentration of <148 pmol/L (200 pg/ml) and marginal status defined as a concentration of 148-221 pmol/L.[1] The main source of vitamin B12 (cobalamin) in humans is the consumption of meat, poultry and dairy products. The Recommended Dietary Allowances (RDA) varies with age [].[2] Prevalence of B12 deficiency varies from 3% to 5% in the general population and 5% to 20% among people older than 65 years.[3] Inadequate intake and low consumption of animal-source foods with pernicious anemia (low intrinsic factor) in younger adults and food bound cobalamin malabsorption in part due to gastric atrophy in older persons are the main cause of low serum vitamin B12 and likely the main cause in poor populations worldwide. [1,2] In the present case the cause of vitamin B12 deficiency was decrease intake with low intrinsic factor. The common systemic features reported were fatigue, glossitis, weight loss and anorexia that was found in 34%, 31%, 27% and 22% of cases respectively.[4] Hyper pigmentation of skin has been reported only rarely as the presenting manifestation of vitamin B12 deficiency as found in this patient.[5] There are only two such Indian reports found in Indian literature.[6,7] After the treatment, hematologic response begins after several days and, moreover, the final hematologic landmark is the blood count, including mean corpuscular volume (MCV) that should be completely normal by the eighth week.[8] The cutaneous manifestation of vitamin B12 deficiency is skin hyper pigmentation, vitiligo, hair changes, and recurrent angular stomatitis. Hyper pigmentation of the extremities especially over the dorsum of the hands and feet, with accentuation over the inter-phalangeal joints and terminal phalanges associated with pigmentation of oral mucosa is characteristic of vitamin B12 deficiency. Aaron et al., reported that 12 out of 63 (19%) patients had glossitis (31%), which was the most common mucocutaneous manifestation, followed by skin hyper pigmentation (19%), hair changes (9%), angular stomatitis (8%), and vitiligo (3%).[4] However, the present case had hyper pigmentation only. As evidenced by James et al., histology from the hyper pigmented area showed irregular epidermal atrophy, absence of basal orientation of epidermal cells, patchy pigmentation of the lower epidermis, and numerous pigment-laden macrophages in the upper dermis and increase of melanin in the basal layer. It is suggested that deficiency of vitamin B12 causes decrease in intracellular reduction potential that leads to oxidation of the reduced glutathione and decrease in GSH/GSSG ratio. The epidermal melanocytes are then stimulated to produce melanin as the tyrosinase inhibiting effect of GSH has been diminished.[9] So, the predominant mechanism of hyper pigmentation in vitamin B12 is hypothesised as 1) Deficiency of vitminB12 decreases the level of reduced glutathione, which activate tyrosinase and thus leads to transfer to melanosomes. 2) Defect in the melanin transfer between melanocytes and keratinocytes, resulting in pigmentary incontinence.[10] We consider that in present case the dominant mechanism of hyper pigmentation is not a defect in melanin transport but is rather an increase in melanin synthesis.

Table 2

Recommended dietary allowances for vitamin B12/daily

This patient was treated with intramuscular injection of vitamin B12 (1000 mg) daily for ten days, then weekly for one month and then monthly for two months. Subsequently, the patient has been receiving a multivitamin tablet daily containing vitamin B12 (1 mg) and showed improvement in her presentation.[7]

CONCLUSION

Though a rare presentation, pigmentation due to vitamin B12 deficiency do mimic Addisons pigmentation. Vitamin B12 deficiency on the background history of vegetarian dietary intake should always be kept in mind after excluding Addisons disease.

Footnotes

Source of Support: Nil

Conflict of Interest: None declared

REFERENCES

1. Allen LH. How common is vitamin B-12 deficiency? Am J Clin Nutr. 2009;89:S693–6. [PubMed] [Google Scholar]2. Washington DC: National Academy Press; 1998. Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. [Google Scholar]3. Gupta A, Damji A, Uppaluri A. Vitamin B12 defiency. Prevalence among South Asians in Toronto clinic. Can Fam Physician. 2004;50:743–7. [PMC free article] [PubMed] [Google Scholar]4. Aaron S, Kumar S, Vijayan J, Jacob J, Alexzander M, Gnanamuthu C. Clinical and laboratory features and response to treatment in patients presenting with vitamin B12 deficiency-related neurological syndromes. Neurol India. 2005;53:55–8. [PubMed] [Google Scholar]5. Hoffman CF, Palmer DM, Papadopoulos D. Vitamin B12 deficiency: A case report of ongoing cutaneous hyperpigmentation. Cutis. 2003;71:127–30. [PubMed] [Google Scholar]6. Ahuja SR, Sharma RA. Reversible cutaneous hyperpigmentation in vitamin B12 deficiency. Indian Pediatr. 2003;40:170–1. [PubMed] [Google Scholar]7. Srivastava N, Chand S, Bansal M, Srivastava K, Singh S. Reversible hyperpigmentation as the first manifestation of dietary vitamin B 12 deficiency. Indian J Dermatol Venereol Leprol. 2006;72:389–90. [PubMed] [Google Scholar]9. Gilliam JN, Cox AJ. Epidermal changes in vitamin B12 deficiency. Arch Dermatol. 1973;107:231–6. [PubMed] [Google Scholar]10. Mori K, Ando I, Kukita A. Generalized hyperpigmentation of the skin due to vitamin B12 deficiency. J Dermatol. 2001;28:282–5. [PubMed] [Google Scholar]

Skin Discoloration – an overview

Skin

Pigmentation of the skin [43] and skin-related structures, such as the as nail beds [44], teeth [45], oral mucosa [46] sclerae [47], and conjunctival cysts [48], is a well-documented adverse effect of minocycline. The bones of the oral cavity are probably the most frequently affected sites of pigmentation. On the skin, the blue-black pigmentation develops most frequently on the shins, ankles, and arms. Other patterns include pigmentation that either is generalized and symmetrical or develops at sites of inflammation. The pigmentation is often permanent when sites other than the skin and oral mucosa are involved [49,50]. The pigment is a product of an oxidation reaction. In an experimental rat study, pigmentation of the thyroid gland was prevented by ascorbic acid [30]. Laser treatment was successfully used in two cases [51,52].

The incidence of skin discoloration from minocycline varies from 2.4% to almost 15% [53,54]. According to a well-accepted classification there are three distinct clinical pictures. Type I is blue-black pigmentation confined to sites of scarring or inflammation on the face. Type II is blue-grey circumscribed pigmentation of normal skin of the lower legs and forearms. Type III is diffuse muddy brown pigmentation of normal skin accentuated in sun-exposed areas. A fourth type has been described [55].

•

Two 22-year-old men with acne were given minocycline. The first took minocycline 100 mg/day for 1 month, estimated cumulative dose 3 g, 2 years before presentation). The second took minocycline in two different periods before presentation, estimated dose 13.5 g. Both had blue-grey pigmentation confined to acne scars on the back, whereas scars on the face and chest were unaffected, and there was no hyperpigmentation in other areas. Histology showed pigment within dendritic cells and extracellularly throughout the dermis. Histochemistry identified a calcium-containing melanin-like substance. Electron microscopy showed electron-dense granules, both free and membrane bound, within macrophages and some other cells in the dermis. Energy-dispersive X-ray analysis confirmed the presence of calcium. The patients were followed for 3 years and their pigmentation did not change.

Two patients developed minocycline-induced pigmentation of the soft tissue of the palate, confirmed by biopsy [56]. Minocycline-induced hyperpigmentation can even take place in scars [57] and, more rarely, in subcutaneous fat [58].

•

A 15-year-old girl with no significant past medical history developed bilateral leg discoloration. The lesions were not painful but were vaguely sensitive to pressure and touch. There was a faint bluish discoloration under the tongue, on the alveolar surface of the gums, and on the hard palate. She had taken minocycline twice daily for acne vulgaris for more than 1 year. A punch biopsy showed normal epidermis and dermis, but deep in the subcutaneous fat there were macrophages and multinuclear giant cells containing brown-greenish pigment in their cytoplasm. A Fontana-Masson stain showed that the pigment was melanin or a melanin-like substance. A Perls stain for iron was negative and a Von Kossa stain was negative for calcium. Minocycline was withdrawn, and after 5 years only subtle hyperpigmentation remained on her legs.

According to the authors, this was the first case of minocycline-induced pigmentation with pigment exclusively localized to subcutaneous fat.

Fixed drug eruptions are characterized by solitary or multiple, round or oval, erythematous patches of variable size; some of them develop into bullae or superficial erosions. Characteristically they appear in the same site each time the responsible drug is given, usually 30 minutes to 8 hours after administration, and with itching or burning as the first symptoms. Over a period of 1–2 weeks they fade, often with crusting and scaling, followed by hyperpigmentation, which can persist for months.

Antimicrobial drugs, especially co-trimoxazole, ampicillin, and tetracyclines, can cause fixed drug eruptions [59], and cases have been attributed to minocycline [60]. There is usually no cross-reactivity [61]. However, a case of fixed drug eruption has been reported after minocycline in a patient with a previous eruption due to doxycycline [62].

•

A 48-year-old man with urethritis took doxycycline 100 mg bd and developed a fixed drug eruption on the glans penis. Doxycycline was withdrawn and the eruption healed with symptomatic treatment. Eight months later he took minocycline 100 mg/day for rosacea. A few hours after having taken the first tablet he became aware of oval erythematous patches on the glans, prepuce, and scrotum. The patches rapidly became violaceous and developed into superficial erosions. He stopped taking minocycline and the lesions faded.

According to the authors, this was the first report of a fixed drug eruption after minocycline in a patient with a previous eruption due to doxycycline. They advised clinicians to be aware of this potential cross-reactivity when prescribing these two drugs.

A generalized pustular eruption was reported in a patient with acne treated with minocycline [63]. Skin prick tests with minocycline were positive at 48 hours.

Sweet’s syndrome is an acute febrile neutrophilic dermatosis marked by non-pruritic, painful, reddish nodules, most often on the head and neck, the chest, and/or the arms, accompanied by fever, arthralgias, and leukocytosis. Histopathology shows a diffuse dermal neutrophilic infiltration. The pathogenesis is not understood, but there is always prompt resolution of the symptoms and lesions with glucocorticoid therapy. Sweet’s syndrome due to minocycline was first reported in 1991 [64], since when several reports have appeared [65,66].

The authors of a systematic review concluded that granulocyte colony-stimulation factor (G-CSF), tretinoin (all-trans retinoic acid, ATRA), and vaccines met two of three criteria for an association with drug-induced Sweet’s syndrome [67]. There were sufficient data for an association with G-CSF and tretinoin and plausible pharmacological mechanisms. Vaccines met the qualitative criteria and also had a plausible pharmacological mechanism. For minocycline, however, the authors concluded that the evidence was of high quality, but the quantity of evidence was small and a plausible pharmacological mechanism was lacking.

Long-term minocycline often results in pigmentation of the skin, nails, bones [68], thyroid, mouth, and eyes; on the skin, the blue-black pigmentation develops most often on the shins, ankles, and arms [69]. In one 15-year-old girl bilateral discoloration on the legs was limited to the subcutaneous adipose tissues and completely spared the dermis; unusually for this form of hyperpigmentation, there was a negative stain for iron [58].

In a retrospective medical records review of 121 patients with rheumatoid arthritis who had taken at least one course of minocycline for 30 days or more, 44 (36%) developed hyperpigmentation, including 33 during the initial course over a median duration of 9 (range 2.2–78) months [70]. Hyperpigmentation was most commonly seen on the arms and legs and in the head and neck. Increasing age was the only significant susceptibility factor (HR = 1.04; 95% CI = 1.00, 1.07).

Hyperpigmentation in an 86-year-old woman taking warfarin was mistaken for bruising but was due to minocycline [71]. The affected areas showed blue-gray discoloration with fading borders in a symmetric distribution over both forearms and hands, more on the ventral than the dorsal surfaces. They were darker during the day and lighter at night.

The histology of minocycline pigmentation in the legs has been described in four cases with subcutaneous involvement [72]. There were brown/black pigment granules in macrophages clustered around vessels and eccrine coils in the reticular dermis. Similar pigmented macrophages were visible in fat septae and between lipocytes. There were macrophages laden with green-gray, flocculent, non-refractile globules in the subcutis in all cases, and two had lipid deposition associated with pigment.

Hyperpigmentation attributed to minocycline in a 23-year-old Hispanic man resolved after treatment with oral isotretinoin for acne vulgaris [73].

Vitiligo (for Teens) – Nemours KidsHealth

Fair, dark, or any shade in between — most of us have skin that is generally the same color all over our bodies. But this isn’t the case for people who have a condition called vitiligo.

What Is Vitiligo?

Vitiligo (pronounced: (vih-tih-LY-go) is a loss of skin pigment that causes white spots or patches to appear on the skin. No one knows exactly why this happens, but it affects people of all races, many of them kids and teens.

Because vitiligo affects a person’s appearance, it can be upsetting. But it isn’t medically dangerous. It’s not a form of skin cancer. It’s not an infection like MRSA. And it’s definitely not contagious, so you can’t catch it from someone else. In fact, most of the people who have vitiligo are every bit as healthy as everyone else.

What Happens?

To explain vitiligo, it helps to know a bit about how skin gets its color in the first place. Skin color is determined by cells called melanocytes. They produce a pigment called melanin, which gives skin its color and helps protect it from the sun.

Skin color is determined not by how many melanocytes someone has (we’re all born with a similar amount), but rather by how active the cells are. Dark-skinned people have cells that naturally produce a lot of melanin, while light-skinned people produce much less.

Sometimes, the skin suddenly stops making melanin. At first, this might cause a small spot, called a macule, that’s lighter in color than the skin around it. In time these white patches may spread and grow to cover a larger portion of the body. Sometimes these white patches spread quickly at first and then remain stable for years. Other times the spread is slower, occurring over a longer period of time.

Although vitiligo affects people of all races equally, the spots tend to be more noticeable on darker skin.

What Are the Types of Vitiligo?

There are three types of vitiligo, depending on how many patches someone has and where they are on the body:

• Focal vitiligo. A person has a few vitiligo spots in a single area.
• Generalized vitiligo. A person has many vitiligo patches all over the body and they tend to affect the right and left sides of the body in a symmetrical pattern, like a mirror image. This is the most common type of vitiligo.
• Segmental vitiligo. A person has vitiligo patches on one part or side of the body and usually nowhere else. This is the least common type of vitiligo.

Vitiligo can happen anywhere on the body, but it’s more likely to develop in some areas:

• skin that’s exposed to the sun, such as the face or hands
• skin that has folds, such as the elbows, knees, or groin
• skin around the eyes, nostrils, belly button, and genital areas

Because pigment cells give color to hair as well as skin, some teens with vitiligo may notice graying of the hair or a loss of color on the lips.

What Causes Vitiligo?

Experts don’t know exactly what causes vitiligo, but they do have theories. Some think it’s an autoimmune disorder, and that the immune system is mistakenly attacking healthy melanocytes. Others think it’s genetic.

Scientists do know that the risk of developing vitiligo increases in people with a family history of thyroid disease, diabetes, and certain conditions like alopecia (an autoimmune disease that causes hair loss).

How Is Vitiligo Diagnosed?

A dermatologist can usually tell if someone has vitiligo just by looking for the telltale white patches. On people with fair skin, a special tool called a Woods lamp might be used. This lamp uses ultraviolet light in a dark room to illuminate areas of damaged skin that would otherwise be hard to see with the naked eye.

Your doctor will ask about your medical history, and probably also ask you about:

• any skin conditions you or anyone in your family has had
• past immune problems you or anyone in your family has had
• any recent rashes or sunburns
• whether you’ve been ill or under stress recently

The doctor also may do a blood test to check for thyroid problems and diabetes, since they can increase the risk of vitiligo.

Very occasionally a doctor may do a biopsy — removing a small piece of the affected area to check whether there are pigment cells in the skin. (The word biopsy might make you think of cancer, but in this case doctors aren’t looking for cancer. People with vitiligo are at no greater risk of developing skin cancer than anyone else.) If the biopsy shows there are no pigment cells, this may confirm a case of vitiligo.

How Is Vitiligo Treated?

There is no “cure” for vitiligo. Sometimes patches go away on their own. But when that doesn’t happen, doctors can prescribe treatments that might help even out skin tone. Some of these treatments are things you can try at home; others are done by a doctor.

People and conditions are very different, so what works for one person may not work for another. And no vitiligo treatment is likely to be 100% effective at making the spots disappear altogether.

Home Care

Sunscreen. Use a good sunscreen every day. Because vitiligo spots have no melanin, they can’t tan. If the skin isn’t protected with sunscreen, vitiligo patches may burn or scar. Getting a tan on the rest of your body will only highlight the white patches, especially if you have light skin.

Cosmetics. Many different kinds of concealers are available, both over-the-counter and through a dermatologist. Ask your doctor for recommendations and try different brands until you find the one that works best for you.

Medical Treatment

Some of the more common medical treatments for vitiligo include:

• Corticosteroid creams. When applied to white patches very early in the disease, corticosteroids may help to bring some color back to the skin by decreasing the inflammationthat leads the skin to have fewer pigment cells. Don’t let the word “steroids” put you off. Corticosteroids are medications, not the type of anabolic steroids that athletes use.
• Photochemotherapy (also known as PUVA). PUVA therapy has two steps: first, a medication called psoralen is either applied to the white patches of skin or taken orally; then, the skin is exposed to ultraviolet light, sometimes from the sun but more often from an artificial source like a UVA lamp. This turns the affected skin pink, which in time tends to fade to a more natural (often slightly darker) color. You’ll want to ask your doc about side effects of PUVA treatment — including a possibility of severe sunburn and skin blistering.
• Narrow-band ultraviolet B (UVB) therapy. This treatment is more widely used than PUVA. It’s similar, except that the ultraviolet light used is UVB instead of UVA. UVB treatment doesn’t require psoralen, eliminating some of the risk associated with PUVA.

Researchers are looking into a procedure called a melanocyte transplant. It works by removing a sample of normally pigmented skin and using it to grow new melanocytes in the lab. These can then be transplanted back into the depigmented skin to return some of the missing color.

Living With Vitiligo

Vitiligo isn’t dangerous to your physical health. But it can still feel like a big deal if you’re concerned about your appearance.

It’s normal to feel like you want to cover up vitiligo, and you need to do what makes you most comfortable. But if you’re starting to turn down every pool party or beach invitation, it’s a signal to take back your life. If people ask about your skin, go ahead and explain — if you want to. It can help to know you’re not alone.

In the end, if people still don’t seem to get it, that’s their problem, not yours. If you’re feeling upset, get support from people you trust, whether that’s a family member, friend, teacher, counselor, or support group. There are plenty of people who love you just the way you are.

Skin Hyperpigmentation Index Facilitating Quantification of Hyperpigmentation in Clinical Practice – FullText – Dermatology 2021, Vol. 237, No. 3

Dear Editor

Hyperpigmentation is a darkening of the skin, mostly caused by increased production of melanin due to melanocyte activation or hemosiderin deposits in the skin [1, 2]. As pigmentary disorders in dermatology can be disfiguring for patients and affect their quality of life, a brightening therapy is often demanded [3]. In order to measure the efficacy of various treatment modalities, skin hyperpigmentation should be evaluated quantitatively [2, 3]. In addition, the hyperpigmentation of skin can also be a cutaneous manifestation of systemic diseases or conditions, which raises the need for a proper quantification of skin hyperpigmentation to monitor disease progression [1-3].

Although histopathological conclusions can be drawn about hyperpigmentation, there are only a few methods that allow clinical quantification of skin hyperpigmentation [4, 5]. Many methods fail due to the lack of standardized conditions such as different illumination, different distances, and use of different devices.

As a result, we recently presented an advanced digital image processing system called the “skin hyperpigmentation index” (SHI) for the automated quantification of skin hyperpigmentation. The SHI is a program with a deconvolution of color and an image histogram profiling of brown pixel intensities for the automated evaluation of quantitative skin pigmentation. It describes the ratio of two scores, namely the hyperpigmented skin of the affected area and normal sun-protected skin from the same patient (technical details were presented elsewhere) [2]. The SHI ranges from 1 (no hyperpigmentation) to 4 (maximum hyperpigmentation). We defined scores between 1 and 2 as light hyperpigmentation, 2–3 as medium hyperpigmentation, and scores between 3 and 4 as severe hyperpigmentation.

To ensure standardized presettings (same exposure and distance), the images should be taken with a dermoscope attachment for the camera (photo camera or smartphone). However, the use of standardized photos without a dermoscope attachment is possible, but results may be less accurate [2].

To facilitate this quantification, an online free SHI Calculator that is accessible to all practitioners is provided: https://shi.skinimageanalysis.com/.

For better illustration, we tested our method with two different cameras and dermoscope attachments on a 62-year-old patient with pigmented purpuric dermatosis (capillaritis) of both legs (Fig. 1a).

Fig. 1.

a Overview image of a 62-year-old patient with a pigmented purpuric dermatosis (capillaritis) of both legs. Encircled area shows the location of the dermoscope image of the darkest hyperpigmented area. A reference image of sun-protected skin was taken on the lower back (not shown here). b Dermoscope image of hyperpigmentation of the right ankle. The photo was taken with an iPhone 7 camera with a dermoscope attachment of DermLite DL1 for iPhone. A reference image was taken from a sun-protected spot on the lower back (not shown here). The calculated SHI was 1.61. c Dermoscope image of hyperpigmentation of the right foot. The photo was taken with a Nikon D810 digital camera with a DermLite 3 dermoscopy lens. A reference image was taken from a sun-protected spot on the lower back (not shown here). The calculated SHI was 1.73.

The image was recorded with a Smartphone iPhone 7 with a dermoscope attachment of DermLite DL1 for iPhone (Fig. 1b). The calculated SHI was 1.61. At the same location, photos were taken with a Nikon D810 digital camera with DermLite 3 dermoscopy lens (Fig. 1c). The calculated SHI was 1.73. Both results showed a slight hyperpigmentation in the examined pictures. The SHI was calculated on https://shi.skinimageanalysis.com/.

With the SHI we have developed a new fully automated method for the quantitative assessment of skin pigmentation, which can be easily used for any skin type with any type of hyperpigmentation with different devices (dermoscope attachments and camera) [2].

This allows an easy, fast, and standardized quantification of skin hyperpigmentation, which can be very useful as follow-up control and planning of a whitening therapy.

Key Message

The skin hyperpigmentation index facilitates quantification of hyperpigmentation in clinical practice.

Statement of Ethics

The patient mentioned in this paper gave written informed consent for the publication of their case (including the publication of images).

Conflict of Interest Statement

The authors declare no conflicts of interest.

Funding Sources

The authors declare no funding sources.

Author Contributions

All authors participated in analyzing the data. S.B. and S.M.S.J. wrote the paper. All authors read and approved the manuscript.

References

1. 
   Chang MW. Disorders of hyperpigmentation. In: Bolognia JL, Schaffer JV, Cerroni L, editors. Dermatology. 4th ed. Amsterdam: Elsevier; 2018. p. 1115–43.
   




2. 
   Bossart S, Cazzaniga S, Willenberg T, Ramelet AA, Baumgartner M, Hunger RE, et al. Skin hyperpigmentation index: a new practical method for unbiased automated quantification of skin hyperpigmentation. J Eur Acad Dermatol Venereol. 2020 Jul;34(7):e334–e336.
   




3. 
   Yadav A, Garg T, Mandal AK, Chander R. Quality of life in patients with acquired pigmentation: an observational study. J Cosmet Dermatol. 2018 Dec;17(6):1293–4.
   




4. 
   Becker F, Fourgeau P, Carpentier PH, Ouchène A. Quantification of early cutaneous manifestations of chronic venous insufficiency by automated analysis of photographic images: feasibility and technical considerations. Phlebology. 2018 Jun;33(5):309–14.
   




5. 
   Tiwary SK, Kumar PK, Dhameeja N, et al. Assessment and grading of pigmentation in chronic venous insufficiency. Phlebology. 2020 Jul;35(6):394–401.
   

Author Contacts

Simon Bossart

Department of Dermatology, Inselspital

Bern University Hospital

CH–3010 Bern (Switzerland)

[email protected]

Article / Publication Details

Received: May 28, 2020
Accepted: June 03, 2020
Published online: August 11, 2020

Issue release date: May 2021

Number of Print Pages: 3

Number of Figures: 1

Number of Tables: 0

ISSN: 1018-8665 (Print)
eISSN: 1421-9832 (Online)

For additional information: https://www.karger.com/DRM

Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.

Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.

Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Vitiligo: Illustrated guide to pigmentation disorder

Getty Images

Michael Jackson put vitiligo in the spotlight almost two decades ago when he acknowledged that he had the pigmentation disorder. Now vitiligo is back in the spotlight as a result of the manslaughter trial of the late entertainer’s doctor.

Want to know more about vitiligo – and see pictures of the disorder? Keep clicking…

What are the symptoms of vitiligo?

Wikimedia Commons

Vitiligo causes white patches on the skin. These are commonly found on parts of the body that get the most sun exposure, including thee hands, feet, arms, face, and lips. Other common sites include the underarms, groin, navel, genitals, rectum, nostrils, and around the eyes and mouth.

In addition to white patches, vitiligo can cause premature graying of the hair.

How common is vitiligo?

istockphoto

Vitiligo is believed to affect 0.5 percent to 1 percent of the world’s population, or up to 65 million people. That includes 1 million to 2 million people in the U.S. The disorder affects both genders and all races equally but is more noticeable in people with dark skin.

What causes the depigmentation?

American Academy of Dermatology

Vitiligo develops when skin cells called melanocytes die, according to the website of the American Academy of Dermatology. Melanocytes are what give color to skin and hair.

Do the patches spread?

Wikimedia Commons

It depends on the form of vitiligo. So-called “focal” vitiligo (patches on one or a few areas) and “segmented” vitiligo (patches on one side of the body) generally don’t spread. But “generalized” vitiligo – often does spread. Sometimes the patches spread slowly, sometimes fast. There’s some evidence that physical and emotional stress can contribute to the spread.

Is the condition hereditary?

American Academy of Dermatology

Vitiligo can run in families. About 30 percent of people with vitiligo have a family member who is also affected, although most people don’t get the disorder even if a parent has it.

But heredity isn’t the only factor. Vitiligo seems to be linked to certain autoimmune disease, including an overactive thyroid gland (hyperthyroidism) and a condition known as adrenocortical insufficiency, in which the adrenal glands don’t produce enough of the hormone known as corticosteroid.

How is vitiligo diagnosed?

Wikimedia Commons

Doctors diagnose vitiligo on the basis of a physical exam and a medical history. To confirm the diagnosis, the doctor might biopsy the affected skin. And he/she might also order blood tests to check for anemia and other conditions that are sometimes associated with vitiligo.

How is vitiligo treated?

American Academy of Dermatology

Vitiligo is hard to treat. But cosmetics can help, and there are a number of treatments that can minimize, camouflage, or even eliminate the white patches. These include steroid creams and a treatment known as photochemotherapy, in which drugs and ultraviolet light are used in combination. People who have vitiligo on more than 50 percent of their bodies may benefit from depigmentation, in which patients apply a drug that fades the skin to match the depigmented areas. Other treatments include skin grafts and tattooing the depigmented skin to make it darker.

What else can people to do manage vitiligo?

Wikimedia Commons

The American Academy of Dermatology recommends limiting exposure to the sun, using sunscreen every day and wearing sun-protective clothing. Tanning beds should be avoided. So should tattoos. The skin damage a tattoo causes can lead to a new patch of vitiligo. Support groups can be helpful. These include the American Vitiligo Research Foundation, the National Vitiligo Foundation, and VitiligoSupport.com.

Facial photorejuvenation at an affordable price in Dolgoprudny

Facial photorejuvenation is a popular cosmetic procedure, which is based on exposure to the skin with pulsed light with wavelengths from 400 to 1200 nanometers of high intensity. Light with different wavelengths leads to heating of certain structures of the dermis (water, melanin, hemoglobin, etc.), contributing to skin rejuvenation. It is important that facial photorejuvenation devices do not use light less than 400 nanometers long (ultraviolet spectrum), which, on the contrary, causes skin aging.In our clinic, facial photorejuvenation is performed using the latest generation Harmony apparatus of the Israeli company Alma Lasers.

We offer:

Prices for photorejuvenation

Sign up for a consultation and facial photorejuvenation procedure on the innovative Harmony apparatus at the Code Beauty Medicine cosmetology clinic!

Make an appointment

Before and after photos (result after one procedure):

Indications for the procedure:

• Reduced skin elasticity
• enlarged pores
• increased vascular pattern, rosacea
• hyperpigmentation
  

  hyperpigmentation Contraindications to the procedure:

  • infectious diseases in acute form
  • oncological diseases
  • autoimmune diseases in severe form
  • epilepsy
  • pregnancy

  Advantages of our Harmony device

  three nozzles with a wide range of light wavelengths.Selectivity of impact on a specific “target” is not achieved. So with the same attachment in the first generation devices, the procedure of photorejuvenation, and photoepilation, and lightening of blood vessels and pigmentation are carried out. To achieve the effect, more procedures had to be carried out, and the desired effect was not always achieved.

  Our Alma Lasers Harmny is equipped with 12 attachments, each of which is designed to effectively solve its task. The cosmetologist individually selects a tip with specific wavelengths to correct various skin imperfections for each individual patient.This way, the Harmony treatments are more effective than other machines and require fewer treatments to achieve results.

  Another fundamental advantage of the Harmony is the “in motion” function, which means “in motion”. In this mode, the facial photorejuvenation procedure is carried out not in separate flashes, but in a multitude of continuous flashes, while the beautician continuously guides the nozzle over the patient’s skin surface. Thus, there are no unworked areas and the pain and time of the procedure are significantly reduced.

  Special attention should be paid to the highly efficient cooling system in the Harmony nozzles. Thanks to the intensive cooling of the nozzle in contact with the skin, the procedures on our device are practically painless.

  Face photo rejuvenation video

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  * There are contraindications. A doctor’s consultation is required.

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  Don’t know which procedure to choose?
  Take online testing and get an individual plan of cosmetic procedures!

  Skin pigmentation how to get rid of – cosmetics Image Skincare

  Only an integrated approach can cope with age spots.It must necessarily include a delicate exfoliation of the layer of pigmented cells, the use of cosmetic products that reduce the secretion of melanin, and reliable protection of the skin from the aggressive effects of ultraviolet radiation using cosmetics with UV filters.

  Iluma brightening line of Image Skincare cosmetics (USA) meets all protocols for correcting age spots, both age and acquired, and also prevents their appearance.

  Intense Lightening Cleanser – Gel Image Skincare

  Oil-based gel actively evens out complexion and brightens age spots.

  All skin types, uneven skin tone, dark spots, pigmentation, dry skin.

  Intense Brightening Exfoliating Powder – Brightening – Exfoliant Image Skincare

  Enzyme Powder cleanses pores, smoothes skin structure, moisturizes and brightens it.

  All skin types, dull skin.

  Intense Brightening Serum – Brightening Serum Image Skincare

  Reduces inflammation and brightens the skin, soothes the skin after active treatments.Does not contain oils.

  Sensitive, irritated, reddened skin after peels. Hyperpigmentation, uneven skin tone.

  Ingredients: extracts: Japanese mandarin, sorrel, bearberry, mulberry, amla, licorice, azelaic acid, vitamin C.

  Intense Brightening Creme – Brightening Image Skincare

  A revolutionary intensive brightening cream that effectively removes hyperpigmentation.

  Ingredients: extracts of watercress, daisy, string (reduces the intensity of pigmentation by 36%), tuberose (inactivates tyrosinase by 24%), DermaPep tetrapeptide is designed to maximally and effectively inhibit destructive matrix metalloproteinases and restore normal collagen levels. hormone, and the Synovea complex is a safe and effective active that is used as a skin brightener with protective properties.It works by modulating the melanogenesis pathway and is a glutathione stimulant. Hexylresorcinol has been clinically proven to be four times more effective than hydroquinone.

  Uneven skin tone, post-inflammatory and age-related hyperpigmentation, melasma.

  Intense Brightening Eye Creme – Brightening for eyelid Image Skincare

  Brightens, rejuvenates, evens out the tone of the area around the eyes. “Erases” visible signs of aging, swelling, dark circles, visible lifting effect after just a few applications.

  Hyperpigmentation, grayish tint, edema, skin atony, age-related changes in the skin of the eyelids.

  Intense Lightening Body Lotion – Body Lotion Image Skincare

  Evens out skin color, corrects age and age spots.

  Ingredients: DermaPep complex, extracts: licorice, tuberose, daisy, turmeric, string; vitamin E, oils: linseed, sea buckthorn, palm, cottonseed oil, orange essential oil.

  Uneven skin tone, hyperpigmentation, age spots, melasma, solar lentigo on the body.

  Pro tip: Use on darker areas of the body such as knees and elbows.

  Buy and order delivery of cosmetics in Kazakhstan Image Skincare (USA) for pigmentation correction – Arannati company

  Removal of pigmentation with a diode laser in Dnepropetrovsk

  Laser removal of age spots (melasma, chloasma, senile and solar lentigo, post-acne spots)

  The shade of our skin depends on the degree of melanin content in it.For a number of reasons, which include exposure to the sun, hormonal changes, as well as disturbances in the functioning of the gastrointestinal tract, in some areas of the skin there is a multiple increase in the content of melanin. This leads to the appearance of age spots on the skin.

  The most common reason for the appearance of age spots is aging of the body. Elderly people often complain of age spots, because with age, the body loses its ability to remove toxins through the intestines, kidneys, liver or lungs, and detoxification occurs through the skin.If you have a spot on your face, treatment should be started immediately.
  All over the world, the removal of age age spots with laser is recognized as the safest and most effective method.
  The unique Laser Pigment Removal Technique removes any color stains without leaving a trace.

  The course of treatment for age spots is from 1 to 3 procedures with an interval of 3 to 4 weeks. Within 5 – 7 days, the laser-treated surface is peeled off and the stains disappear.During the procedure, the radiation is so selective that it destroys only cells with a high melanin content.

  Superficial pigment spots are removed most quickly with this method . Elimination of pigmented formations, which lie in the deep layers of the skin, consisting of significant accumulations of melanin, may require more sessions. The lightening of skin pigment in these cases occurs gradually – as the layer-by-layer destruction of melanin from procedure to procedure.In such cases, we recommend that you undergo a course of superficial peels before starting laser therapy.

  ADVANTAGES OF LASER PIGMENT SPOT REMOVAL:

  no risk of infection
  scars and cicatricial changes in the skin do not remain at the site of the removed age spots
  the procedure is painless, does not take much time
  no restrictions on the usual way of life are required.

  PREPARATION FOR PROCEDURE:

  avoid exposure to direct sunlight for 7-14 days before the procedure, do not visit the solarium
  if there is hair in the laser-affected area, it must be shaved off immediately before the procedure.

  MAIN CONTRAINDICATIONS FOR THE PROCEDURE:

  acute infectious diseases
  exacerbation of chronic diseases 90 320
  inflammatory process at the site of the procedure
  pregnancy, lactation
  hormone-dependent bronchial asthma
  rheumatoid arthritis
  hypertension stage 3
  diabetes mellitus
  systemic connective tissue diseases
  tendency to keloid scars.

  AFTER PROCEDURE:

  avoid exposure to direct sunlight for 7-14 days before the procedure, do not visit the solarium
  use high SPF
  sunscreen
  exclude water procedures in the area of ​​laser exposure, and also do not apply makeup, skin care products for 24 hours
  visit your healthcare professional 7-10 days after your procedure.

  Cost:

  Laser rejuvenation of the whole face (pigmentation, blood vessels, small pores, flabbiness)	1290
  Laser removal of 1 pigment spot, up to 10 pcs.	490
  Laser removal of 1 pigment spot, more than 10 pcs.	290
  Laser removal of dark spots in the décolleté area	790
  Laser removal of age spots on hands	790

  Read all reviews

  Scientific digest: can gray hair darken again and what the pandemic gave to pets

  • Leonid Luneev
  • BBC

  July 4, 2021

  Among scientific news weeks:

  • “Turn gray back” – can an irreversible process be reversed?
  • How the pandemic helped open up cat love
  • What, where, when: what is the memory in your head built of

  Gray hair is not forever?

  Photo author, Getty Images

  It has long been known that strong feelings can turn gray, and sometimes literally overnight.Especially many such cases are noted during wars, natural disasters and sudden personal tragedies.

  People get gray and due to natural causes – hair loses pigment with age. You can live with this, you can, in the end, use hair dye, But so that the gray hair goes away by itself – hardly anyone has heard of this. Until Columbia University associate professor Martin Picard got down to business.

  He conducted a study in which 14 volunteers, aged between nine and 65 years old, who had graying and completely gray hair, took part.

  Samples of these hairs were scanned at high resolution to accurately determine how much pigment they lost. At the same time, an interesting feature was revealed: in some cases, the beginning of hair color loss was observed, but then this process was inhibited.

  By comparing the color variations with the participants’ diaries, in which they recorded periods of calm and stress throughout the year, the researchers noticed a definite link between stress cycles and loss of hair pigmentation.

  “One of these people went on vacation, and during that time five of his hairs darkened again,” says Picard.

  After analyzing hundreds of proteins inside the hair, scientists have found a connection between graying hair and protein mitochondria – indicators of energy expenditure at the cellular level and metabolic stress.

  Having applied a mathematical model to extrapolate their findings to more people of different ages, scientists have suggested that graying and gray hair, in some cases, may actually return to its previous color.While this seems to contradict the study in mice at first glance, this discrepancy can be explained by the difference between the hair follicles of mice and humans.

  “Understanding the mechanisms that allow graying hair to regain youthful pigmentation can reveal a lot about the human aging process and how stress affects this process,” emphasizes Martin Picard.

  However, the researchers are in no hurry to reassure those who are worried about the gray hair that has broken through.They say that partial restoration of hair color is possible, but only up to a certain age, so it is quite easy to turn gray ahead of time as a result of stress or other biological reasons, but it will hardly be possible to become a burning brunette in his declining years without the help of dye.

  You – me, I – you: how the pandemic has brought the owners closer to the pets

  Photo author, Getty Images

  Pets have provided us, people, an invaluable service during the pandemic.Several studies have shown conclusively that they have helped us cope with stress and overcome feelings of loneliness.

  But we also somehow influenced our pets?

  As a group of researchers from the Universities of York and Lincoln found out – and here the cat lovers nod their heads in agreement, and the dog lovers frown in disbelief – during the lockdown, cats have become more loving towards their owners.

  Scientists have developed a questionnaire for owners of a wide variety of pets, from horses and reptiles, to birds and fish, and, of course, did not ignore the owners of dogs and cats to find out how they, animals, were affected by the pandemic.

  Out of more than 5,000 people who responded, over 65% noted a change in the behavior of their pets during the first lockdown in 2020.

  The survey participants were asked to talk about their pets, their relationship with them, and their own psychological state.

  In general, many owners noted that their relationship with their pets has improved, with the exception of dog owners who drew attention to changes for the worse.

  “My dog ​​began to demand something from me all the time and howls when I leave the house, even if I’m in the garden and she sees me,” wrote one of the survey participants.“I can’t imagine what will happen to her when I have to go to work.” themselves more at ease and relaxed, and another 15% found a surge of strength and energy altogether.And about a third of all respondents, mainly owners of cats and dogs, said that their pets began to follow them.

  One of the main problems, which the dog lovers noted, was to change the mode of walking and communication.

  “My dog ​​does not have enough communication, she does not understand what is happening,” writes one of the respondents, “Labradors are sociable dogs, and my dog ​​cannot understand why everyone tried to pet him before, and now they go to the other side roads “.

  It may seem strange to someone (who is new to the psychology of these animals), but cats also crave companionship.

  “My cat is a registered therapist,” complains another respondent, “and we really miss regular visits to our fans (it’s written just like that).We can’t wait to visit them again: he really misses the adoration on their part. ” who had problems during the pandemic.

  special attention to animals.This, in turn, could have pushed cats to more actively begging for sweets and begging for other privileges for themselves.

  One of the authors of the study (its results are published in the International Journal of Environmental Research and Public Health), Emily Shusmith from the University of York, admits that the questionnaire had a number of shortcomings, in particular, people’s responses could be influenced by their psychological state at that time, therefore, they might not be entirely objective. In addition, the overwhelming majority of respondents were women, which may not quite accurately reflect the general mood of the population.

  Yet research shows that changing our habits has a profound effect on the pets we share with us and demonstrates that they are willing to appreciate the increased attention we give them.

  A chronometer in your head

  Photo author, Getty Images

  How is it that the events that happen to us do not mix in one pile in our head, but appear as a sequential chain?

  As the international team of scientists from France and the Netherlands found out, the whole point is in the so-called “time neurons” – cells of the hippocampus, which perform the function of short-term memory and are responsible for the subsequent translation of information into long-term memory.It is they that allow us to reproduce the correct order of the events that have occurred.

  Actually, as is often the case, such cells responsible for the sequential arrangement of events in our memory were first discovered in rats, but about the mechanism of encoding episodic memory (that is, memory of autobiographical events, including the time and place of action, as well as the entire the accompanying information) the person could only guess.

  To turn conjectures into facts, researchers led by neuroscientist Leila Reddy of the French Center for the Study of Cognitive Abilities of the Brain conducted a study on 15 epileptic patients whose hippocampus had already been implanted with microelectrodes.

  During the experiments, the participants were offered a series of images in a specific order and were asked to memorize this order.

  In this case, the electrodes recorded the response of individual neurons in the hippocampus during the display of images, in the breaks when no pictures appeared on the screen, and during pauses, when the participants were asked to guess what the next image would be.

  According to scientists, in this way they identified both neurons involved in the process of memorizing and reproducing pictures, and those neurons that were activated in the absence of an image.It was they who were responsible for encoding the time even in those moments when nothing was happening.

  “Temporal modulations during these pauses could not be triggered by external stimuli,” the researchers write in their paper published in The Journal of Neuroscience. next dose of information. ”

  In other words, even when nothing happens, the time counter in our head keeps ticking.

  Researchers do not exclude that it is at such moments that the “neurons of time” perform multilevel work, recording “what, where and when” related to this or that event, and creating a clear picture of memory from scattered elements.

  “The phenomenon of subjective ‘mental time travel’ is the cornerstone of episodic memory,” the scientists write, “and neurons in the hippocampus enable us to vividly recall events that occurred at a particular time and place.”

  Laser removal of age spots

  Cosmetologists of the Medical Center “Medassist” use one of the most effective and safe ways to remove age spots – laser exposure.

  Effect of laser removal of age spots on the skin

  The more melanin in the skin, the darker its color. During malfunctions in the body, melanin can be produced unevenly, which causes age spots.The laser beam penetrates deep into the cells that contain melanin and destroys the pigment. During the procedure, the patient feels a slight tingling sensation. The destroyed cells come out and form a small crust, which peels off after a few days, depending on the characteristics of the skin. As a result, age spots lose their color intensity or disappear completely.

  During the procedure, our specialists use alexandrite and CO2 lasers, which remove freckles and age spots from any area of ​​the skin.

  Stages of laser exposure

  Laser removal of age spots on average takes 30-60 minutes. At this time, the following stages are carried out:

  1. Skin Makeup Remover.
  2. Laser exposure.
  3. Application of anti-inflammatory and regenerating cream.
  4. Applying sunscreen.

  No method can guarantee that age spots will not reappear.Therefore, you should take good care of your skin, use sunscreens and contact a beautician or dermatologist in a timely manner.

  Contraindications

  Laser removal of age spots is not recommended during pregnancy and lactation. The procedure also has contraindications for patients with the following diseases:

  • skin diseases during an exacerbation;
  • oncological diseases;
  • Tendency to form keloid scars.

  How to clean? Photo. Effective Methods

  Pigmented spots are considered one of the signs of skin aging, but often this aesthetic defect begins to bother even schoolchildren. Today, this cosmetic defect is successfully eliminated by cosmetologists, and proper home care helps to consolidate the result for a long time.

  Content

  1. What are age spots
  2. Causes of occurrence
  3. Alternative methods of removal
  4. Solving a problem with a beautician
  5. Pigmentation masking

  What are age spots and how they look

  This is a common cosmetic defect that manifests itself on the face and body and is the result of an excessive concentration of melanin in the epidermis.

  How age spots look on the face will be demonstrated by the following photos:

  This is what pigment spots on the back look like:

  The cosmetic defect often affects the hands (especially the hands). Often, hyperpigmentation occurs on the neck and décolleté, less often on the legs.

  Aesthetic deficiency affects not only adults. Pigmented spots also occur in children, and even in infants. Most often the reason for this is a hereditary factor. In most cases, these cosmetic defects fade over time.

  Varieties of pigment spots:

  • Chloasma is one of the most common types. Brown stains
  • melasma superficially resembles chloasma.The difference between these types of age spots lies in the nature of their occurrence;
  • lentigo – rounded or oblong brown spots with a diameter of 0.5-1.5 cm, which often appear with aging. They need a histological examination, as they can develop into malignant neoplasms;
  • vitiligo – white spots resulting from the loss of melanin in the skin. Areas with impaired pigmentation enlarge over time.Today, doctors have not yet sufficiently studied the causes of vitiligo, and it is almost impossible to cure this disease. It is only known that vitiligo appears on the basis of a genetic predisposition, as well as due to autoimmune diseases.

  What is the difference between age spots and freckles?

  Many people often think that they are one and the same thing. In fact, this is a misconception, although the nature of the occurrence of age spots and freckles is the same.Solar activity and hereditary factors provoke these cosmetic imperfections. However, freckles appear only in people with very fair skin, and mainly in the spring-summer season. With age, they gradually brighten. And hyperpigmentation can occur in anyone due to metabolic disorders and hormonal imbalances.

  If it is easier to remove freckles with cosmetics, then in the case of age spots, it is important to first eliminate the cause of their occurrence, and then proceed to beauty procedures.

  Causes and risk factors

  Pigmented spots appear due to hereditary factors (genetic predisposition), dysfunctions of internal organs or previous diseases. Their appearance is influenced by the intake of a number of medications, including hormonal ones.

  The appearance of age spots provokes endocrine diseases, stress and mental disorders. They also signal that it is time to check the liver: disruption of the gastrointestinal tract affects the appearance of this aesthetic defect.

  Risk factors:

  • pregnancy;
  • age-related aging of the skin;
  • prolonged exposure to the sun.

  In men, age spots appear as a result of past diseases of the liver, kidneys or endocrine system. Age-related changes are also the cause of these aesthetic defects.

  Folk methods of removing age spots

  At home, you can lighten age spots using a whitening cream (eg Skinoren) or a line of medicinal cosmetics (eg Christina).

  There are a number of drugs from the pharmacy that are available to everyone due to their low cost. For example, 3% hydrogen peroxide. It is applied with the applicator pointwise to each spot. It is recommended to carry out such sessions no more than 1 time a week and after a month of use, take a long break.

  Badiaga from age spots is another pharmacy remedy that works well even for old pigmentation. You need to use it carefully and strictly according to the instructions, otherwise you can get burned and aggravate the problem.

  Does zinc ointment help whiten age spots?

  There are very few reviews of the successful results of using this tool. Salicylic-zinc ointment deserves more positive recommendations, which helps to whiten the skin, cope with acne and acne.

  Folk recipes for removing age spots

  • Alcohol tincture of celandine. 2 tbsp crushed plants are poured with 200 g of alcohol and infused for 2 weeks in a dark place.After the lotion is filtered and used pointwise.
  • Turmeric mask. 1 tsp spices mixed with 1 tbsp. sour cream and applied to the skin for 10 minutes. Turmeric will gradually lighten age spots if such a mask is done regularly at intervals of 2 times a week.
  • Mask with starch and lemon juice. It is applied only to the centers of hyperpigmentation! Composition – 2 tbsp. starch, diluted with freshly squeezed lemon juice to the consistency of gruel. Soak on the face for 15 minutes.

  Should you try castor oil?

  Reviews indicate that this tool is quite effective if used in the form of masks with other “home” ingredients.But there are two “buts” that call into question the benefits of castor oil. Firstly, it provokes the growth of facial hair, and secondly, it clogs the pores of the skin.

  Additional advice on home skin care

  Foods that should be included in your diet – parsley, cucumbers, lemons. Skip coffee and take ascorutin, which will help balance melanin production.

  Protect your face from the sun: ultraviolet light provokes hyperpigmentation, especially in the spring-summer season.Protective cream SPF 30 or more and wide-brimmed hats will help maintain an even and healthy skin tone.

  A solution to the problem with a beautician. Treatments for removing age spots

  Today, there are several ways to get rid of the aesthetic flaw. Let’s take a closer look at each of them.

  Laser removal

  The most radical and therefore demanded way to remove age spots. Laser removal is carried out in courses of 2-3 procedures or more.Modern equipment allows you to use it even to remove hyperpigmentation on dark skin.

  During the period of inflammatory or infectious diseases, as well as during pregnancy, laser removal is not performed. The recommended season is autumn and winter.

  Photographs taken before and after procedures demonstrate a clear result of removing age spots.

  The mechanism of hardware procedures resembles laser removal.

  Phototherapy and Elos

  Phototherapy – exposure to problem areas with light pulses.This method is also used for anti-age programs and acne treatments. Unlike a laser, light waves of different lengths are used here. The required number of procedures – from 2 to 6.

  Elos-therapy is based on the effects of optical and radio wave energies. To remove age spots, an average of 3 treatments are required.

  Mesotherapy

  A course of medical injections can significantly lighten age spots. For this purpose, a special meso-cocktail is used, which contains chemical acids, arbutin, peptides, vitamin C, and plant extracts.The production of such drugs is mainly carried out by European countries (Spain, France, Italy). The drug Dermaheal from the manufacturer of medical Korean cosmetics is also popular.

  Many meso cocktails contain hyaluronic acid. Thus, the procedure is doubly useful – it helps to get rid of age spots and rejuvenate aging skin.

  Peeling

  In the fight against hyperpigmentation, retinoic, salicylic and azelaic acids have shown themselves to be positive.Yellow and TCA peels provide good results. The minimum number of procedures required is 3-5.

  Recently, peeling “Melanostop” has been widely used in cosmetology practice. Its formulation is specially formulated to combat age spots. The peeling contains azelaic and phytic acids, as well as resorcinol.

  Chemical peeling is a successful way not only to get rid of aesthetic imperfections, but also to improve the condition of the skin, making it smoother and more elastic.

  Alternative options. Decorative cosmetics and permanent pigmentation masking

  When contraindications do not make it possible to attend cosmetic procedures, it remains to resort to decorative cosmetics.

  How to cover age spots?

  Concealer Pencil plus foundation will hide aesthetic imperfections and ensure even skin tone. Some makeup tricks (contouring, using products with reflective particles) can help distract attention from age spots.

  BB Glow Treatment – permanent foundation with a healing effect

  This new fashionable procedure came to us from Korea. BB Glow Treatment – the introduction of a caring serum with a toning effect into the upper layers of the epidermis. The procedure is performed using a dermapen, a small pen with disposable microneedles.

  The result of the procedure is a uniform, healthy complexion and camouflage of pinpoint defects.The effect lasts for a year.

  The treatment serum contains hyaluronic acid and vitamins. Cosmetologists say: this is not a pigment for tattooing and not a filler. The toning effect is provided by CC particles that adapt to the client’s skin tone. Therefore, the name “permanent foundation” is actually not entirely correct.

  How the BB Glow Treatment proceeds and what are its results, the following video demonstrates.

  You can find out more about the prices for pigmentation removal in the Barb catalog.pro, where this service is offered by cosmetologists and beauty salons.

  90,000 The best anti-pigmentation products

  We erase age-related changes from the face and look 10 years younger than

  Ports 1961 Fall-Winter 2021/22 Fashion Show Moles or nevi, freckles, age-related or post-inflammatory pigmentation are all types of age spots that appear as a result of increased melanin synthesis in the skin. Most often, this process is provoked by ultraviolet light, although hormonal imbalance may also be to blame (be sure to consult a doctor!).Since sunny days are gradually returning to us, it’s time to stock up not only with sunscreen, but also with anti-dark spots. They can hardly perform a miracle – rid you of pigmentation forever – but they can lighten and prevent new formations. An important point: After using these creams, serums, foams and ampoules, be sure to apply a generous layer of the high SPF product.

  Vichy

  Vichy Liftactiv Specialist Glyco-C Night Peeling Serum Ampoules Liftactiv Specialist Glyco-C Peeling Serum works while you sleep.A high concentration of ingredients such as a complex of acids (the main one is glycolic), vitamin C of natural origin, hyaluronic acid and remineralizing thermal water conjure over your skin night after night, neutralizing its imperfections (pigmentation and wrinkles), evening out tone and restoring elasticity and radiance.

  La Roche-Posay

  La Roche-Posay Redermic Retinol Care The experts at La Roche-Posay have refined the already ideal Redermic Retinol formula for sensitive skin with pigmentation and pronounced wrinkles.They have added to the two types of retinol (pure and sustained release) that play a major role in the composition, hepes (responsible for smoothing the microrelief) and neurosensin (soothes the skin). The result is an intense, concentrated anti-aging treatment that smoothes wrinkles, brightens dark spots and evens out complexion.

  SkinCeuticals

  SkinCeuticals Phloretin CF Serum Phloretin CF broad-spectrum serum not only corrects the already obvious signs of premature aging, but also prevents their further appearance.And all thanks to phloretin, ferulic acid and vitamin C – it is this mix that has a noticeable antioxidant and regenerating effect.

  Elemis

  Elemis Dynamic Resurfacing SerumDynamic Resurfacing Serum evens and smoothes skin texture, makes pores and wrinkles less visible, and brightens the complexion. The patented Tri-Enzyme technology, Selastin and floral AHA-acids stimulate the renewal processes, acting gently but effectively.

  EviDenS de Beauté

  EviDenS De Beaute The Serum The Serum works like a long-awaited vacation. Yes, yes, after it you look as if you have just returned from a SPA resort or from the best cosmetologist in the world. Natural water Eau de la Foux included in its composition soothes and nourishes the skin with microelements, and vitamin E neutralizes free radicals, working as an anti-age. It also strengthens the capillaries (vascular network, goodbye!).The only thing: the serum is very concentrated and can tingle a little and not for long.

  Lancôme

  Lancôme Advanced Genifique Sensitive Youth Activator Concentrate Double-acting youth activator concentrate with Advanced Genifique Sensitive ferulic acid is the result of the latest research and the advanced development of Lancôme scientists. This tool neutralizes the effects of stress and aggressive effects of external factors on the skin.It removes any manifestations of sensitivity, enhancing the protective functions of the skin and protecting it from premature aging. In a word – we recommend!

  Filorga

  Filorga Pigment White Brightening CreamPigment White Brightening Cream is your secret weapon against age spots, redness, yellowish or grayish complexion. In addition to a quick and noticeable result (but this is provided that you use it daily in the morning and / or in the evening), it also has a preventive effect.A unique mix of ingredients helps him to make his face flawless: a mineral complex, vitamin C and other effective components, the names of which you do not need to remember.

  Evercell

  Cellular concentrate and serum Evercell Absolute LuxeA special program of cell renewal Absolute Luxe includes a cell activator serum and pearls of a cell concentrate (immediately before use, these two components must be mixed) – they, like yin and yang, complement and enhance each other’s action.Lyophilisate, a cellular complex with amino acids, peptides and growth factors, day after day, rejuvenate the skin and restore its elasticity and firmness, reduce the severity of wrinkles and reduce pigmentation.

  dr. brandt

  Polishing foam dr. brandt Radiance Resurfacing Foam Radiance Resurfacing Foam with acids and water lily extract is a cool alternative to the cosmetic dermaplining procedure (this is when dead cells, impurities and excess sebum are scraped off the skin with a surgical scalpel).In this tool, the function of the blade is performed by a plastic spatula, and the foam itself helps it, which in action rather resembles a bubble mask. You put it on your face, wait a minute for it to bubble, take a scapula and peel it off, and then apply sunscreen (if you used it in the morning or afternoon). Unlike salon treatment with a scalpel, this procedure does not thin the skin or violate its protective mantle, but delicately removes all unnecessary from the surface. The result is obvious, more precisely on the face – dense, moisturized, elastic skin without the slightest imperfections.

  Is Clinical

  Is Clinical White Lightening Complex One of the most effective and safe anti-pigmentation products for the skin – White Lightening Complex (it will soon change its name to Brightening Complex, but the composition remains the same), which 72 hours after application reduces melanin synthesis by 37% (clinically proven!). It can cause slight flaking, which will, however, go away quickly.The main thing is that dark spots will lighten and decrease in size and depth, and with them, wrinkles will begin to go away for company.

  Erborian

  Erborian Sesame Milk Sheet Mask Do not underestimate the anti-pigment express remedies. Especially if you only have 15 minutes to moisturize and brighten your face and restore radiance to your skin. In this case, you should have at hand the Sesame Milk Sheet Mask, which combines the properties of an enzyme-based peeling and a highly nourishing mask soaked in sesame milk.First, apply the peeling, avoiding the eye area, wait until it dries completely, and then grab a cloth mask. The first stage helps to cleanse the skin and even out the tone, while the second soothes and makes the face velvety.

  Dr. Pierre Ricaud

  Dr. Pierre Ricaud Ceramides Anti-Aging Face CreamCeramides nourishing anti-age spots repair cream with ceramides, licorice extract, provitamins and the unique Glycalox complex (a combination of peptide and vitamin E) fights pigmentation spots, evens out the complexion and prevents the natural aging process of the skin.In short, he’s perfect.

  Matromi

  Matromi Pearl Radiance Brightening Cream The main tasks of the Pearl Radiance cream, with which it does an excellent job, are to reduce visible pigmentation by lightening spots, and to improve the complexion by giving it a pearly glow. In addition, it stimulates the process of tissue renewal, enhancing cellular metabolism, which contributes to high-quality skin restoration. And all this happens thanks to the composition, which includes the extract of ruperia hypoxis (African potato), lemon and prickly caesalpinia (tropical Tara tree), avocado and coconut oil, hyaluronic acid and D-panthenol.

  Text: Svetlana Antonova

  See also: How to get rid of nasolabial folds without injections and operations

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