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Pigmentation Abnormalities


Vitiligo is a chronic skin disorder causing white patches of skin to appear on the body due to loss of pigment. This happens when pigment-making cells in the skin, called melanocytes, are destroyed. The precise cause of vitiligo is complex and not fully understood. Some evidence suggests a combination of autoimmune, genetic and environmental factors are to blame. Vitiligo usually develops before a person’s 40th birthday and can also affect mucous membranes and the eye area.

Vitiligo’s course and severity differs with each person. Vitiligo is obvious year-round on darker skinned people, while fair-skinned people usually notice the contrast between vitiligo patches and suntanned skin only in the summer.

The degree of pigment loss varies within each vitiligo patch. Different shades of pigment may appear within a patch, or a border of darker skin may encircle an area of light skin. Vitiligo often begins with a rapid loss of pigment that may continue until, for unknown reasons, the process suddenly stops. Cycles of pigment loss may follow periods of inactivity and continue indefinitely.

Sometimes the best treatment for vitiligo is no treatment at all. In mild cases, makeup and other camouflaging solutions may hide vitiligo patches. Fair-skinned people can blend in patches of vitiligo with normal skin by avoiding tanning. Safe stains that dye the skin can also help match white patches to normal skin color. Self-tanning compounds, which contain a chemical that does not require melanocytes to tan skin, can also help hide white patches. These compounds won’t change the condition, but can improve its appearance.

Dermatologists traditionally prescribe topical corticosteroid cream to treat vitiligo, which can effectively return pigment to white patches. However, these creams can thin the skin in certain areas and should be used only as prescribed. Research offers hope for new treatments but a cure has not yet been found.


Melasma occurs when estrogen and/or progesterone stimulate pigmentation hormones to produce irregular-sized dark brown or grey patches on both sides of an adult’s face. These patches typically appear on the cheeks, bridge of the nose, forehead or upper lip, and occur most frequently in darker skinned women, although it is has also affected lighter skinned men and women.

Individuals with a family history of melasma are more likely to develop the condition, but its precise cause is unknown and a cure has not been found. Changes in hormonal status, such as pregnancy, may trigger melasma. Birth control pills and sun exposure are also known to activate melasma.

Sunscreen with an SPF of 30 or higher is one treatment for melasma because it protects against the sun’s UVA and UVB rays, which can trigger melasma during even limited outdoor activities such as walking down the street, driving a car or sitting next to a window.

Bleaching creams also work well. These creams don’t bleach the skin, but rather decrease pigmentation production. Over-the-counter creams contain low concentrations of hydroquinone, the most commonly used de-pigmenting agent. At Raleigh Dermatology, we may prescribe creams with higher concentrations of hydroquinone for melasma when appropriate, and it usually takes about three months to substantially improve the condition.

Melasma management requires a comprehensive and professional approach. Raleigh Dermatology partners with melasma patients to provide close supervision for a successful outcome.

Please contact us at 919-876-3656 to learn more about Pigmentation Abnormalities or to schedule an appointment.

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American Society for Laser Medicine & Surgery, Inc. American Academy of Cosmetic Surgery American Society for Mohs Surgery American Society for Dermatologic Surgery North Carolina Dermatology Association North Carolina Medical Society