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Post-Inflammatory Hyperpigmentation in Adults: Condition, Treatments, and Pictures – Overview

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Overview

Post-inflammatory hyperpigmentation is darkening of the skin in an area of prior injury or skin disorder from increased pigment (melanin) left from the healing process. Sometimes the darkening may also be due to an iron pigment left behind when old red blood cells die. Acne is a common cause as well as any type of skin injury (scrapes, cuts, burns, insect bites, or chronic rubbing) or many other skin disorders, such as eczema (atopic dermatitis).

Who’s at risk?

Dark-skinned individuals are more likely to have post-inflammatory hyperpigmentation.

Signs and Symptoms

One or more areas of darker brown or sometimes red-brown discoloration. The appearance varies in size, shape, and location depending upon the cause of skin injury. Acne tends to leave light to dark brown spots on the face or trunk. Burns, insect bites, cuts, or scrapes often affect exposed areas on the arms and legs.

Self-Care Guidelines

Most post-inflammatory pigment fades with time, although it takes many months, and some areas never fade (particularly on the legs).

• Since sunlight may cause further darkening, protect yourself from sun exposure with clothing, a hat, and sunscreen (SPF 15 or more).
• You may be able to use makeup to cover the affected areas. Waterproof makeup is available for use on arms and legs.
• If you have an underlying skin disorder such as acne, seek medical care.
• While bleaching creams are available over the counter (0.5–2% hydroquinone in the US and stronger, but possibly dangerous, concentrations overseas), weaker forms have limited effectiveness, and there is some concern about their safety. In fact, the Food and Drug Administration (FDA) is considering removing them from the market. If you do try them, stop using them if there is no improvement after 4–6 months of use. The stronger foreign products may worsen pigmentation with overuse or cause permanent pigment loss, so DO NOT USE THEM.
• Cocoa butter and aloe are common home remedies, but they have not been proven to be effective.
• Cortisone creams should not be used unless recommended by your physician, as they thin the skin with prolonged use.

When to Seek Medical Care

If the discoloration is distressing to you or you have a chronic skin condition leading to the darkening, seek medical advice. Also see your doctor if you notice a general change in skin color without any obvious explanation.

Some creams may help fade dark marks. These include 2–4% hydroquinone, tretinoin, tazarotene, azelaic acid, and glycolic acid. These products are often used in combination. Chemical peels or microdermabrasion are treatments not generally covered by insurance and need to be repeated monthly for a total of 4–6 sessions. If not done by experts, they may cause further irritation and darkening.

MedlinePlus: Skin Pigmentation DisordersClinical Information and Differential Diagnosis of Hyperpigmentation, Post-Inflammatory

References

Bolognia, Jean L., ed. Dermatology, pp.975-1004. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick’s Dermatology in General Medicine. 6th ed, pp.819, 823, 2141, 2537. New York: McGraw-Hill, 2003.

Hyperpigmentation and Hypopigmentation: Albinism, Vitiligo, and More

Pigmentation is the coloring of a person’s skin. When a person is healthy, their skin color will appear normal. In the case of illness or injury, the person’s skin may change color, becoming darker (hyperpigmentation) or lighter (hypopigmentation).

Hyperpigmentation and Skin

Hyperpigmentation in skin is caused by an increase in melanin, the substance in the body that is responsible for color (pigment). Certain conditions, such as pregnancy or Addison’s disease (decreased function of the adrenal gland), may cause a greater production of melanin and hyperpigmentation. Exposure to sunlight is a major cause of hyperpigmentation, and will darken already hyperpigmented areas.

Hyperpigmentation can also be caused by various drugs, including some antibiotics, antiarrhythmics, and antimalarial drugs.

Melasma

An example of hyperpigmentation is melasma. This condition is characterized by tan or brown patches, most commonly on the face. Melasma can occur in pregnant women and is often called the “mask of pregnancy;” however, men can also develop this condition. Melasma sometimes goes away after pregnancy. It can also be treated with certain prescription creams (such as hydroquinone).

If you have melasma, try to limit your exposure to daylight. Wear a broad-brimmed hat and use a sunscreen with an SPF of 30 or higher at all times, because sunlight will worsen your condition. Sunscreens containing the physical blockers zinc oxide or titanium dioxide are also helpful in blocking daylight’s UVA rays, which makes hyperpigmentation worse.

Consult with your doctor before treating the condition yourself.

Hypopigmentation and Skin

Hypopigmentation in skin is the result of a reduction in melanin production. Examples of hypopigmentation include:

• Vitiligo: Vitiligo causes smooth, white patches on the skin. In some people, these patches can appear all over the body. It is an autoimmune disorder in which the pigment-producing cells are damaged. There is no cure for vitiligo, but there are several treatments, including cosmetic cover-ups, corticosteroid creams, calcineurin inhibitors (Elidel cream, Protopic ointment) or ultraviolet light treatments. New topical treatments using Janus Kinase inhibitors are being investigated.
• Albinism: Albinism is a rare inherited disorder caused by the absence of an enzyme that produces melanin. This results in a complete lack of pigmentation in skin, hair, and eyes. Albinos have an abnormal gene that restricts the body from producing melanin. There is no cure for albinism. People with albinism should use a sunscreen at all times because they are much more likely to get sun damage and skin cancer. This disorder can occur in any race, but is most common among whites.
• Pigmentation loss as a result of skin damage: If you’ve had a skin infection, blisters, burns, or other trauma to your skin, you may have a loss of pigmentation in the affected area. The good news with this type of pigment loss is that it’s frequently not permanent, but it may take a long time to re-pigment. Cosmetics can be used to cover the area, while the body regenerates the pigment.

Facial UV photo imaging for skin pigmentation assessment using conditional generative adversarial networks

Overview of training process of UV-photo Net

UV-photo Net converts color photo images to synthetic UV photo images using a deep neural network model called U-net, which is one of the widely used deep neural network structures for image conversion and image segmentation20. The size of color photo images considered in UV-photo Net is thousands of pixels in both width and height. Since whole color photo images are too large to handle directly in U-net, we used pairs of color and UV photo image patches of 256 ×256 pixels from face regions to train U-net. We trained U-net under CGAN by considering sets of color photo images and UV-photo images as the input and target domains, respectively. Training under CGAN considers two types of models called generator and discriminator. U-net serves as the generator in UV-photo Net to generate synthetic UV image patches from color photo image patches. The discriminator in UV-photo Net classifies the original UV photo image patches and synthetic UV image patches, and the loss based on the classification results from the discriminator is considered in the training process of the generator. With the loss from the discriminator, the generator is expected to re-generate synthetic UV image patches that are more perceptually realistic as UV photo image patches.

Color photo images and their corresponding UV photo images are not matched completely in pixel-level due to the subtle movement of subjects in photographing time interval, and such pixel-level mismatches could cause blurred points in synthetic UV images. We thus considered the following steps to train UV-photo Net as shown in Fig. 1:

1. 1.

Detect face regions by a deep neural network, from which color and UV photo image patches are extracted for training data of UV-photo Net (Fig. 1a-1).

2. 2.

Train U-net without considering the loss from the discriminator to obtain temporal synthetic UV images from color photo images (Fig. 1a-2-i).

3. 3.

Align large image patches of 900 × 900 pixels from the temporal synthetic UV images and their corresponding UV photo images, and reflect the alignment results to their corresponding color photo images (Fig.  1a-2-ii).

4. 4.

Train U-net under CGAN using the locally aligned color and UV photo image patches (Fig. 1a-2-iii).

Since digital information of color and UV photo images is quite different, it is difficult to directly align color and UV photo image patches at pixel levels. We thus proposed to prepare temporal synthetic UV images from color photo images, which were expected to be the digital information comparable to UV photo images (Fig. 1a-2-i). We then used the temporal synthetic UV images for the alignment with UV photo images (Fig. 1a-2-ii). For the generation of the temporal synthetic UV images, we used U-net trained without considering the discriminator. The local alignment results for the temporal synthetic UV images were reflected to the corresponding color photo images. We then used the locally aligned color and UV photo image patches of $$256\times 256$$ pixels to train deep learning models for the generator and the discriminator (Fig.  1a-2-iii).

In the process of synthetic UV image generation, UV-photo Net first converted color photo image patches of $$256\times 256$$ pixels into synthetic UV image patches by the trained U-net (Fig. 1b). UV-photo Net then assembled the synthetic UV image patches to reconstruct whole synthetic UV images.

Evaluation

We used color and UV photo image pairs of 184 Japanese individuals taken with VISIA Skin Analysis System (Canfield Imaging Systems, Fairfield, NJ, United States)21. We divided the 184 individuals into 160 individuals as training samples and the remaining 24 individuals as test samples. Age distributions of the training and test samples are shown in Table 1. Among the 160 training samples, we used color and UV photo image pairs taking front face appearances of 150 samples as a training dataset, and used image pairs for the remaining 10 samples as a validation dataset. The width and height of photo images taken with the VISIA system in our datasets is $$3,456\times 5,184$$ pixels, $$3,000\times 4,000$$ pixels, or $$2,964\times 3,560$$ pixels. We trained the deep neural network models by iteratively updating their parameters using the training dataset. The validation dataset was used for early stopping of the iteration.

Table 1 Age distributions of training and test samples.

Evaluation in terms of per-pixel L1 loss and Fréchet Inception Distance

We used the color and UV photo image pairs of the 24 test samples to evaluate the accuracy of UV-photo Net. In order to examine the effectiveness of CGAN and the local alignment, we compared four training conditions; UV-photo Net, UV-photo Net trained without the discriminator, UV-photo Net trained without the local alignment, and UV-photo Net trained without both the discriminator and the local alignment. Table 2 shows per-pixel L1 loss and Fréchet Inception Distance (FID) of synthetic UV images generated in the four training conditions. We defined per-pixel L1 loss as the median of pixel-wise absolute distance between the synthetic UV images and the original UV photo images. {1/2}\right) , \end{aligned}

where $$\varvec{\mu }_1$$ and $$\Sigma _1$$ are respectively the mean and covariance matrix of the features for one type of images, and $$\varvec{\mu }_2$$ and $$\Sigma _2$$ are respectively the mean and covariance matrix of the features for the other type of images. In accordance with the FID calculation in22, we applied image patches of 256 × 256 pixels to Inception-v323 trained on the ILSVRC-2012-CLS image classification dataset (http://www.image-net.org/challenges/LSVRC/2012/) and obtained the mean and covariance in the final layer of Inception-v3 to calculate FID values.

Both per-pixel L1 loss and FID were calculated in face regions, and the smaller value is better for both evaluation metrics. From the comparison, the consideration of the discriminator was effective for the reduction of both evaluation metrics, especially for FID. The local alignment additionally contributed to the reduction of both per-pixel L1 loss and FID. We also considered the per-pixel L1 loss and FID for grayscale images, blue channel images, and melanin emphasized images by an independent component analysis (ICA)-based method by Tsumura et al.24,25. The blue channel of color photo images was expected to be closer to UV photo images than grayscale images. In the ICA-based method, a color skin image is decomposed into two types of images by ICA: one indicates melanin component and the other indicates hemoglobin component as shown in Supplementary Fig. 2a,b. By synthesizing the two components with a higher weight for the melanin component, images emphasizing the melanin component are obtained as shown in Supplementary Fig. 2c. We restricted the sum of weights for the melanin and hemoglobin components to two, and selected the weights minimizing the per-pixel L1 loss from a grid search with a step size of 0.1. The selected weights for the melanin and hemoglobin components were 1.3 and 0.7, respectively. In the comparison of these additional cases, blue channel images were closer to the UV photo images than grayscale images in terms of both per-pixel L1 loss and FID. The use of the ICA-based method further reduced both per-pixel L1 loss and FID. Both per-pixel L1 loss and FID for synthetic UV images by UV-photo Net with any condition were lower than those for images by the ICA-based method, blue channel images ,and grayscale images, which supported the effectiveness of UV-photo Net.

Figure 2 shows color photo images (a,d), synthetic UV images generated by UV-photo Net from the color photo images (b,e), and the original UV photo images corresponding to the color photo images (c,f). The subject was in his fifties and agreed to showing his face photo images. The subject was also included in the 24 test samples, and hence his images were not used for training UV-photo Net. Pigment spots identified in the original UV photo images were well reproduced in the synthetic UV images although there exist pigment spots that UV-photo Net failed to reproduce, e.g., the pigment spots in red circles. Of note, pigment areas were also successfully reproduced in the synthetic UV images for profile faces (Fig.  2e) despite the fact that only the color photo images for front faces were used for the training and validation datasets. In addition, UV-photo Net was able to reproduce some of pigment spots that were difficult to be recognized in the color photo images such as those in yellow circles. We also compared synthetic UV images for the subject by UV-photo Net trained without the discriminator or the local alignment (Supplementary Figs. 3 and 4). The comparison confirmed that both the discriminator for CGAN and the local alignment were effective to generate sharp and clear images.

Figure 3 show heatmap images where heatmaps indicating pixel-wise L1 loss from the UV photo image are overlaid on the UV photo image. From the heatmap images for the front face (Fig. 3a–d), we confirmed that the synthetic UV image by UV-photo Net overall has less L1 loss than the images by the ICA-based method, the blue channel image, and the grayscale image. For the heatmap image for the synthetic UV image by UV-photo Net (Fig.  3a), high L1 loss regions were observed around eyes and nasolabial folds, and these regions were blurred in the synthetic UV image in Fig. 2b. Since the specular reflectance in these regions was different from other regions due to 3D facial geometry, UV-photo Net may fail the precise reconstruction of the synthetic image. For the right profile face, shadowed regions caused by the 3D facial geometry such as the region around the right side of the base of the nose and the left part of the face similarly have high L1 losses in the heatmap image (Fig. 3e).

Table 2 Per-pixel L1 loss and Fréchet Inception Distance (FID) for synthetic UV images generated by UV-photo Net, grayscale images, blue channel images, and images obtained with the ICA-based method (grayscale and blue channel) ($$+$$) denotes the case using the corresponding learning technique for training, while (−) denotes the case without the corresponding learning technique.
Figure 2

Color photo images of a front face and a right profile face (a,d), synthetic UV images generated by UV-photo Net (b,e), and UV photo images (c,f) for a subject.

Figure 3

Heatmap images indicating pixel-wise L1 distance from the UV photo image for (a) the synthetic UV image by UV-phot Net, (b) the image by the ICA-based method, (c) the blue channel image, and (d) the grayscale image for a front face as well as (e) the synthetic UV image by UV-photo Net for a right profile face.

Detection of pigment spots in synthetic UV images generated by UV-photo Net

In order to evaluate the practical usefulness of UV-photo Net for pigment spot detection, we performed pigment spot detection for cheek regions in both synthetic UV images by UV-photo Net and UV photo images. For the pigment spot detection, we devised a U-net-based method named Spot Net. In Spot Net, U-net was trained by using UV photo images and their corresponding pigment spot information from the VISIA system.

We used Spot Net to detect pigment spots in synthetic UV images and UV photo images. Since the VISIA system detects pigment spots in cheek regions only for profile face images, we trained Spot Net using the profile face images for samples included in the training samples. Figure 4a shows pigment spots detected by Spot Net for a cheek region of the UV photo image in Fig. 2f. Spot Net well reproduced pigment spots detected by the VISIA system for the same UV photo image as shown in Supplementary Fig. 5. Figure 4b shows pigment spots detected by Spot Net for the cheek region of the synthetic UV image in Fig. 2e. The pigment spots detected by Spot Net for the synthetic UV image in Fig. 4b formed a similar pattern to those for the UV photo image in Fig. 4a.

We used Spot Net to detect pigment spots in the cheek regions of front face UV photo images and their corresponding synthetic UV images generated by UV-photo Net for the 24 test samples. In order to consider the pigment spot detection directly from color photo images, we also prepared Spot Net that was trained by using color photo images as input images instead of UV photo images. Figure 5a shows boxplots for intersection over union score (IoU), recall, precision, and F-measure obtained by designating pigment spots detected from the UV photo images as true pigment spots. IoU is a metric used for the evaluation on object detection and obtained by calculating the size of the intersection of true and estimated regions divided by the size of their union. F-measure is given by the harmonic mean of recall and precision and used to evaluate the aggregated accuracy considering both recall and precision. For IoU, recall, precision, and F-measure, the maximum and minimum values are 1 and 0, and the higher value is better. The results of synthetic UV images were better than those for color photo images for all IoU, recall, precision, and F-measure. Although the synthetic UV images were also obtained from the color photo images, the information from the UV-photo images via UV-photo Net presumably contributed to the more accurate pigment spot detection.

We measured the percentages of pigment spot areas detected by Spot Net in the cheek regions of the UV photo images and synthetic UV images for the 24 test samples (Fig. {-10}\)). The red line in Fig. 5b indicates the linear regression without intercept for the pairs of the percentages, for which the regression coefficient is 1.05. Since the percentage of the pigment spot areas was highly correlated between UV photo images and synthetic UV images, the size of pigment spot areas in the UV photo images can be estimated by evaluating synthetic UV images. Also, the tendency in the increase of the percentage of pigment spot areas along with the age was observed for both UV photo images and synthetic UV images (Fig. 5c).

Figure 4

Detected pigment spots by Spot Net for (a) the UV photo image of a right profile face and (b) the corresponding synthetic UV image by UV-photo Net. The area surrounded by a blue line is a manually selected cheek region, and the areas surrounded by yellow lines denote the detected pigment spots.

Figure 5

(a) Boxplots of IoU, recall, precision, and F-measure of Spot Net for synthetic UV images and color photo images for 24 test samples. (b) A plot comparing the percentages of pigment spots in cheek regions between UV photo images and synthetic UV images by UV-photo Net for the test samples. Dots indicate pairs of the percentages, and the red line is a linear regression line without intercept for the pairs of the percentages. The regression coefficient is 1.05. The red dot indicates the pair of the percentages for the subject in Fig. 4. (c) A plot showing the relationship between the age and percentage of pigment spot areas for UV photo images and synthetic UV images by UV-photo Net for the test samples. The x-axis indicates the age of the samples, and the y-axis indicates the percentage of pigment spot areas in the cheek regions for the UV photo images and synthetic UV images of the respective samples.

Verification of synthetic UV images for smartphone photo images

We applied UV-photo Net to front, right profile, and left profile face photo images taken by iPhone (Fig. 6a,d,g). The width and height of iPhone images was $$2320\times 3088$$ or $$3024\times 4032$$. The photo images for the front face and the right profile face were taken by putting iPhone near the camera position of the VISIA system. In order to examine the influence of lightning conditions to UV-photo Net, the iPhone image for the left profile face was taken under a standard fluorescent light. Figure 6b,e,h show synthetic UV images by UV-photo Net from the iPhone images in Fig. 6a,d,g, respectively. Two board-certified dermatologists evaluated the synthetic UV images for the iPhone images through the comparison with the original iPhone images (Fig. 6a,d,g) and the UV photo images taken with the VISIA system (Fig. 6c,f,i). Red circles indicate examples of pigment spots that UV-photo Net failed to reproduce, and yellow circles indicate examples of pigment spots that were difficult to be recognized in the iPhone images by the two dermatologists.

The iPhone image for the front face is not well-focused, and hence pigment spots were not reproduced clearly in the corresponding synthetic UV image. On the other hand, the iPhone image for the right profile face is clear, and the pigment spots were well reproduced in the synthetic UV image for the right profile face. The synthetic UV image for the left profile face is less realistic somewhat as the UV photo image due to the difference of the lightning condition. However, the pigment spots were well reproduced in the synthetic UV image because of the clear photographing of the left profile face in the iPhone image. While we demonstrated that UV-photo Net was also effective for the pigment spot detection in the iPhone images, we confirmed the importance of stable environments for taking well-focused photo images for the accurate pigment spot detection from smartphone images.

Figure 6

Color photo images for front, right profile, and left profile faces taken by iPhone (a,d,g), their respective synthetic UV images by UV-photo Net (b,e,h) from the iPhone photo images, and UV photo images for the front, right profile, and left profile faces taken by the VISIA system (c,f,i).

Oral pigmentation: A review

J Pharm Bioallied Sci. 2015 Aug; 7(Suppl 2): S403–S408.

C. Sreeja

Department of Oral and Maxillofacial Pathology, Adhiparasakthi Dental College, Melmaruvathur, Tamil Nadu, India

K. Ramakrishnan

Department of Oral and Maxillofacial Pathology, Adhiparasakthi Dental College, Melmaruvathur, Tamil Nadu, India

D. Vijayalakshmi

Department of Oral and Maxillofacial Pathology, Adhiparasakthi Dental College, Melmaruvathur, Tamil Nadu, India

M. Devi

Department of Oral and Maxillofacial Pathology, Adhiparasakthi Dental College, Melmaruvathur, Tamil Nadu, India

I. Aesha

1Department of Oral and Maxillofacial Pathology, Chettinad Dental College, Chennai, Tamil Nadu, India

B. Vijayabanu

2Department of Oral and Maxillofacial Surgery, Adhiparasakthi Dental College, Melmaruvathur, Tamil Nadu, India

Department of Oral and Maxillofacial Pathology, Adhiparasakthi Dental College, Melmaruvathur, Tamil Nadu, India

1Department of Oral and Maxillofacial Pathology, Chettinad Dental College, Chennai, Tamil Nadu, India

2Department of Oral and Maxillofacial Surgery, Adhiparasakthi Dental College, Melmaruvathur, Tamil Nadu, India

Received 2015 Apr 28; Revised 2015 Apr 28; Accepted 2015 May 22.

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms

Abstract

Pigmentations are commonly found in the mouth. They represent in various clinical patterns that can range from just physiologic changes to oral manifestations of systemic diseases and malignancies. Color changes in the oral mucosa can be attributed to the deposition of either endogenous or exogenous pigments as a result of various mucosal diseases. The various pigmentations can be in the form of blue/purple vascular lesions, brown melanotic lesions, brown heme-associated lesions, gray/black pigmentations.

KEY WORDS: Endogenous, exogenous, oral mucosa, pigmentation

Pigmentation is defined as the process of deposition of pigments in tissues. Various diseases can lead to varied colorations in the mucosa. Pigmented lesions of oral cavity are due to:

• Augmentation of melanin production

• Increased number of melanocytes (melanocytosis)

• Deposition of accidentally introduced exogenous materials.[1,2,3,4]

Oral pigmentation may be physiologic or pathologic. Pathologic pigmentation can be classified into exogenous and endogenous based upon the cause [Tables and ].[2] Exogenous pigmentation could be induced by drugs, tobacco/smoking, amalgam tattoo or heavy metals induced. And endogenous pigmentation can be associated with endocrine disorders, syndromes, infections, chronic irritation, reactive or neoplastic [].

Table 1

Endogenous pigmentation in oral mucosal disease

Table 2

Exogenous pigmentation of oral mucosa

Table 3

Classification of oral pigmentation

Melanin

There are four pigments which contribute to the normal color of the skin and mucosa.

• Melanin

• Carotenoids

• Reduced HB

• Oxygenated HB.

Of these four pigments, melanin is the most important. Melanin is an endogenous nonhematogenous pigment. It is produced by melanocytes in the basal layer of the epithelium and is transferred to adjacent keratinocytes via membrane-bound organelles called melanosomes. It is also synthesized by nevus cells, which are neural crest derivatives and are found in the oral mucosa and skin. Depending on the location and amount of melanin in the tissues, melanin induced pigmentation can be either black, gray, blue or brown in color.[5,6] Oral melanin pigmentation has been reported even among healthy individuals of the dark skinned African population to the prevalence of 100% and in Asians between 30% and 98%.[7] The different types of melanin are

• Eumelanin

• Pheomelanin

• Mixed type melanin

• Neuromelanin

• Oxymelanin.

Drugs

Pigmentation can be produced by various drugs like, hormones, oral contraceptives, chemotherapeutic agents like cyclophosphamide, busulfan, bleomycin and fluorouracil, transquilizers, antimalarials like clofazamine, chloroquine, amodiaquine, anti-microbial agents like minocycline, anti-retroviral agents like zidovudine and antifungals like ketaconazole.

Palate and gingiva are most common sites affected. In addition to mucosal changes, teeth in adults and children may be bluish gray owing to minocycline/tetracycline use. The pathogenesis underlying drug-related pigmentation can be categorized as that occurs because of drug or drug metabolite deposition in dermis and epidermis, enhanced melanin deposition with or without increase in melanocytes, drug-induced post-inflammatory changes to the mucosa especially if the drugs induce an oral lichenoid reaction and bacterial metabolism, alone or in combination, may result in oral pigmentations.[7]

Tobacco

Tobacco habits are practiced in different forms, and many of these habits are specific to certain areas of India. This habit may broadly be classified as smoked tobacco and smokeless tobacco. May occur in up to one of five smokers, especially females taking birth control pills or hormone replacement than in men. Gingival pigmentation in children has been linked to passive smoking from parents and other adults who smoke.[8] Saraswathi et al. in their clinic pathological study reported that the intensity of the pigmentation was more in the labial mucosa than in the buccalmocosa. Also, they mentioned that the pigmentation was absent in smokeless tobacco users but mild pigmentation was observed away from the site of quid placement with the concurrent increase in number of melanocytes and melanocytic activity.[4,8]

Human Immunodeficiency Virus

In human immunodeficiency virus (HIV) the immune system is dysregulated, which leads to increase in inflammatory mediators like interleukin (IL)-1, (IL)-6, tumor necrotic factor (TNF) α which in turn cause a febrile response, as a result of which α melanocytes stimulating hormone (MSH) is released from the anterior pituitary. This opposes the fever induced by IL-1, 6, TNF, α. The αMSH is a potent stimulator of melanocyte, and IL-1 upregulates MSH receptor expression by melanocytes. Therefore, the body’s natural mechanism for controlling fever and inflammation lead to the release of αMSH, which contributes to pigmented lesions in HIV patients.[9]

In HIV, the patient is infected by mycobacterium avium, which in turn involves the adrenal cortex and cause its destruction. The adrenal hypofunction causes increase in level of adrenocorticotropin hormone (ACTH) and MSH as a negative feedback, which causes hyperpigmentation in these patients. Also drugs like ketaconazole, zidovudine given to treat these patients cause oral pigmentation.[9,10]

Tuberculosis

Tuberculous infection can destroy the adrenal gland, and it accounts for <20% of cases of Addison’s disease in the developed countries. In 1849, adrenal insufficiency was identified first by Dr. Thomas Addison Tuberculosis (TB) was the most common cause of Addison’s disease during those times. As, treatment of TB improved, the incidence of adrenal insufficiency due to TB of adrenal glands also showed a great reduction. Here too the pigmentation can be due to the Addisonian effect.[11]

Candidasis

The first description of the association between hypoparathyroidism and candidiasis was published in 1929, and the association of these two diseases with idiopathic adrenal insufficiency was reported in 1946. Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy is a rare, hereditary disease with the classic triad of mucocutaneous candidiasis, adrenocortical failure, and hypoparathyroidism. Any two of these triad is required for the diagnosis. The first clinical manifestation to appear is candidasis in majority of cases, usually before the age of 5 years, followed by hypoparathyroidism (usually before the age of 10 years), and later by Addison’s disease (usually before 15 years of age).[12] Therefore here too the pigmentation probably should be because of Addissonian effect. Furthermore antifungal like ketoconazole also cause oral pigmentation possibly by ACTH pathway.

Heavy Metals

Increased levels of heavy metals (e. g., lead, bismuth, mercury, silver, arsenic and gold) in the blood are commonly known to cause oral mucosal discoloration. Various metals cause various types of pigmentation. For example, pigmentation due to lead poisoning also called as plumbism appears as a blue-black line along the marginal gingiva known as Burtonian line. Occupational exposure to heavy metal vapors is the common cause of pigmentation in adults. The most common cause in the past was, treatment of syphilis with drugs containing heavy metals, such as arsenicals for syphilis.[13,9]

Amalgam Tattoo

Amalgam tattoo is one of the most common causes of intraoral pigmentation. Amalgam tattoos are twice as common as melanotic macules and 10 times as common as oral nevi.[9] The gingiva and alveolar mucosa are most commonly involved. It presents clinically as a localized, blue-gray lesion. Biopsy should be performed to demonstrate the presence of amalgam particles in the connective tissue, in cases of doubt. Reasons for amalgam tattoo are:

(1) Previous areas of mucosal abrasion can be contaminated by amalgam dust within the oral fluids (2) broken amalgam pieces can fall into extraction sites (3) if dental floss becomes contaminated with amalgam particles of a recently placed restoration, linear areas of pigmentation can be created in the gingival tissue as a result of hygiene procedures (4) amalgam from the endodontic retrofill procedures can be left within the soft tissue at the surgical site (5) fine metal particles can be driven through the oral mucosa from the pressure of high-speed air turbine drills.[13,14]

Graphite

Sometimes, graphite may be incorporated into the oral mucosa through accidental injury with a graphite pencil which in turn cause pigmentation. This kind of lesion commonly occurs in children. Clinically, it appears as an irregular gray to black macule in the anterior palate region. Malignant lesions like melanoma should be differentiated from these lesions as melanoma too commonly occurs on the palate.[9]

Autoimmune destruction of the adrenal glands, also known as autoimmune adrenalitis, is now the most common cause of Addison disease in both children and adults.

Hyperpigmentation of the skin and mucosal surfaces, the most specific sign of Addison disease, occurs in up to 92% of patients. This dyspigmentation may precede other manifestations by up to 10 years.

Pigmentation of the oral mucosa is considered pathognomonic for Addison disease. The oral hyperpigmented macules of Addison disease can be found diffusely on the tongue, gingiva, buccal mucosa, and hard palate. The macules tend to be blue-black or brown and can be spotty or streaked in the configuration. Hyperpigmentation associated with Addison disease presumably occurs secondary to overproduction of the pro-opiomelanocortin byproduct-lipotropin, which is secreted in excess amounts concomitantly with corticotrophin from the pituitary gland because of the lack of feedback inhibition seen in adrenal insufficiency states. Cushing’s syndrome, acromegaly and hyperthyroidism also show pigmentation similar to Addison’s disease.[9,13]

Pregnancy

Pregnancy and aging can alter the body and in some cases lead to xazskin dysfunction. Skin becomes more sensitive to MSH and tyrosinase and can develop hyperpigmentation. After pregnancy, melasma – the mask of pregnancy is commonly seen in women. Pigmentation is seen on the face, usually on the upper lip, cheeks, and forehead. It is because the release of a hormone in pregnancy has signaled these distinct areas of the face.

Thyrotoxicosis

Thyroid hormone affects the normal pigmentation of the skin. Both vitiligo and hyperpigmentation have been associated with thyrotoxicosis. Depigmentation that resembles vitiligo seen in thyrotoxicosis may precede thyroid symptoms by many years. Hyperpigmentation may occur in about 7% of cases. It may be a brown diffuse pigmentation or may be localized to the face, neck and palmar creases. There is no mucosal or genital hyperpigmentation in contrast to Addison’s disease. The exact mechanism of hyper and hypopigmentation in thyroid disease is not known. Both autoimmune and thyroid hormone effects are probably responsible. Another theory of explaining these hyperpigmentation could be due to hyperactivity of the sympathetic nervous system.[15,16]

Polyostotic Fibrous Dysplasia

Fibrous dysplasia is a developmental tumor-like lesion in which the bone is replaced by dysplastic fibrous tissue intermixed with irregular bony trabaculae. It occurs because of GNAS 1 mutation. The undifferentiated stem cells during the early embryonic life, the osteoblasts, melanocytes and endocrine cells that represent the progeny of that mutated cell all will carry that mutation and express the mutated gene. It is classified as monostotic (single bone) and polyostotic (multiple bones).

The polyostotic form can be of Jaffe-Lichtenstein or McCune Albright type. Café au lait pigmentation is the common feature in both the for the borders are irregular and called as the coastline of maine. In McCune Albright, additional endocrinopathies are present like sexual precocity, pituitary adenomas or hyperthyroidisim.[13]

Neurofibromatosis

Neurofibromatosis is an autosomal dominant disorder with a high degree of penetrance and variable expressivity. They are classified as neurofibromatosis 1 (NF1) and NF2. Café au lait pigmentation of the skin is commonly seen in NF1. They appear as light brown, oval patches of size more than 5 cm in diameter, the borders of which are smooth, which are compared to the coast of California. It is also known as von Recklinghausen’s disease of the skin.[13]

Hemochromatosis

It was first described by von Recklinghausen in 1889. It is characterized by excessive accumulation of body iron most of which is deposited in parenchymal organs like liver and pancreas and also deposited in other organs. It is a homozygous-recessive inherited disorder that is caused by excessive iron absorption.

Secondary hemochromatosis or acquired hemochromatosis or hemosiderosis occurs as a consequence of parenteral administration of iron, which results in accumulation of iron in tissues. The total body iron pool ranges from 2 g to 6 g in normal adults out of which about 0.5 g is stored in the liver, 98% of which is in hepatocytes. In hemochromatosis, the total iron accumulation may exceed 50 g, over one-third of which accumulates in the liver. Skin pigmentations occur in 75–80% of patients.[15]

Peutz-Jeghers Syndrome

Peutz-Jeghers syndrome is an autosomal dominant disorder. It is associated with germline mutations in the LKB1/STK11 gene, located on the short arm of the chromosome. The syndrome consisted of mucocutaneous macules, intestinal polyposis and increased the risk of carcinomas of the pancreas, gastro-intestinal tract, thyroid, and breast. The macular melanin deposits often involve the lips, buccal mucosa, and fingers. Lesions may also develop on the gingiva, palate, and tongue. Histologically, the oral lesions show an increase in melanin in the basal layer, without an obviously increased melanocyte count. The spots are usually found to fade or disappear in older age 70.[16,17]

Laugier-Hunziker Syndrome

Laugier-Hunziker syndrome is a rare acquired macular hyperpigmentation of oral mucosa and lips frequently associated with longitudinal pigmentation of the nails of unknown cause. Ultrastructural studies have revealed an increase in the number and size of mature melanosomes located in the cytoplasm of basal keratinocytes and dermal melanophages.[8] Few studies have suggested that functional alteration of the melanocytes in the form of an increased production of melanosomes and its subsequent transport to the basal layer cells may give rise to hyperpigmented lesions.[18]

LAMB and LEOPARD Syndrome

LAMB syndrome is characterized by lentigines of the skin and mucosa (lentigines are small, pigmented flat or slightly raised spot with a clearly defined edges that is surrounded by normal-appearing skin or mucosa), atrial and mucocutaneousmyxomas, and multiple blue nevi, while LEOPARD syndrome is characterized by lentigines, ocular hypertelorism, pulmonic stenosis, electrocardiographic abnormalities, abnormalities of genitalia, deafness and retardation of growth.[19]

Posttraumatic Pigmentation

Discoloration that occurs due to hematoma secondary to trauma that leads to hemosiderin deposition, which gives a bluish black discoloration. The color varies from red to blue to purple depending on the age of the lesion and the degree of degradation of the extravasated blood. The clinical feature of these lesions occasionally may be confused with pigment deposition of hematogenous origin. Soft tissue hemorrhagic lesions usually appear in areas accessible to trauma such as the buccal mucosa, lateral tongue surface, lips and junctional of the hard and soft palate.[20]

Postinflammatory Pigmentation

Mucosal diseases in particular lichen planus can cause mucosal pigmentation. These pigmented areas clinically present as multiple brown-black pigmented areas adjacent to reticular or erosive lesions of lichen plants. These areas microscopically show increased production of melanin by the melanocytes and accumulation of melanin-laden macrophages in the superficial connective tissue.[17]

Pigmented Cellular Nevus

Nevis is also called birthmarks. Pigmented cellular nevus is a benign hamartomatous proliferation of the nevus cell either in the epithelium or in the connective tissue. They are basically classified as congenital or acquired. Based on their size the congenital melanocytic nevi are further classified as giant melanocytic congenital nevi (>20 cm) and small melanocytic congenital nevi (<1.5 in diameter). The giant melanocytic congenital nevi are also called as garment nevus, bathing trunk nevus or giant hairy nevus. The acquired melanocytic nevus frequently occurs on the skin and is commonly called as a mole. The hard palate is the common intraoral site. Microscopically based on the location of the nexus cells, they are classified as junctional, intradermal or intramucosal and compound nevi. The color also varies based on the location of nevus cells. Superficial nevi like junctional nevi are darker brown when compared to deeper intramucosal and compound nevi, which are lighter brown. In blue nevi, the blue color of the lesion can be accounted to the fact that the dermal melanocytes proliferate within the deeper part of the connective tissue, far from the surface epithelium (Tyndal effect).[9,13]

Labial Melanotic Macule (Labial Lentigo)

Labial melanotic macule is flat, oval, well defined, solitary brownish black patch which ranges from 1 mm to 8 mm in diameter. These lesions commonly occur on the lower lip with predilection for women.[6] Ultraviolet radiation exposure is thought to be the important etiology this lesion.

Oral Melanotic Macule

Oral melanotic macule is a flat, brown, solitary or multiple mucosal discoloration of oral mucosa, which is produced by a focal increase in melanin deposition along with an increase in melanocyte count. The most commonly involved sites are lip, buccal mucosa, gingiva and palate. Melanin deposition, mainly around the basal layers can be observed on microscopical examination of the lesion.

Oral Melanoacanthoma

Oral melano acanthoma was reported in 1978. It is a rare, reactive, benign lesion of the oral mucosa. It occurs frequently in younger age group with female predilection with buccal mucosa being the most common site. Clinically they appear ad dark brown to black hyperpigmented slightly raised lesion. Microscopically the lesion is characterized by melanocyte proliferation along the acanthotic, hyperkeratotic epithelium.[21]

Pigmented Malignant Lesion

Malignant melanoma

Melanoma is a malignant neoplasm of the epidermal melanocytes. Benign lesions like common acquired nevus, congenital nevus, dysplastic nevus and cellular blue nevus are said to undergo a malignant transformation to melanoma.

Criteria for clinical diagnosis of melanoma.

(ABCDE-rule).

• Asymmetry – is when one-half of the lesion does not match the other half of lesion

• Border irregularity – is when the edges are, notched, ragged or blurred

• Color irregularity – pigmentation is not various colored pigmentation is seen ranging from black, brown, tan, red, blue and white

• Diameter – more than 6 mm

• Elevation – a rise in the surface is also sign.

Types of melanoma

Of these, acral lentiginous and mucosal lentiginous melanoma commonly occur in the oral cavity. Hard palate is the most commonly involved site where it presents as a brown to black macule with irregular borders.[22]

Conclusion

Pigmentation is defined as the process of deposition of pigments in tissues. Various diseases can lead to varied colorations in the mucosa. It can arise from intrinsic and extrinsic factors and can be physiological or pathological. The dentist should be aware of the various lesions to aid in the proper treatment plan.

Footnotes

Source of Support: Nil

Conflict of Interest: None declared.

Photos of skin cancer | Cancer Research UK

Skin cancers can look very different. They might be:

• a spot or sore
• a lump
• a red or dark patch
• itchy, crusty or bleeding

The earlier a skin cancer is diagnosed, the easier it is to treat. So it’s important you visit your GP as soon as possible if you notice a change in your skin.

Looking for signs of skin cancer

Non melanoma skin cancers tend to develop most often on skin that’s exposed to the sun.

To spot skin cancers early it helps to know how your skin normally looks. That way, you’ll notice any changes more easily.

To look at areas you can’t see easily, you could try using a hand held mirror and reflect your skin onto another mirror. Or you could get your partner or a friend to look. This is very important if you’re regularly outside in the sun for work or leisure.

You can take a photo of anything that doesn’t look quite right. If you can it’s a good idea to put a ruler or tape measure next to the abnormal area when you take the photo. This gives you a more accurate idea about its size and can help you tell if it’s changing. You can then show these pictures to your doctor.

Basal cell skin cancers

There are different types of basal cell skin cancers. These include:

• nodular basal cell skin cancer
• pigmented basal cell skin cancer
• morphoeic basal cell skin cancer – also known as sclerosing or infiltrating basal cell skin cancer
• superficial basal cell skin cancer

Nodular basal cell cancer

Nodular basal cell cancers can look see through (translucent) and shiny. You can often also see their blood vessels. Sometimes they have a sore (ulcerated) area and it may also have fluid filled sacs (cystic).

Pigmented basal cell cancer

Pigmented basal cell cancers have dark areas, often brown, blue or grey in colour. They can look like warts or sometimes a melanoma.

Morphoeic basal cell cancer

Pronounced mor-fee-ic, this type of basal cell skin cancer may look like a sore area on the skin that doesn’t heal. It might look skin coloured, waxy, like a scar or thickened area of skin that’s very slowly getting bigger. You might also see small blood vessels.

Squamous cell skin cancers

Squamous cell skin cancers can vary in how they look. They usually occur on areas of skin exposed to the sun like the scalp or ear.

Thanks to Dr Charlotte Proby for her permission and the photography.

You should see your doctor if you have:

• a spot or sore that doesn’t heal within 4 weeks
• a spot or sore that hurts, is itchy, crusty, scabs over, or bleeds for more than 4 weeks
• areas where the skin has broken down (an ulcer) and doesn’t heal within 4 weeks, and you can’t think of a reason for this change

Your doctor can decide whether you need any tests.

Pediatric Benign Skin Growths and Pigmentation Disorders

Abnormal skin growths and abnormal pigmentation of the skin may be present at birth or develop later in life. Although harmless in most cases, skin growth and pigmentation disorders should be monitored closely for any changes that may indicate a development of cancerous skin cells.

There are many types of skin growths and pigmentation disorders that require clinical care by a physician or other healthcare professional. The most common are listed below.

For more information on skin growths, or to find information about conditions not listed, visit the Dermatology Resources for Families, Useful Web Sites section.

What are birthmarks?

Birthmarks are areas of discolored and/or raised skin that are apparent at birth or within a few weeks of birth. Birthmarks are made up of malformed pigment cells or blood vessels. About 10 in every 100 babies have vascular birthmarks (birthmarks made up of blood vessels).

Although the cause of birthmarks is not known, most of them are benign (non-cancerous) and do not require treatment. For safety, however, all babies with birthmarks should be examined and diagnosed by a physician.

What are the most common types of vascular birthmarks?

This list includes the most common types of vascular birthmarks:

• Flat stains (also known as “angel’s kisses or stork bites)
The most common type of vascular birthmark, characterized by pink to red marks that may appear anywhere on the body
• Angel’s kisses: marks located on the forehead and eyelids, which usually disappear after age 2
• Stork bites: marks on the back of the neck, which may last into adulthood
• Hemangioma. A common vascular birthmark. Hemangiomas become visible within the first few weeks of life and continue to grow rapidly for about six to nine months. Then they gradually lose their red color and shrink in size. They are called strawberry hemangiomas.
• Port-wine stains. A port-wine stain, also called a nevus flammeus, is a flat, pink, red, or purple mark that appears at birth, often on the face, arms, and legs, and continues to grow as the child grows. Port-wine stains do not go away and often require treatment if located on the eyelid or forehead. Port-wine stains on the face may cause eye problems.

Other Benign Skin Growths

What are other benign skin growths?

As a person grows older and is exposed to sunlight, the skin changes. Children may have freckles and moles, which may multiply or darken over time.

What are the different types of skin growths?

Skin Growth Characteristics Treatment
Dermatofibromas Small, firm, red or brown bumps caused by an accumulation of fibroblasts (soft tissue cells under the skin). They often occur on the legs and may itch. Dermatofibromas can be surgically removed if they become painful or itchy.
Dermoid Cyst A benign tumor which contains hair, sweat glands, and sebaceous glands. Some internal dermoid tumors may contain cartilage, bone fragments, and teeth. Dermoid cysts may be removed surgically for cosmetic reasons.
Freckles Darkened, flat spots that typically appear only on sun-exposed areas of the skin. Freckles are common in people with blond or red hair. No treatment is necessary for freckles.
Keloids Smooth, firm, raised, fibrous growths on the skin that form in wound sites. Keloids are more common in African-Americans. Keloids respond poorly to most treatment approaches. Injections of corticosteroid drugs may help to flatten them. Other treatment options include surgery or silicone patches to further flatten the keloids.
Lipomas Round or oval lumps under the skin caused by fatty deposits. Lipomas are more common in women and tend to appear on the forearms, torso, and the back of the neck. Lipomas are generally harmless, but if the lump changes shape, the physician may perform a biopsy. Treatment may include removal by surgery.
Moles (nevi) Small skin marks caused by pigment-producing cells in the skin. Moles can be flat or raised, smooth or rough, and some contain hair. Most moles are dark brown or black, but others are skin-colored or yellowish. Moles can change over time and often respond to hormonal changes. Most moles are benign and no treatment is necessary. However, some benign moles can develop into skin cancer (melanoma).
Atypical Moles (dysplastic nevi)  Larger than normal moles (more than one half inch across), atypical moles can be round or irregular in shape. Colors range from tan to dark brown, on a pink background. Atypical moles can occur anywhere on the body. Treatment may include removal of any atypical mole that changes in color, shape, and/or diameter. People with atypical moles should avoid sun exposure, since sunlight can accelerate changes in those moles. Anyone with atypical moles should consult a physician with any changes that may indicate skin cancer.
Pyogenic Granulomas Red, brown, or bluish-black raised marks caused by excessive growth of capillaries (small blood vessels) and swelling. Pyogenic granulomas usually form after an injury to the skin. Some pyogenic granulomas disappear without treatment, while in other cases a biopsy is necessary to rule out cancer. Treatment may include surgical removal.

Distinguishing benign moles from melanoma

According to recent research, certain moles are at higher risk for changing into cancerous growths, including malignant melanoma, a form of skin cancer. Moles that are present at birth and atypical moles have a greater chance of becoming malignant. Recognizing changes in any moles, by following this ABCD Chart, is crucial in detecting malignant melanoma or other cancerous skin growths at their earliest stage of development. The warning signs are:

• Asymmetry: When half of the mole does not match the other half.

• Border: When the border (edges) of the mole are ragged or irregular.

• Color: When the color of the mole varies throughout.

• Diameter: If the mole’s diameter is larger than a pencil’s eraser.

Skin Pigment Disorders

What are skin pigment disorders?

Skin color is determined by pigment (melanin) made by specialized cells in the skin called melanocytes. The amount and type of melanin determines a person’s skin color.

What is the function of melanin?

Melanin gives color to the skin, hair, and the iris of the eyes. Levels of melanin depend on race and amount of sunlight exposure. Sun exposure increases melanin production in order to protect the skin against harmful ultraviolet rays. In addition, hormonal changes can affect melanin production.

What are the different types of skin pigment disorders?

Pigment Disorder Characteristics Treatment
Albinism This rare, inherited disorder is characterized by a total or partial lack of melanin in the skin, compared to the pigmentation of siblings and parents. Albinos (people with albinism) have white hair, pale skin, and pink eyes. Vision is often affected. There is no cure for albinism. Albinos should avoid sunlight because they lack natural protection from sunlight (melanin).
Pigment loss after skin damage Sometimes following an ulcer, blister, burn, or infection, the skin does not replace some of the pigment in that area. No treatment is necessary. Cosmetics can usually cover the blemish.
Vitiligo Smooth, white patches in the skin. Vitiligo is caused by the loss of pigment-producing cells in the skin (melanocytes). The white patches are very sensitive to the sun. There is no cure for vitiligo. Treatment may include covering smaller patches with long-lasting dyes, light-sensitive drugs, ultraviolet A light therapy, corticosteroid creams, and depigmentation of the remaining skin.

Skin Cancer

What is skin cancer?

Skin cancer is a malignant tumor that grows in the skin cells. Skin cancer accounts for 50 percent of all cancers. Melanoma, the most serious type of skin cancer, accounted for about 62,190 cases of skin cancer in 2006. Furthermore, melanoma accounted for most (nearly 8,000) of the 10,710 deaths due to skin cancer in 2006, according to the American Cancer Society.

Fortunately, skin cancers (basal cell and squamous cell carcinoma, as well as malignant melanoma) are rare in children. When melanomas occur, they usually arise from pigmented nevi (moles) with the following characteristics:

• Large (diameter greater than 6 mm)
• Asymmetric
• Irregular borders
• Irregular coloration

Bleeding, itching, and a mass under the skin are other signs of cancerous change. If a child has had radiation treatment for cancer, nevi in the radiated area are at increased risk of becoming cancerous.

What causes skin cancer?

Exposure to sunlight is the major contributing factor to developing skin cancer later in life. In particular, blistering sunburns in childhood and adolescence significantly increase the risk of developing malignant melanoma.

Most people receive more than 50 percent of their lifetime ultraviolet (UV) dose by the age 20. Limiting exposure to sunlight in children and teens may pay large dividends in preventing cancers later in life.

What are the different types of skin cancer?

There are three main types of skin cancer, including:

• Basal cell carcinoma accounts for approximately 75 percent of all skin cancers. This highly treatable cancer starts in the basal cell layer of the epidermis (the top layer of skin) and grows very slowly. Basal cell carcinoma usually appears as a small, shiny bump or nodule on the skin – mainly those areas exposed to the sun, such as the head, neck, arms, hands, and face. It commonly occurs among persons with light-colored eyes, hair, and complexion.
• Squamous cell carcinoma although more aggressive than basal cell carcinoma, is highly treatable. It accounts for about 20 percent of all skin cancers. Squamous cell carcinoma may appear as nodules or red, scaly patches of skin, and is usually found on the face, ears, lips, and mouth. Squamous cell carcinoma can spread to other parts of the body. This type of skin cancer is usually found in fair-skinned people.
• Malignant melanoma accounts for only 4 percent of all skin cancers, but 79 percent of deaths from skin cancer. Malignant melanoma starts in the melanocytes cells that produce pigment in the skin. Malignant melanoma usually begins as a mole that then turns cancerous. This cancer may spread quickly. Malignant melanoma most often appears on fair-skinned men and women, but persons with all skin types may be affected.

Distinguishing benign moles from melanoma

Melanomas vary greatly in appearance. Some melanomas may show all of the ABCD characteristics, while other may only show changes in one or two characteristics. Always consult a physician for a diagnosis.

What are the risk factors for melanoma?

Skin cancer is more common in fair-skinned people, especially those with blond or red hair and light-colored eyes. However, no one is safe from skin cancer. Almost half of all Americans who live to age 65 will be diagnosed with skin cancer at some point in their lives, according to the National Cancer Institute.

Other risk factors include:

• Family history of melanoma
• Sun exposure (the amount of time spent unprotected in the sun directly affects a child’s risk of skin cancer)
• Early childhood sunburns (research has shown that sunburns early in life increase a child’s risk for skin cancer later in life)
• A large number of freckles
• A large number of ordinary moles (more than 50)
• Atypical moles (dysplastic nevi)

What can be done to prevent skin cancer?

The American Academy of Dermatology (AAD) has declared war on skin cancer by recommending these three preventive steps:

• Wear protective clothing, including a hat with a four-inch brim.
• Apply sunscreen all over the child’s body and avoid the midday sun from 10 a.m. to 4 p.m. (Keep infants under 6 months of age out of direct sunlight at all times.)
• Regularly use a broad-spectrum sunscreen with an SPF of 15 or higher, even on cloudy days.

The following six steps have been recommended by the AAD and the Skin Cancer Foundation to help reduce the risk of sunburn and skin cancer:

• Minimize exposure to the sun at midday – between the hours of 10 a.m. and 4 p.m.
• Apply sunscreen, with at least a SPF-15 or higher that protects against both UVA and UVB rays, to all areas of a child’s (older than 6 months of age) body that are exposed to the sun.
• Reapply sunscreen every two hours, even on cloudy days. Reapply after swimming or perspiring.
• Make sure the child wears clothing that covers the body and shades the face. Hats should provide shade for both the face and back of the neck. Wearing sunglasses will reduce the amount of rays reaching the eyes by filtering as much as 80 percent of the rays, and protecting the lids and the lens.
• Avoid exposure to UV radiation from sunlamps or tanning parlors.
• Protect children from excessive sun exposure when the sun is strongest (between 10 a.m. and 4 p.m.), and apply sunscreen liberally and frequently to children 6 months of age and older.

The American Academy of Pediatrics (AAP) approves of the use of sunscreen on infants younger than 6 months old if adequate clothing and shade are not available. Parents should still try to avoid sun exposure and dress the infant in lightweight clothing that covers the skin. However, parents also may apply a minimal amount of sunscreen to the infant’s face and back of the hands.

Remember, sand and pavement reflect UV rays even under the umbrella. Snow is a particularly good reflector of UV rays. Reflective surfaces can reflect up to 85 percent of the damaging sunrays.

How to perform a skin examination

Finding suspicious moles or skin cancer early is the key to treating skin cancer successfully. Examining children is usually the first step in detecting skin cancer. The following suggested method of examination comes from the American Cancer Society:

• Examine the child’s body front and back, then the right and left sides, with arms raised
• Look carefully at the child’s forearms, the back of the upper arms, and the palms of the hands
• Look at backs of the legs and feet, spaces between the toes, and the soles of the feet
• Examine the back of the neck and scalp
• Check the back and buttocks
• Become familiar with the child’s skin and the pattern of moles, freckles, and other marks
• Be alert to changes in the number, size, shape, and color of pigmented areas
• Follow the ABCD Chart when examining moles of other pigmented areas and consult the child’s physician promptly if any changes occur

Treatment for Skin Cancer

What are the treatments for skin cancer?

Specific treatment for skin cancer will be determined by the child’s physician based on the following:

• The child’s overall health and medical history
• Extent and type of the disease
• The tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Child or parent’s opinion or preference

There are several kinds of treatments for skin cancer:

Melasma vs. Hyperpigmentation: Treatments and Symptoms

Chances are, you’re here to find a melasma treatment, but before we get to that, we’ve got a few bases to cover — namely, the differences between melasma and regular old hyperpigmentation. First things first: Hyperpigmentation is a broad term that refers to a skin condition in which the skin is discolored or darkened due to an array of factors, including sun damage, acne scarring, and inflammation lingering from an eczema flare-up. So what is melasma? Well, it’s a form of the condition that’s more common in women and is usually most prevalent on the face in areas like the forehead, chin, and above the lip.

Melasma affects an estimated five million Americans — most of whom are women — and is sometimes referred to as “the mask of pregnancy,” as it frequently appears during pregnancy due to the vast hormonal changes. Much like general hyperpigmentation on the face though, melasma appears in the form of discoloration and is exacerbated by exposure to the sun. Thus, this begs the question: How can you tell if you actually have melasma?

Body & Mind Guide

Symptoms, treatment options, and personal experiences for various physical, mental, and health conditions and concerns.

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To find out, Allure tapped four trusted dermatologists, who detailed how to distinguish melasma vs. hyperpigmentation. Learn everything you need to know, ahead.

Hyperpigmentation can refer to any darkening of the skin.

Post-blemish scarring from a stubborn breakout, freckles that expanded into full-blown sun spots from excess exposure, or discoloration caused by a condition like eczema or psoriasis usually all fall under the umbrella of hyperpigmentation.

This is because acne, sunlight, skin rashes, and the like have the potential to stimulate melanocytes, the pigment-making cells in the skin, to make a surplus of pigment, “causing them to dump their pigment into lower levels of the skin, like tattoo pigment, where it doesn’t belong,” explains Adam Friedman, an associate professor of dermatology at George Washington University Medical Faculty Associates in Washington, D.C.

The deeper the pigment, the tougher it is to treat. Put it this way: A section of skin that’s been consistently exposed to harmful UV rays without the proper protection will be harder to heal or treat than say, a dark spot leftover from a pimple that you’ve been careful to shield from the sun. In other words, the level of severity varies, but if you spot discoloration on your skin that wasn’t there before, it’s safe to assume it’s hyperpigmentation. But always consult your doctor to be sure, of course.

What is melasma?

Melasma is a form of hyperpigmentation that’s more commonly seen in women (especially in those with darker skin tones) and is thought to be triggered by UV exposure, as well as hormonal influences. The latter is what differentiates it from traditional hyperpigmentation and makes it tougher to treat.

Laser removal of age spots in Rostov-on-Don

• pigmented scars
• freckles
• age spots
• seborrheic keratosis
• “sunspots”
• epidermal moles
• traumatic pigmentation

Sooner or later, everyone has to deal with such a problem as pigmentation.The appearance of age spots on the face and on the body is a lot of worries and troubles.

Pigmented spots are the result of excess accumulation of melanin, which turns the skin yellow-brown. The most common causes of pigmentation are: skin aging, excessive exposure to the sun or tanning beds, pregnancy, hormonal changes, systemic metabolic disorders, various diseases, etc.

The presence of pigmentation in some cases may even be unsafe for health: if skin cancer is detected, the pigment can make it difficult to detect.

To remove age spots, as a rule, cryotherapy, acid washout, whitening, phototherapy, low-energy impulse therapy, etc. are used. Often these methods do not provide the desired result and the effect of the treatment does not last long. To date, the most effective technology for removing pigmentation without a trace of any etymology, complexity and size is FT laser pigmentation removal.

Procedure description:

• The pigmentation area is treated with several laser flashes
• Immediately after the procedure, the stain will become darker and more visible
• On the 3-4th day, a dark crust forms, after its exfoliation, clean healthy skin remains, or the stain becomes much lighter

The essence of the procedure:

The FT laser pigmentation removal procedure consists in the action of a laser beam on the melanin particles and the layer-by-layer destruction of the pigment.After laser exposure on the skin, in the treated area, young cells are formed, which synthesize and accumulate the required amount of pigment, from which the color of the treated area changes to a lighter one. As a result, clean and healthy skin forms at the site of the age spot. The procedure is performed without anesthesia and has no side effects.

Effect:

after 2 weeks, the treated pigment disappears without a trace.

Course:

from 3 or more procedures with an interval of 3-4 weeks.

Recovery period:

2 weeks. On these days, a slight swelling is possible, which disappears in 2 days. Within 5-7 days, a thin crust forms on the skin, which heals without scarring.

Results before and after

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90,000 Hyperpigmentation – occurrence, treatment methods

Disorders of skin pigmentation are associated with an increase in the content of melanin in the skin.Melanin is a protein pigment that determines the color of our skin. Normally, as a natural filter, it protects the skin from dangerous UV rays from the sun. However, melanocytes, the skin cells that produce melanin, are sensitive to many factors, primarily hormonal fluctuations, inflammation, medication, trauma, hypoxia and stress. This can lead to increased pigment production. As a result, foci of hyperpigmentation are formed – areas of the skin of a dark brown color.Unfortunately, once having appeared, they do not pass over time, like an “ordinary” tan, but persist for a long time, increasing and increasing in size after each “meeting” with the sun.

Many patients ask the question: how to “erase” age spots and achieve an even skin tone without the risk of cancer and side effects. There are many ways to combat pigmentation, but not all products are equally effective and safe.

For example, some peels are able to “erase” age spots, but are too aggressive. The skin reacts to them with irritation, dryness, complete loss of pigment, or even, paradoxically, with the same hyperpigmentation.

Preparations for external use with a whitening effect work sparingly, however, they are often inconvenient to use, since the application of such products requires jewelry precision, and this is difficult to achieve, especially when pigmentation is localized on the back. Many of our patients have encountered a problem in the use of such funds.The fact is that when they get on the skin outside of pigmentation, bleaching agents discolor it too, thereby enhancing the “visual” effect – on bleached skin, the areas of hyperpigmentation look even brighter.

The most effective and safe method of treating skin hyperpigmentation is photo and laser therapy. The method consists in percutaneous photothermal coagulation of melanin. At the same time, healthy skin remains intact. This technique is safe, after treatment there is no scar or other damage to the skin.Several modern therapy devices are used. The FRAXEL laser allows you to solve the problem of deep, long-term skin hyperpigmentation. The IPL device, which uses selective pulsed phototherapy technology, removes areas of pigmentation in parallel by coagulating dilated microcapillaries.

The course of treatment is purely individual, it takes into account the “phototype” of the patient, the duration of the hyperpigmentation that has arisen and many additional factors.

A pleasant addition to even out skin tone is the rejuvenating effect, the so-called photorejuvenation, which is achieved by stimulating collagen and elastin-producing cells with infrared rays.

It remains to add that we have accumulated significant experience in the treatment of skin hyperpigmentation, so our patients are guaranteed a lasting cosmetic result.

90,000 causes of occurrence, symptoms of the disease, diagnosis and treatment methods

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-medication. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests.For a diagnosis and correct treatment prescription, you should contact your doctor.

Chloasma: causes, symptoms, diagnosis and treatment.

Definition

Chloasma is an acquired limited hypermelanosis, or hyperpigmentation of the skin (a violation of the process of melanin pigment formation in the direction of amplification). Melanin grains accumulate in the cells of the basal and prickly layers of the epidermis, the number of melanosomes in the surface layers of the dermis increases.Dark yellow or dark brown spots more often appear in women between the ages of 20 and 50, have an irregular shape and are usually localized on the skin of the face – in the cheeks, upper lip, around the eyes, on the temples and the bridge of the nose.

Chloasma occurs in pregnant women, patients with chronic liver disease, women who are diagnosed with gynecological inflammatory processes, or using drugs for oral contraception.

What causes chloasma

The exact cause of chloasma is unknown.There are observations that indicate a genetic predisposition to excessive formation of melanin – cases of the disease are known in several family members at once. Exposure to sunlight plays a significant role in the development of chloasma – exacerbations occur after prolonged exposure to the sun and fade away when there is no insolation.

Chloasma often appears during pregnancy, therefore its other name is “mask of pregnant women”. This type of dyschromia partially or completely disappears in the postpartum period after the resumption of menstruation.However, residual effects can persist for a fairly long period.

Chloasma can manifest against the background of taking hormonal contraceptives, in patients with ovarian tumors, since there is a connection between increased melanin production and changes in the level of sex hormones estrogen and progesterone.

The risk factors that provoke the formation of chloasma include:

• pregnancy, menopause;
• viral hepatitis, liver cirrhosis, tuberculosis;
• inflammatory diseases of the genital organs in women;
• taking oral contraceptives;
• Excessive sun exposure, including artificial tanning.

Classification of the disease

Depending on the localization of foci on the face, the following clinical forms of the disease are distinguished:

• centrofacial chloasma – located in the center of the forehead, on the nose, in the upper lip, chin;
• molar chloasma – located on the cheeks and wings of the nose;
• mandibular (mandibular) chloasma – located on the skin of the lower jaw.

According to the clinical course there are:

• passing forms – spots disappear on their own, without treatment;
• persistent forms – spots decrease during treatment, the progress of the disease slows down, but hyperpigmentation does not completely go away.

Depending on the level of deposition of pigment melanin, there are:

• epidermal type;
• dermal type;
• mixed type.

Chloasma symptoms

Chloasma is characterized by various sizes of light brown, dark brown or irregularly colored spots of irregular shape, single or multiple. As a rule, they are located symmetrically on open areas of the skin of the face, less often on the neck, in the décolleté area.The spots have clear uneven borders, are not raised above the surface of the skin, they can merge with each other. Chloasma does not cause physical discomfort, since it is not accompanied by peeling, itching and soreness.

In pregnant women, chloasma spots can be localized on the midline of the abdomen, in the area of ​​the nipples and external genitalia.

Chloasma Diagnostics

The diagnosis of “chloasma” is established by a doctor on the basis of examination and collection of anamnesis – to exclude the congenital or post-inflammatory nature of hyperpigmentation.

A specialist carries out a more detailed study of age spots using the dermatoscopy method. A dermatoscope is a device designed to examine the superficial and deep layers of the skin under 10x (sometimes more) magnification. Dermatoscopy is widely used in modern dermatology and cosmetology and allows detecting malignant changes in the early stages, as well as observing age spots in dynamics to assess the effectiveness of treatment.

Using a Wood’s lamp (ultraviolet lamp) helps to distinguish between epidermal and dermal types of chloasma.

Laboratory diagnostics includes the determination of the level of sex hormones in the blood: estradiol, progesterone, luteinizing hormone, testosterone.

Since in some cases hyperpigmentation can be one of the manifestations of an ovarian tumor, an ultrasound examination (ultrasound) of the pelvic organs is performed.

If a malignant neoplasm is suspected, a blood test is prescribed for the ovarian tumor marker – SA.
Which doctors should I contact

Examination and treatment of patients with hyperpigmentation are performed by dermatologists.Since the development of the disease can be associated with hormonal imbalances, it is often involved in the examination and treatment process.
gynecologist.

Chloasma treatment

Benign hyperpigmentation does not affect health in general, does not degenerate into malignant neoplasms, but their appearance on the face often brings psychological discomfort.

For effective treatment of chloasma, first of all, it is necessary to eliminate the cause that triggered the development of this disease.For example, if chloasma occurs as a result of liver disease, then first of all, the function of this organ is restored. In cases where chloasma has become a consequence of hormonal disorders, drugs are prescribed that correct this condition, change or completely cancel oral contraceptives, etc.

Before proceeding with the cosmetic removal of chloasma stains, you need to make sure that the skin care products used on a regular basis do not contain photosensitizing ingredients – retinoids, alpha and beta hydroxy acids, etc.etc.

In the arsenal of modern cosmetology there are many methods aimed at correcting age spots. Their appointment is the competence of a dermatologist. In cases where chloasma is localized in the epidermis, it is often possible to limit ourselves to depigmenting cosmetic preparations, which include arbutin, kojic, ascorbic and azelaic acids, hydroquinone, rucinol and other active substances with whitening properties. In addition, mesotherapeutic procedures are performed, as well as chemical peels (phytic, retinoic, pyruvic, azelaic, glycolic, etc.).In case of ineffectiveness of treatment, hardware procedures are used – microdermabrasion, laser resurfacing or laser peeling.

Fractional laser or neodymium laser procedures are recommended for dermal chloasma.

Complications

Chloasma does not have complications that could affect a person’s vital activity, but it brings considerable psychological discomfort.

Prevention of chloasma

The main preventive measure is limiting exposure to the open sun, excluding visiting tanning salons and using sunscreens even in cloudy weather.

When using hormonal contraceptives, it is necessary to discuss the possibility of their cancellation with the gynecologist.

A number of medicines and cosmetics have a photosensitizing effect – they increase the sensitivity of the skin to the sun’s rays. The doctor will help you choose their counterparts, which will minimize the risk of further development of chloasma.

Sources:

1. Melasma – European guidelines.
2. Kurbanova D.Ch. The problem of the prevalence of chloasma and melasma in women. Bulletin of Science and Practice, journal. Vol.5, No. 7. 2019.
IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-medication. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For a diagnosis and correct treatment prescription, you should contact your doctor.

Information checked by an expert

Lishova Ekaterina Alexandrovna

Higher medical education, work experience – 19 years

90,000 Pigmentation of skin and hair in dogs: causes, symptoms, diagnosis, treatment

Contents of article

The skin and hair of a dog is a “mirror” of its inner state.The appearance of pigmentation in these areas signals the owner about abnormal processes in the animal’s body.

The article discusses the causes of the appearance of pigmentation in dogs, symptoms, treatment and preventive measures.

The reason for the appearance of pigmentation

Pigmentation (spotting), as well as a change in coat color from the root, do not refer to certain diseases, but speak about the reaction of the animal’s body to a change in its state.

The causes of stains are divided into two large groups:

• genetic;
• purchased.

Genetic pigmentation includes:

• Lentigines are single or group spots on the trunk, neck, abdomen and limbs of a dog caused by excessive formation of melanin pigment;
• “moles” (epidermal or pigmented nevi) are found on the skin of the animal, the upper eyelid, the mucous membrane of the eye;
• acanthosis nigricans is characterized by thickening of the skin with darkening of color and the formation of warts in the folds of the skin.

Acquired pigmentation may result from the following factors:

• post-inflammatory pigmentation that occurs at the site of skin inflammation or injury;
• increase in the level of hormones, as a result of which the melanin pigment increases;
• metabolic disorder of an animal.This is a process in which improper lipid, protein, fluid and vitamin-mineral metabolism occurs;
• unbalanced nutrition;
• unfavorable environmental conditions, provoking allergic reactions and activation of histamines, leading to a malfunction of metabolic processes;
• tumors that acquire a pigmented color and carry the risk of malignant formation.

Breeds susceptible to manifestations of pigmentation or changes in coat color

No breed of dog is immune from the manifestations of pigmentation, especially in adulthood.

But there are breeds in which genetic abnormalities were tracked and their course was observed – these are pugs (lentigo) and dachshunds (black acanthosis).

Tendency to lentigo has been noted in pygmy schnauzers and sharpei.

German Shepherds are prone to acquired pigmentation. These are bacterial infections affecting the face and lupus vulgaris.

Scottish Shepherds are prone to lupus vulgaris, which also affects the face of the animal.

Chow Chow and Akita Inu have a predisposition to an acquired disease of an autoimmune nature, in which the skin is affected with inflammatory purulent discharge.

Loss of pigmentation in the area of ​​the nose and lips is threatened by inflammation of the anterior part of the eye in breeds such as Akita Inu, Samoyed and Siberian Huskies.

Doberman Pinschers, Rottweilers, Siberian Huskies, Alaskan Malamutes and Labrador Retrievers are prone to depigmentation (dyeing the coat white).

Poodle, Yorkshire, Silky and Bedlington Terriers, Old English Sheepdog are breeds in which, due to a malfunction of the sebaceous glands or during the recovery period after an illness, a change in coat color may be noted.

Main symptoms

The development of pigmentation can be sluggish or, conversely, with a rapid development, depending on the symptoms that cause it.

Signs of genetic pigmentation can be:

• single or groups of dark spots on the belly, limbs, torso of the dog, as well as on the eyelids and mucous membranes of the mouth;
• pigmentation in armpits, groin without signs of inflammation.

Signs of acquired pigmentation and ongoing inflammatory processes are:

• strangely shaped spots that change their size from slight to noticeable changes in skin color;
• inflamed spots of dark or red color;
• spots become thicker, itchy, the skin is smoothed;
• irritation due to friction in the armpits;
• depigmentation or pigmentation of the pet’s nose;
• Change in coat color, for example, infectious pathogens cause a light coat to turn rusty brown.

Diagnostics in a veterinary clinic

If the dog’s appearance changes, it should be shown to the veterinarian. Spots on the skin or a change in coat color indicate hidden pathologies in the dog’s body.

The specialist, having carried out the examination, prescribes an examination with the delivery of tests:

• blood tests – general and biochemical;
• urine analysis – general and electrolyte;
• skin scrapings for bacterial and fungal cultures;
• samples of fluid from the joints of the animal to exclude lupus, if symptoms are typical for it;
• ultrasound examination of the thyroid gland, kidneys and adrenal glands;
• skin samples for allergic reactions.

Treatment method and prognosis

Depending on the results of the examination, the doctor selects the treatment method. These can be antibiotics or immunosuppressants.

With a genetic basis for pigmentation, treatment is not prescribed to a pet. In such cases, it is excluded from breeding and stains are monitored. Their control is necessary due to the possible thickening and development of seborrhea or other disease. This development of pigmentation will require taking special medications prescribed by a specialist.

For the treatment of diseases of acquired pigmentation, the doctor prescribes a course of therapy. After taking medications and applying ointments, the main cause of pet spotting or changes in coat color is eliminated and the condition of the animal is normalized.

When suspicious spots appear on the dog’s skin, it is important to show the pet to the doctor: after all, these can be signs of both skin cancer and other disorders in the animal’s body.

What to do at home

The appearance of spots on the skin, a change in the color of the coat in dogs – all these insidious abnormalities cannot be treated on their own.

Without specific diagnostics in a veterinary clinic, finding out the main cause of the changes that have appeared, it is impossible to alleviate the condition of the animal.

Therefore, at home, you should follow all the doctor’s prescriptions, and if the diagnosis of lupus is confirmed, protect the dog from exposure to ultraviolet rays.

The use of ointments and medicines, selected by the doctor, will speed up the pet’s recovery.

Possible complications

With a genetic basis for pigmentation, the condition of the spots should be monitored.If a red halo appears around them (a sign of inflammation), you should consult a doctor.

Self-medication is not allowed. A dangerous infection can develop in the dog’s body and assistance provided out of time will require either long-term severe treatment, or will not be able to overcome the advanced form of the disease.

Preventive measures

The animal’s body is constantly metabolizing, which provides the pet with energy.

To exclude diseases leading to metabolic disorders with pronounced pigmentation phenomena, it is necessary to ensure:

1. Balanced nutrition.If you are obese, it is advisable to discuss a low-calorie diet with your doctor.
2. To exclude allergic reactions – control the introduction of new feed.
3. When taking vitamins, the individual needs of the animal should be discussed with the veterinarian, excessive use of vitamins can lead to a change in coat color, pigmentation.
4. Provide physical activity to the pet, based on the needs of the breed.

We must not forget that latent processes, which are expressed on the skin by pigmentation, signal the owner to visit a veterinarian.And an important factor in recovery will be the owner’s compliance with all prescribed procedures and attention to the sick pet.

Time Wise® Serum

• Description
• Tips for using
• Key Ingredients
• How the tool
• works

Shine like never before!

• TimeWise® Tone Serum will transform tired and lifeless skin.
• Pigmentation, hyperpigmentation, dark spots and freckles – this serum will help you to cope with all these imperfections.
• Restore the natural, bright glow of the skin; return a healthy and even tone; present the world with beautiful and radiant skin.
• Use the product twice a day – morning and evening.
• For one application on the face, the product obtained from 1-2 taps on the dispenser is sufficient.
• Using your fingertips, spread the product evenly over the face, following the massage lines.

PERFECTLY BRIGHT Complex:

• White Kidney Bean Extract – brightens the skin, reduces the appearance of age spots and evens out skin tone *.
• Algae extract – affects the proteins of the skin *, which are responsible for the reduction of pigmentation on its surface *.
• Niacinamide – reduces the appearance of age spots on the skin surface.

• Extracts of pine and birch – affects the proteins of the skin *, which are responsible for the natural skin tone *.
• Hexylresorcinol – has antibacterial and antiseptic properties.
• Alpine edelweiss extract – has a softening and moisturizing effect, as well as photoprotective and antioxidant properties.

• Dermatologically tested.
• Suitable for sensitive skin.
• Clinically tested for skin irritation and allergic reactions.

* Based on in-vitro studies.

This lightweight, fast-absorbing serum works great on a variety of skin tone imperfections (uneven tone, age spots, freckles) on all skin tones and types.

• Contains Perfectly Bright ™ brightening complex based on white kidney bean extract, pioneered in a cosmetic product.
• Significantly evens out skin tone, reduces the appearance of age spots and freckles, giving the skin a natural glow.
• Effectively improves the appearance of the skin, making it flawless.
• 95% of women noticed a reduction in the size of age spots after 12 weeks * of use.
• Suitable for all skin tones and types.

* Results of a clinical study with independent experts in which 60 women used the product twice a day for 12 weeks

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90,000 What is vitiligo: causes, symptoms, treatment

With vitiligo, light spots with evenly defined edges are formed on the skin of the hands, face or the whole body.The pathology is not contagious and has the character of a chronic disease that occurs for internal reasons. The disease can progress, that is, go through several stages in development and become more and more noticeable. The appearance of a person with vitiligo attracts the wary attention of others and often causes psychological discomfort.

It is important to understand that vitiligo is not just a cosmetic skin defect. A pigmentation disorder can cause serious malfunctions in the body that require attention and, without treatment, threaten with complications.You can get a doctor’s consultation for vitiligo symptoms, undergo diagnostics and discuss therapy options with a specialist at the Medical Center on Botanicheskaya.

What is vitiligo and how does this disease manifest itself

Vitiligo disease is a violation of the synthesis of melanin, a skin pigment. In some areas of the skin, the number of special cells – melanocytes, which give the skin its usual color – is sharply reduced.

As a result, light beige, almost white spots of irregular shape are formed, which stand out sharply against the background of healthy skin and are separated from it by clear boundaries.The number and size of spots may vary depending on the stage of the disease.

Light areas appear:

• on the face;
• on the skin of the hands, more often on the elbows, wrists and backs of the palms;
• under the knees;
• in the armpit area;
• in the groin and other parts of the body.

Sometimes the disease also affects the scalp, and in men, the skin in the area of ​​beard and mustache growth.

Stages and forms of vitiligo

There are several stages of vitiligo:

1. Initial stage.The first light area appears on the skin and, in general, the pigmentation of the skin is disturbed.
2. Progressive vitiligo. At this stage, the shade of the spots changes, the difference in the pigmentation of the skin areas becomes more noticeable, new light areas appear. This usually happens gradually over 3-4 months. But in 20% of cases, vitiligo develops with lightning speed.
3. Stationary vitiligo. During this period, new spots no longer appear and there are no special changes in the condition of the skin.The shade of the affected areas may vary slightly, but within the established boundaries.
4. Repigmentation. This is the stage of improvement, when light spots on the skin gradually regain their natural shade. It can occur as a result of effective treatment or with mild reversible forms of vitiligo (arising, for example, as a side effect after a procedure with a beautician or taking medication).

There are also two forms of the disease, depending on the size of the affected area.If light spots are located within one zone on the body (for example, vitiligo on the face), they speak of a segmental form of the disease. If vitiligo affects almost the entire body, it is a generalized form.

Causes of Vitiligo

The causes of vitiligo are always internal: it is a non-communicable disease.

Factors such as:

can provoke the development of the disease

1. Heredity. Melanin deficiency can be congenital and this increases the risk of vitiligo.
2. Malfunctions of the immune system. In 1959, A. Lörints suggested that some patients develop vitiligo due to autoimmune disorders, and today this is a theory recognized in science.
3. Neuroendocrine causes – malfunctions of the adrenal glands, pituitary gland, ovaries, pancreas and other hormone-producing organs.
4. Solar, thermal and chemical burns, skin injuries, as well as systematic ultraviolet irradiation without protective equipment with SPF.
5. Gastroenterological diseases: disturbances in the functioning of the liver, stomach, intestines.
6. Infectious diseases of a viral or bacterial nature (vitiligo can develop against the background of a weakened immune system).
7. Severe intoxication.
8. Severe stress.

Although it has been proven that a predisposition to vitiligo is sometimes transmitted genetically, a child is rarely born with such a pathology. As a rule, vitiligo on the hands, face or body develops later: in the period from 10 years to about 30 years of age.

Science established the causes of vitiligo not so long ago, but the disease itself has been known since antiquity. For the first time the term “vitiligo” was used by the ancient Roman physician Aulus Cornelius Celsus (1st century AD).

Diagnostics of vitiligo

To establish the cause of vitiligo in a particular case, the doctor may prescribe laboratory diagnostic methods (primarily general and biochemical blood tests), as well as ultrasound or MRI of internal organs. In addition, consultation of a neurologist, gastroenterologist, endocrinologist and other specialized specialists is often required.For treatment to be successful, it is important to diagnose associated disorders in the body.

Is vitiligo amenable to treatment

Success in treating vitiligo depends on the underlying causes of the disease.

If the pathology is genetic or has appeared as a result of incurable autoimmune disorders, it is often impossible to completely restore pigmentation. But well-chosen therapy will help stop the progression of vitiligo.

If the cause of vitiligo is reversible disturbances in the work of internal organs, you need to start with their diagnosis and treatment.In this case, there is a chance for a significant improvement.

In parallel with the treatment of the main internal problem, the doctor can prescribe procedures that affect the condition of the skin:

• course of specially selected hormonal medicines, as well as vitamin complexes;
• phototherapy;
• laser therapy;
• methods of hardware cosmetology: peeling, resurfacing, etc .;
• treatment with a UV lamp;
• skin whitening.This method does not directly treat vitiligo, but it can reduce the contrast between light spots and pigmented areas;
• in rare cases – surgical intervention by transplanting healthy skin cells. This method is not always justified and has contraindications.

Diagnostics and treatment of vitiligo in Moscow

If you are faced with signs of vitiligo and other skin diseases, the doctors of the Medical Center on Botanicheskaya will help you.Sign up for a consultation to solve the problem on time and reduce the risk of complications.

Laser removal of age spots in Volgograd

“No” – pigmented spots, “yes” – beautiful skin!

“They meet by their clothes …” – says a Russian proverb. Beautiful healthy skin is our “clothing”, a visiting card of any person. It’s no secret that beautiful people inspire more confidence, they are confident and doomed to success. And skin problems can cause complexes.Pigmented spots on the face are one of such aesthetic defects, which for the most part does not pose any threat to human health. No one is immune from the appearance of age spots. They appear from prolonged exposure to the sun and are found on the skin of 90% of the inhabitants of the Earth. There are other reasons for the appearance of age spots:

• fluctuations in the level of hormones, which are most often caused by pregnancy or taking hormonal contraceptives;
• use of substandard or unsuitable cosmetics;
• taking certain medications.

A quick and safe method of getting rid of age spots on the skin using a copper vapor laser “Yakhroma-Med” is offered by the clinic GAUZ “Medical Center” “Cosmetology clinic”.

How does a laser work?

A pigmented spot is a large accumulation of melanin in a limited area of ​​the skin. The Yakhroma-Med copper vapor laser emits two wavelengths. The green wave is used to remove benign pigmented lesions. A focused light spot is directed to the neoplasm.Under the influence of heat, melanin (pigment) and melanocytes (pigment-producing cells) are destroyed. If everything is done correctly, then the age spot changes color from dark to light gray or even flesh-colored. In rare cases, a second procedure is required if the spot is too pigmented or large in size.

Benefits of laser pigmentation removal:

• The planned result is achieved in 90% of applications.
• Complications are practically excluded.
• There is practically no rehabilitation period. Immediately after the procedure, you can start your daily activities.
• The procedure is painless and safe.
• After the procedure, it is necessary to refrain from exposure to direct sunlight and mechanical impact on the treated area.

You can also get rid of age spots at home. GAUZ “Medical Center” “Cosmetology Clinic” recommends complex care for age spots with professional cosmetics “Premium”.It includes: cream for the care of skin with freckles, stagnant and age spots. The cream has a brightening effect, activates regeneration and suppresses the production of melanin.

• Brightening Serum. It is used to achieve a pronounced whitening effect in various types of skin pigmentation disorders, including freckles.
• “Brightening” cream-mask – intended for intensive care of the skin requiring correction of hyperpigmentation – freckles, age spots and chloasma.Thanks to koic acid, glycolic acid, superoxide dismutase and shea and corn oils, it has a pronounced whitening effect.