Skin is just like the humans who wear it: It's not perfect. In a perfect world, the skin would be evenly pigmented (have even tone) without discolorations.
But that's not the case. There are birthmarks and other pigmentation disorders that affect many people. We've included some of the most common pigmentation problems here.
Remember: Never self-diagnose! If you think you have one of these skin pigmentation abnormalities, make sure you visit a doctor to receive an official diagnosis.
As might be expected, this type of abnormal skin coloration will appear at birth or in a few weeks or months following birth. It's important to remember that although most birthmarks are noncancerous, a doctor should examine your child if they are born with abnormally colored skin or develops birthmarks shortly after birth. Certain birthmarks described below can pose health risks.
Most pigmented birthmarks will be flat and smooth and may range in color from white to tan to blue. There are several types of pigmented birthmarks, including Mongolian spots -- bruised or bluish in color, typically appearing on the buttocks or lower back; cafe-au-lait spots -- light brown; and typical moles that appear at birth, which are also called congenital nevi. Moles should be monitored for color, shape, or size changes, and/or itching or bleeding.
These are a type of birthmark that may appear anywhere on the body as light red, flat marks. Macular stains are the most common type of vascular (developing from blood vessels) birthmark. These marks can come in two forms known commonly as angel’s kisses or stork bites.
- Angel's kisses may appear on the forehead and eyelids, but will typically disappear early in childhood.
- Stork bites will appear on the back of the neck and can last into adult years.
Because these marks are often mild and have no symptoms, there is no treatment necessary.
Hemangiomas are caused by many tiny blood vessels bunched together and are raised off of the skin. They can vary in size from a few millimeters to several centimeters. Hemangiomas can grow very rapidly through the first year of a child's life. Most hemangiomas will slowly go away in a few years.
Most hemangiomas will go away on their own; roughly 50% resolve by age 5, 70% by age 7, and 90% by age 9.
Some hemangiomas may be near the eye, nose, lips or genitalia. Hemangiomas in these sensitive areas sometimes need to be treated so that they don’t interfere with seeing, breathing, eating, or defecating. These hemangiomas can also break down or ulcerate easily, becoming very painful. Reasons to treat a hemangioma include problems with functions (such as sight, eating, hearing, or defecation), ulceration, or pain. Hemangiomas can be treated in different ways, each of which carries its own risks.
Corticosteroid medication, which can be injected or taken orally, is one option for treating hemangiomas. Risks associated with corticosteroid medication include high blood pressure, high blood sugar, poor growth, or cataracts. If corticosteroids fail, there are other medications called selective beta-blockers, such as propranolol, atenolol and nadolol, that may be an option. Topical timolol is also used, especially for smaller heamngiomas.
Certain hemangiomas can also be treated with lasers to stop them from growing.The VBeam laser has been successful at treating early superficial hemangiomas. Risks associated with that treatment include pain, ulceration and scarring.
In some cases, a hemangioma can also be removed with surgery. Other times, a combination of these approaches is the most beneficial treatment.
Port-wine stains are caused by abnormal development of blood vessels (capillaries) and last a lifetime. The port-wine stain (also known as nevus flammeus) appears as a flat, pink, red or purple mark, and can occur on the head, trunk, arms, or legs.
If you or your child has a port-wine stain present on eyelids, this is thought to pose an increased risk of glaucoma, an eye disease associated with increased pressure in the eyes that can lead to blindness if it's not treated.
Doctors have tried many ways to treat port-wine stains, including radiation, tattooing, freezing, dermabrasion, or sclerotherapy. Laser treatment is the preferred treatment because it is the only method that destroys capillaries in the skin without causing damage to the rest of the skin.
Port-wine stains may be seen in certain medical disorders, including Sturge-Weber Syndrome, with symptoms that include port-wine stains on the face, vision problems, convulsions, intellectual disability, and perhaps even paralysis; and Klippel-Trenaunay Syndrome, which may include symptoms of many port-wine stains, varicose veins, and/or too much bone and soft tissue growth. Each of these syndromes is very rare.
Skin Pigmentation Disorders
Albinism, an inherited disorder, is caused by the absence of the pigment melanin and results in no pigmentation in skin, hair, or eyes. In albino patients, the body has an abnormal gene, which restricts the body from producing melanin, the pigment that gives skin its color. There is no cure for albinism, and individuals should use sunscreen at all times, because they are much more likely to get sun damage and skin cancer. This disorder can occur in any race.
Melasma (also known as chloasma) is characterized by tan or brown patches on the cheeks, nose, forehead, neck, arms, and chin. Melasma most commonly develops during pregnancy or while a patient is taking birth control pills or other hormones. Although this condition is typically termed the "pregnancy mask," men can also develop this condition. Melasma may go away after pregnancy but, if it persists, can be treated with certain prescription creams, serums and pills, chemical peels, microdermabrasion, microneedling and some over-the-counter skin care products. Remember to consult your doctor or dermatologist for a proper diagnosis of this condition before you choose to treat it yourself. If you have melasma, use a broad-spectrum tinted sunscreen at all times, because sunlight will worsen your condition.
Pigmentation Loss From 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 is that with this type of pigment loss, cosmetics can be used to cover the area. However, the affected areas have an increased lifetime risk for developing skin cancer.
Vitiligo is a pigmentation disorder in which melanocytes (the cells that make pigment) are destroyed. As a result, white patches of skin appear on different parts of the body. Vitiligo may appear after physical injury to the skin or can be associated with autoimmune diseases such as diabetes or thyroid problems. There is no cure for vitiligo, but prescription corticosteroid creams or ointments, topical calcineurin inhibitor creams and ointments, ultraviolet light treatments done in your dermatologist’s office, and surgery, can be helpful in repigmenting the affected areas. Several Janus kinase (JAK) inhibitors in cream and pill forms are showing promise in clinical trials for treatment of vitiligo.