Pigmentation

This is a common condition in adults, which results in the appearance of brown or grey patches on the skin on the face, including on the cheeks, chin, forehead, upper lip and nose. It may also affect other areas of skin that are routinely exposed to the sun, including the neck and forearms. The affected skin is not itchy or painful.

Melasma is more common in women than in men and is particularly common in pregnancy, when up to 50 percent of women may be affected by melasma. For this reason, this particular condition is colloquially known as ‘pregnancy mask’. It is more common in people of colour, but can happen to anyone.

Melasma is caused by the over-production of melanin, but several factors can contribute to developing melasma, including pregnancy and the use of hormonal drugs, for example, HRT or the contraceptive pill. Other contributing factors include thyroid problems, taking certain medications, including anti-epileptic drugs (AEDs), and exposure to ultraviolet light from the sun or tanning beds. 

Vitiligo is a long-term medical condition that causes pale white patches to appear on the skin, mainly on the face, hands and neck, but vitiligo can also affect the mouth, fingers, armpits genitals, groin and inside the mouth. Sometimes it can also affect the scalp, or another part of the body with hair roots, turning hair in the affected area white or grey as a result. Patches of skin affected by vitiligo are more susceptible to sunburn. Although the condition does not cause pain or discomfort, some people find the white patches can feel itchy. The white patches caused by vitiligo are usually permanent.

There are two main types of vitiligo, non-segmental vitiligo and segmental vitiligo. Non-segmental vitiligo is the most common type of vitiligo, affecting nine out of the 10 people who have the condition. Also known as bilateral or generalised vitiligo, the symptoms appear on both sides of the body as symmetrical white patches. In contrast, segmental vitiligo only affects one area of the body. Segmental vitiligo is sometimes called localised or unilateral vitiligo.

Non-segmental vitiligo is thought to be an autoimmune condition that occurs when the body’s immune system destroys the melanocyte skin cells that make melanin, which gives the skin its pigmentation. Risk factors for non-segmental vitiligo include a family history of the condition, the existence of another autoimmune condition, melanoma, non-Hodgkin lymphoma or certain gene changes which are associated with the condition.

Segmental vitiligo is believed to be caused by neurochemicals released from the nerve endings that are poisonous to the melanocyte skin cells.

In rare cases, it's possible for vitiligo to affect your whole body. This is known as universal or complete vitiligo.

Also known as age spots or liver spots, lentigines are flat, brown lesions with well-defined edges that are caused by sun damage. Measuring between five and 20 mm, these spots are commonly found on areas of skin that have been regularly exposed to the sun, such as the shoulders and forearms. Sometimes smaller lentigines can merge together to form larger spots. They vary in colour from yellow-brown to black. Although solar lentigo is caused by sun exposure, these lesions are benign. They are common in adults aged over 50, but are often seen in young people who have spent a lot of time in the sun.

You are at a higher risk of developing age spots if you have fair skin or a history of intense sun exposure or sunburn.

Freckles are small brown spots that appear on areas of skin that have been exposed to the sun, such as the nose and cheeks. They are trigged by ultraviolet light and are a result of an over-production of melanin. Solar lentigines are a type of freckle, but ephelides are what most people would think of as a ‘traditional’ freckle.

Freckles are more common in people with lighter skin and hair colour. Freckles generally appear at around two or three years old, although you may continue to get new freckles into your 20s, and they usually fade with age. In contrast, solar lentigines don’t appear until later in life, usually after the age of 40. To prevent freckles you should stay out of the sun and avoid using sunbeds. If you have to go out in the sun, make sure you use a water-resistant sun cream with an SPF of 30 or above.

Freckles are non-cancerous but can be confused with skin cancer. You should see a doctor without delay if your freckles have jagged borders, start to grow or change colour, are sore, are asymmetrical, become raised, are multiple colours or have a diametre of more than six millimetres.

Post-inflammatory hyperpigmentation (PIH) is skin discolouration left behind after a wound heals. This may be caused by acne, sunburn, eczema or skin trauma. PIH is a flat area of discolouration and can present as red, pink, white, brown, purple or black spots, depending on a person’s skin tone and the depth of the discolouration. Although PIH can develop in all skin tones, it is generally more severe and long-lasting in people with medium to dark skin.

PIH is very common in people who suffer with acne. Even the smallest spots or blemishes can leave behind these scars. Squeezing or popping spots can increase the chance of PIH because it increases inflammation. 

There is currently no cure for melasma, although there are a number of treatments available to help with the appearance of melasma.

You may be prescribed a skin lightening cream called hydroquinone, that prevents pigment cells in the skin from producing melanin. However this can only be used for a short period of time as it can cause an over-lightening of the skin and skin irritation.

Retinoid creams and some types of acid cream can also help improve the appearance of melasma but may also result in skin irritation for some people. Sometimes these remedies can be mixed with steroid creams to reduce the likelihood of skin irritation. A procedure called microneedling, which sees the skin repeatedly punctured by a series of tiny needles, may help these skin creams to penetrate deeper into the affected areas of skin.

Alternatively, your dermatologist may recommend a chemical peel, which works by removing the outermost skin cells that contain the pigment. This layer of skin can also be removed by laser therapy. Other types of laser therapy work to target the cells responsible for producing this excess pigment.

It is advisable to avoid anything which triggers your melasma and to always take adequate protection when going out in the sun, including wearing a wide-brimmed hat and suncream with an SPF of 30 or above, with a high UVA rating.

If melasma appears in pregnancy, you may find that the darkened areas of skin return to their normal colour a few months after childbirth.

Although the white patches associated with vitiligo are permanent, there are treatments available that can reduce their appearance.

A dermatologist may prescribe steroid creams which can be rubbed into the affected areas of skin in order to restore some pigment. However using steroid cream over a long period of time can cause skin thinning, so steroid cream can’t be used as a long-term treatment. Alternatively, light therapy, also known as phototherapy, delivers a carefully measured dose of ultraviolet light to help restore colour to the affected area of skin. However the effect is only temporary and ongoing treatment would be required. Treatment cannot stop vitiligo from spreading to other areas of the body.

This pigment is located at the base of the epidermis (the top layer of skin) so any age spot treatment must be able to penetrate this layer of skin. Liver spot treatment includes skin lightening creams (hydroquinone and retinol), laser therapy, cryotherapy or a chemical peel to remove the top layer of skin, with new smoother skin forming in its place. Some of these may take more than one treatment to produce the desired result.

Another treatment that may be used to remove age spots is dermabrasion, which uses a rapidly rotating brush to ‘sand down’ the affected area of skin, removing the top layer and allowing fresh new skin to grow in its place. However this treatment can cause temporary redness or pinkness, swelling and scabbing, which may take time to fade. Microdermabrasion is a gentler alternative to dermabrasion.

As mentioned above, freckles often fade with age. However if you find your freckles unsightly, there are treatments available, including laser treatments, cryotherapy, chemical peels and creams like retinol. The treatment will depend on the individual and the location and severity of the freckles.

Post-inflammatory hyperpigmentation (PIH) can fade over time, but it can take anywhere between three or 24 months for this discolouration to disappear completely, sometimes even longer. Sometimes this discolouration is permanent. For this reason, many people choose to have treatment to get rid of, or reduce the appearance of, PIH.

Treatment for PIH can take several forms. Depending on the severity of the PIH and your skin tone, the dermatologist may recommend applying hydroquinone. This should only be applied directly to the darkened areas of skin, otherwise this may lighten your natural skin colour. It can also cause skin irritation in some people. Topical retanoids, acid creams, chemical peels, laser treatments, microneedling and microdermabrasion may also be used. However one treatment session alone is unlikely to be enough to have an impact on post-inflammatory hyperpigmentation. Several sessions will be required, spaced two to four weeks apart. Our expert dermatologist will be able to determine which treatment is right for you and how many treatment sessions you would need.