August is dedicated to skin pigmentation, which will include information on skin conditions that reduce the pigmentation of the skin and also a debate on the more controversial topic of skin lightening. 

There are some skin conditions that cause pigmentation of the skin, the main ones being melasma and vitiligo. 

Vitiligo

Vililigo is a condition in which some parts of the skin lose their pigmentation, becoming white.  It affects around 1% of the world’s population and is caused when the body reacts against the pigment cells of the skin.  The reason for this is unknown, so it is difficult to treat.  Sometimes vitiligo seems to be triggered by sunburn. It affects men and women of all races, but is more noticeable on dark-skinned people.

Vitiligo often begins on the face and hands and later spreads, with the patches slowly changing their shape and size.  It is commonly seen around openings of the body, like the nose, mouth, eyes and genitals.

There is not currently a cure for vitiligo, but occasionally it goes away by itself.  Some treatments may slow its progress, but ensure that you discuss all treatments with your GP.  Ultraviolet light treatment can sometimes stimulate the skin pigment to be made in the skin again.  However, if the treatment does not work, it can cause the pale areas of the skin to burn and turn the surrounding skin a darker colour.  Some pigments can be brought back by using a strong corticosteroid cream, but side effects, such as thinning of the skin, are a definite risk.

Using a sunscreen with a minimum sun protection factor of 25 helps to prevent burning of the white patches and in light-skinned individuals, it also minimises pigmentation of the skin around the patches.

If the vitiligo has spread very widely, it may be easier to get rid of the small amounts of pigment that are left by using a bleaching cream prescribed by your GP. There are, however, social implications of becoming white all over, which must be discussed before this treatment is used.

You can conceal the white patches of skin with cosmetics, which are now widely available in a range of colours and can be waterproof.  Diet doesn’t affect vitiligo.

Melasma

Melasma is increased, patchy pigmentation, usually on the face.  If you suffer from melasma, it is very important to protect your skin from the sun.  When exposed to the sun the darker parts of melasma become even darker.  Various treatments can be tried for melasma, but they are not always effective. 

Creams can be prescribed by your GP to lighten the skin.  We recommend that you go to your GP, because skin lightening creams contain an active ingredient called hydroquinone, which are safe at concentrations of 4% or less.  Bleaching creams that are not prescribed by your GP may contain a higher concentration, which can be very dangerous for the skin.  Use these creams cautiously because it can cause the skin to further darken permanently.

Laser treatment is not usually advisable to treat melasma, but sometimes a mild chemical peel of the skin can help. Ensure you go to someone who is qualified and experienced in using chemical peels, as there can sometimes be adverse reactions.

Skin lightening/bleaching creams

The most important way to lessen the occurrence of pigmentation is to wear a high factor sunscreen daily.  However, bleaching creams can work and reduce the melanin (brown pigment) in the skin. Topical creams include tretinoin (a vitamin A derivative) cream and hydroquinone cream.  Strong and combination treatments can be prescribed by your doctor or dermatologist, but can cause irritation, dryness and redness of the skin. It may take months to see an improvement in the skin.

It is important to note that it is illegal to sell cosmetic products (other than some hair dyes) containing hydroquinone.  Medically approved preparations containing hydroquinone are not dangerous within reason, when prescribed by your GP or a dermatologist. 
 

If there is anything you would like us to cover this month, then please let us know, by emailing indy@bad.org.uk