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Pigmentation – melasma

PIGMENTATION – hyperpigmentation or dark patches
There are many causes for hyperpigmentation, that is excess pigment causing dark patches on the skin. Making a diagnosis is important as treatment can then be effectively directed towards the cause, therefore an initial consultation is required.
The common conditions are briefly described below

1. MELASMA

What is melasma?
Melasma is the most common cause of hyperpigmentation in people with skin of colour, presenting as dark patches on both sides of the face, mostly cheeks, but also on the forehead, bridge of nose, upper lip and chin.

What is the cause of melasma?
It is more common if there is an affected family member, but other triggers include pregnancy, birth control pills, and most importantly sun exposure (both UV and visible light from the sun or light bulbs).

What is the treatment of melasma?
An initial consultation is required to assess the skin, make the diagnosis (most cases clinically, rarely requires a biopsy) and discuss treatments.

Treatment options (both medical and cosmetic) include:
i) depigmenting creams – treatment for 3 – 6 months are required to reach maximal results
ii) sunscreen – specific sunscreens that are most effective at blocking pigmentation are essential as UVA/UVB sunscreens alone are insufficient. Also specific quantities should be applied regularly which will be discussed in detail during the consultation
iii) chemical peels – in some carefully selected patients, this can be beneficial, however there are risks therefore should be performed by dermatologists with expertise in managing skin of colour. Multiple sessions may be required.
iv) laser – some types of laser can be used with varying results and benefit inc are fully selected patients, however should be performed by specialised dermatologists only. Multiple sessions may be required.
v) tranexamic acid – this is one of the newer and effective treatments, which is available in one of the 3 forms (oral, topical and injectable). Treatment courses can last between 2 – 6 months. This clinic has one of the very few dermatologists in the country who has experience in using these.

2. POST-INFLAMMATORY HYPERPIGMENTATION

What is post-inflammatory hyperpigmentation (PIH)?
PIH is the brown to purple patches left behind after irritation or damage to the skin in skin of colour patients.

What are the causes of PIH?
Any cause of irritation to the skin such as skin diseases (acne, eczema, psoriasis, seborrhoeic dermatitis, lichen planus etc) or physical injury (burns, grazes) can heal with dark marks.

What is the treatment of PIH?
An initial consultation is required to establish the diagnosis and cause (clinical or with help of biopsy), and discuss treatments.

Treatment is aimed at:
i) treating the underlying cause of skin irritation
ii) methods to lighten the pigmentation

3. LICHEN PLANUS PIGMENTOSUS

What is lichen planus pigmentosus (LPP)?
LPP is diffuse gray to brown pigmentation affecting the face (temples, forehead or entire face), neck and upper limbs. Skin folds such as underarms, and groins may be involved as well.

What is the cause of LPP?
The exact cause is not known, but there is inflammation in the skin.

What is the treatment of LPP?
At the consultation, a diagnosis is made initially, followed by a detailed discussion of the treatment.

Treatment options include:
i) reduction of the inflammation
ii) lightening the pigmentation.

4. ACANTHOSIS NIGRICANS

What is acanthosis nigricans (AN)?
Acanthosis nigricans presents as velvety, thick, dark skin affecting the back of the neck, underarms and groin area. On the face, it affects the forehead and upper cheeks.

What is the cause of AN?
It is associated with high blood pressure, obesity, high cholesterol and heart disease.

What is the treatment of AN?
After the diagnosis is made, further tests may be recommended. Treatment includes depigmenting or skin lightening agents.

PIGMENTATION- hypopigmentation or light patches
There are many causes of light patches on the skin, which requires expert assessment by a dermatologist to make a diagnosis.