Hypopigmentation

Hypopigmentation is characterized specifically as an area of skin becoming lighter than the baseline skin color, but not completely devoid of pigment. This is not to be confused with depigmentation, which is characterized as the absence of all pigment.[1] It is caused by melanocyte or melanin depletion, or a decrease in the amino acid tyrosine, which is used by melanocytes to make melanin.[2] Some common genetic causes include mutations in the tyrosinase gene or OCA2 gene.[3][4] As melanin pigments tend to be in the skin, eye, and hair, these are the commonly affected areas in those with hypopigmentation.[2]

Hypopigmentation
Hypopigmentation in vitiligo.
SpecialtyDermatology 

Hypopigmentation is common and approximately one in twenty have at least one hypopigmented macule. Hypopigmentation can be upsetting to some, especially those with darker skin whose hypopigmentation marks are seen more visibly. Most causes of hypopigmentation are not serious and can be easily treated.[5]

Presentation

Associated conditions

It is seen in:

Diagnosis

Areas of lighter pigmentation can be indications of hypopigmentation.[6] Biopsies and genetic information are also used to diagnose.

Treatments

Often, hypopigmentation can be brought on by laser treatments; however, the hypopigmentation can be treated with other lasers or light sources.[7] Micropigmentation can also be used to obtain a more normal appearance of the hypopigmentated skin.[8]

Treatment for hypopigmentation depends on the initial cause of the discoloration.[9]

Treatments for Hypopigmentation[10]
Initial Cause of Discoloration Treatment
Idiopathic guttate hypomelanosis No treatment
Postinflammatory hypopigmentation Treat the underlying inflammatory disease to restore pigmentation
Pityriasis versicolor A topical ointment, such as selenium sulfide 2.5% or imidazoles.

Can also use oral medications, such as oral imidazoles or triazoles.

Vitiligo Topical steroids, including calcineurin inhibitors.

Patients can also have transplants if they're stable or a depigmentation with topical MBEH if the patient has widespread discoloration.

Chemical or drug induced leukoderma Avoidance of causative agent with subsequent treatment similar to vitiligo.
Piebaldism None; occasionally transplants.

See also

References
  1. Shinkai, Kanade; Fox, Lindy (2018). "Dermatological Disorders". Current Medical Diagnosis & Treatment. New York, NY: McGraw-Hill.
  2. Ferrier, Denise R. (2017). Biochemistry (Seventh ed.). Philadelphia. ISBN 978-1-4963-4449-6. OCLC 956263971.
  3. Bolognia, Jean; Braverman, Irwin (2014). "Skin Manifestations of Internal Disease". Harrison's Principles of Internal Medicine. New York, NY: McGraw-Hill.
  4. Cross, Harold. "Biochemical Basis of Diseases". The Big Picture: Medical Biochemistry Eds. New York, NY: McGraw-Hill.
  5. Hill, Jeremy P.; Batchelor, Jonathan M. (2017-01-12). "An approach to hypopigmentation". BMJ. 356: i6534. doi:10.1136/bmj.i6534. ISSN 0959-8138. PMID 28082370. S2CID 26827617.
  6. "Hypopigmentation: Causes, Risk Factors, Treatments, More". 7 December 2017.
  7. Reszko, Anetta; Sukal, Sean A.; Geronemus, Roy G. (14 July 2008). "Reversal of Laser-Induced Hypopigmentation with a Narrow-Band UV-B Light Source in a Patient with Skin Type VI". Dermatologic Surgery. 34 (10): 1423–1426. doi:10.1097/00042728-200810000-00021. PMID 18637814.
  8. Haney, Beth (September 21, 2019). "Permanent and Semi-permanent Micro-Pigment Treatments". Aesthetic Procedures: Nurse Practitioner's Guide to Cosmetic Dermatology. Cham: Springer International Publishing. pp. 59–66. doi:10.1007/978-3-030-19948-7_7. ISBN 978-3-030-19947-0. S2CID 203829421.
  9. "What Causes Hypopigmentation, and How Is It Treated?". Healthline. 7 December 2017. Retrieved 10 May 2020.
  10. Harrison's Principles of Internal Medicine. Longo, Dan L. (Dan Louis), 1949-, Fauci, Anthony S., 1940-, Kasper, Dennis L., Hauser, Stephen L., Jameson, J. Larry., Loscalzo, Joseph. (18th ed.). New York: McGraw-Hill. 2012. ISBN 9780071748902. OCLC 747712285.{{cite book}}: CS1 maint: others (link)


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