Hyperpigmentationis the darkening of an area ofskinornailscaused by increasedmelanin.
| Hyperpigmentation | |
|---|---|
 | |
| Specialty | Dermatology |
| Causes | Melanogenesis |
The article'slead sectionmay need to be rewritten.(February 2024) |
Causes
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Hyperpigmentation can be caused by sun damage,inflammation,or other skin injuries, including those related toacne vulgaris.[1][2][3]: 854 People with darker skin tones are more prone to hyperpigmentation, especially with excess sun exposure.[4]
Many forms of hyperpigmentation are caused by an excess production of melanin.[4]Hyperpigmentation can be diffuse or focal, affecting such areas as the face and the back of the hands. Melanin is produced bymelanocytesat the lower layer of theepidermis.Melanin is a class of pigment responsible for producing color in the body in places such as the eyes, skin, and hair. The process of melanin synthesis (melanogenesis) starts with the oxidation ofl-tyrosine tol-dopaby the enzymetyrosine hydroxylase,then tol-dopaquinoneanddopachrome,which forms melanin.[5]
As the body ages, melanocyte distribution becomes less diffuse and its regulation less controlled by the body. UV light stimulates melanocyte activity, and where concentration of the cells is greater, hyperpigmentation occurs. Another form of hyperpigmentation is post-inflammatory hyperpigmentation. These are dark and discoloured spots that appear on the skin following acne that has healed.[6]
Diseases and conditions
editHyperpigmentation is associated with a number of diseases or conditions, including the following:
- Addison's diseaseand other sources ofadrenal insufficiency,in which hormones that stimulate melanin synthesis, such asmelanocyte-stimulating hormone(MSH), are frequently elevated.
- Cushing's diseaseor other excessiveadrenocorticotropic hormone(ACTH) production, because MSH production is a byproduct of ACTH synthesis fromproopiomelanocortin(POMC).
- Acanthosis nigricans—hyperpigmentation ofintertriginousareas associated withinsulin resistance.
- Melasma,also known as 'chloasma' or the “mask of pregnancy,” when it occurs in pregnant women.— It is a common skin problem that causes dark discolored patchy hyperpigmentation. It typically occurs on the face and is symmetrical, with matching marks on both sides of the face. The condition is much more common in women than men, though men can get it too. According to theAmerican Academy of Dermatology,90 percent of people who develop melasma are women.[7]
- Post-Acne marksfrom post-inflammatory hyperpigmentation.
- Linea nigra—a hyperpigmented line found on theabdomenduringpregnancy.
- Peutz–Jeghers syndrome—anautosomal dominantdisorder characterized by hyperpigmentedmaculeson the lips and oral mucosa and gastrointestinalpolyps.
- Exposure to certain chemicals such assalicylic acid,bleomycin,andcisplatin.
- Smoker's melanosis
- Coeliac disease
- Cronkhite–Canada syndrome
- Porphyria
- Tineafungal infections such asringworm.
- Haemochromatosis—a common but debilitating genetic disorder characterized by the chronic accumulation ofironin the body.
- Mercury poisoning—particularly cases of cutaneous exposure resulting from the topical application of mercurial ointments or skin-whitening creams.
- Aromatase deficiency
- Nelson's syndrome
- Graves' disease
- Schimke immunoosseous dysplasia (SOID).[8]
- As a result oftinea cruris.
- Due toB12 deficiency.[9]
- Atopic dermatitisas a result of inflammation.[10]
Hyperpigmentation can sometimes be induced bydermatologicallaserprocedures.
Diagnosis
edit- Skin examination includingWood's lampexamination.
- Viewingmedical history.
Treatment
editThere are a wide range of depigmenting treatments used for hyperpigmentation conditions, and responses to most are variable.[11]
Most often treatment of hyperpigmentation caused by melanin overproduction (such as melasma, acne scarring, liver spots) includes the use of topical depigmenting agents, which vary in their efficacy and safety, as well as in prescription rules.[12]
Topical treatments
editMany topical treatments disrupt the synthesis of melanin by inhibiting the enzymetyrosine hydroxylase.[5]
Several are prescription only in the US, especially in high doses, such ashydroquinone,azelaic acid,[13]andkojic acid.[14]Some are available without prescription, such asniacinamide,[15][16]l-ascorbic acid,[citation needed]retinoids such astretinoin,[17]orcysteamine hydrochloride.[18][19]Hydroquinone was the most commonly prescribed hyperpigmentation treatment before the long-term safety concerns were raised,[20]and the use of it became more regulated in several countries and discouraged in general byWHO.[21]For the US, only 2% is at present sold over-the-counter, and 4% needs prescription. In the EU hydroquinone was banned from cosmetic applications.[22]
Oral
editOral medication withprocyanidinplus vitamins A, C, and E also shows promise as safe and effective for epidermal melasma. In an 8-week randomized, double-blind, placebo-controlled trial in 56 Filipino women, treatment was associated with significant improvements in the left and right malar regions, and was safe and well tolerated.[23]Other treatments that do not involve topical agents are also available, including fraction lasers[24]and dermabrasion.[12]
Laser treatments
editLaser toning usingYAGlasers[25]andintense pulsed lighthave been used to treat hyperpigmentation such as melasma and post-inflammatory hyperpigmentation.[26]
See also
editReferences
edit- ^"Hyperpigmentation".Dermatalogic Disease Database.American Osteopathic College of Dermatology.Retrieved2006-03-08.
- ^Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007).Dermatology: 2-Volume Set.St. Louis: Mosby.ISBN978-1-4160-2999-1.
- ^James, William; Berger, Timothy; Elston, Dirk (2005).Andrews' Diseases of the Skin: Clinical Dermatology.(10th ed.). Saunders.ISBN0-7216-2921-0.
- ^abChandra, M; Levitt, J; Pensabene, CA (May 2012)."Hydroquinone therapy for post-inflammatory hyperpigmentation secondary to acne: not just prescribable by dermatologists".Acta Dermato-Venerologica.92(3): 232–5.doi:10.2340/00015555-1225.PMID22002814.
- ^abKim, Ji Hye; Kang, Nam Joo (2015-07-14)."Potent whitening effects of rutin metabolites".Korean Journal of Food Preservation(in Latin).22(4): 607–612.doi:10.11002/kjfp.2015.22.4.607.ISSN2287-7428.Retrieved2022-03-15.
- ^Hyperpigmentation on Face (Acne Scars)Hyperpigmentation, Dark Spots, Acne Scars, Meladerm.
- ^"Melasma".American Academy of Dermatology, Inc.
- ^"Schimke immunoosseous dysplasia | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program".rarediseases.info.nih.gov.Archived fromthe originalon 2017-10-25.Retrieved2019-03-13.
- ^Kannan, R.; Ng, M. J. (2008)."Cutaneous lesions and vitamin B12 deficiency: An often-forgotten link, Rajendran Kannan, MB BS MD".Canadian Family Physician.54(4): 529–532.PMC2294086.PMID18413300.
- ^Lawrence, Elizabeth; Al Aboud, Khalid M. (2022),"Postinflammatory Hyperpigmentation",StatPearls,Treasure Island (FL): StatPearls Publishing,PMID32644576,retrieved2022-03-27
- ^Gupta, AK; Gover, MD; Nouri, K; Taylor, S (December 2006). "The treatment of melasma: a review of clinical trials".Journal of the American Academy of Dermatology.55(6): 1048–65.doi:10.1016/j.jaad.2006.02.009.PMID17097400.
- ^ab"Variety of options available to treat pigmentation problems | American Academy of Dermatology".www.aad.org.Retrieved2017-02-12.
- ^Mazurek, Klaudia; Pierzchała, Ewa (2016-09-01). "Comparison of efficacy of products containing azelaic acid in melasma treatment".Journal of Cosmetic Dermatology.15(3): 269–282.doi:10.1111/jocd.12217.ISSN1473-2165.PMID27028014.S2CID25303091.
- ^Monteiro, Rochelle C.; Kishore, B. Nanda; Bhat, Ramesh M.; Sukumar, D.; Martis, Jacintha; Ganesh, H. Kamath (2013-03-01)."A Comparative Study of the Efficacy of 4% Hydroquinone vs 0.75% Kojic Acid Cream in the Treatment of Facial Melasma".Indian Journal of Dermatology.58(2): 157.doi:10.4103/0019-5154.108070.ISSN1998-3611.PMC3657227.PMID23716817.
- ^Hakozaki, T.; Minwalla, L.; Zhuang, J.; Chhoa, M.; Matsubara, A.; Miyamoto, K.; Greatens, A.; Hillebrand, G.G.; Bissett, D.L. (2002-07-01). "The effect of niacinamide on reducing cutaneous pigmentation and suppression of melanosome transfer".British Journal of Dermatology.147(1): 20–31.doi:10.1046/j.1365-2133.2002.04834.x.PMID12100180.S2CID39489580.
- ^"Spotlight On: Niacinamide - FutureDerm".FutureDerm.2007-10-30.Retrieved2017-02-12.
- ^Callender, Valerie D.; Baldwin, Hilary; Cook-Bolden, Fran E.; Alexis, Andrew F.; Stein Gold, Linda; Guenin, Eric (2021-11-09)."Effects of Topical Retinoids on Acne and Post-inflammatory Hyperpigmentation in Patients with Skin of Color: A Clinical Review and Implications for Practice".American Journal of Clinical Dermatology.23(1). Springer Science and Business Media LLC: 69–81.doi:10.1007/s40257-021-00643-2.ISSN1175-0561.PMC8776661.PMID34751927.
- ^Mansouri, P.; Farshi, S.; Hashemi, Z.; Kasraee, B. (2015-07-01). "Evaluation of the efficacy of cysteamine 5% cream in the treatment of epidermal melasma: a randomized double-blind placebo-controlled trial".The British Journal of Dermatology.173(1): 209–217.doi:10.1111/bjd.13424.ISSN1365-2133.PMID25251767.S2CID21618233.
- ^"Cysteamine Cream® -- New Hyper Intensive Depigmenting Treatment".Scientis Pharma.Archived fromthe originalon 2016-12-24.Retrieved2017-02-12.
- ^Draelos, Zoe Diana (2007-09-01)."Skin lightening preparations and the hydroquinone controversy".Dermatologic Therapy.20(5): 308–313.doi:10.1111/j.1529-8019.2007.00144.x.ISSN1529-8019.PMID18045355.S2CID24913995.
- ^Hyrdoquinone Guidance published under the joint sponsorship of the United Nations Environment Programme, the International Labour Organisation, and the World Health Organization.World Health Organization. 1994.hdl:10665/39218.ISBN9789241571579.
- ^"Hydroquinone - Substance evaluation - CoRAP - ECHA".echa.europa.eu.Retrieved2017-02-12.
- ^Handog, Evangeline (2009-07-20)."A randomized, double-blind, placebo-controlled trial of oral procyanidin with Vitamins A, C, E for melasma among Filipino women".International Journal of Dermatology.48(8): 896–901.doi:10.1111/j.1365-4632.2009.04130.x.PMID19659873.S2CID28886093.
- ^"Laser Skin Whitening - Advantages and Disadvantages | Skin Whitening News".skinwhiteningnews.org.2014-04-05. Archived fromthe originalon 2021-09-19.Retrieved2017-02-12.
- ^Kim, Young Jae; Suh, Hyun Yi; Choi, Myoung Eun; Jung, Chang Jin; Chang, Sung Eun (2020-04-17). "Clinical improvement of photoaging-associated facial hyperpigmentation in Korean skin with a picosecond 1064-nm neodymium-doped yttrium aluminum garnet laser".Lasers in Medical Science.35(7). Springer Science and Business Media LLC: 1599–1606.doi:10.1007/s10103-020-03008-z.ISSN0268-8921.PMID32300974.S2CID215794622.
- ^Arora, Pooja; Sarkar, Rashmi; Garg, Vijay K; Arya, Latika (2022-01-27)."Lasers for Treatment of Melasma and Post-Inflammatory Hyperpigmentation".Journal of Cutaneous and Aesthetic Surgery.5(2): 93–103.doi:10.4103/0974-2077.99436.PMC3461803.PMID23060704.
External links
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