Some of the most common are pigmented birthmarks, macular stains, hemangiomas, port wine stains, while disorders include albinism, melasma, vitiligo and pigmentation loss due to skin damage. Birthmarks and other skin pigmentation (coloration) disorders affect many people. Skin pigmentation disorders are conditions that affect the color of the skin. Some common types of skin pigmentation disorders include: Pigmented birthmarks Macular stains Hemangiomas Port wine stains Albinism Melasma Vitiligo Skin pigment loss due to sun damage Other factors that can affect skin pigmentation include: Pregnancy, Addison's disease, Sun exposure. Some treatments for skin pigmentation disorders include: Over-the-counter or prescription creams Topical pimecrolimus or tacrolimus Light therapy Melanocytes in the basal epidermis control skin pigmentation through synthesis of melanin, a complex process thought to be primarily regulated by alpha-melanocyte stimulating hormone (αMSH) Light therapy exposes your skin to a type of ultraviolet (UV) light that can restore your natural skin color. If a large area of your body needs treatment, your dermatologist may prescribe a type of light therapy called phototherapy. During phototherapy, you expose your skin to UV light for a specific amount of time.

1. Disorders of pigmentation
Assistant Professor Jagruti N . Marathe
Dept. Of Clinical Pharmacy

2. Melanin and melanin unit
• Melanin is the most important determinant of skin color
it is produced in melanosomes in melanocytes →
is transferredd to a group of keratinocytes → epidermal
melanin unit
• Color of the skin → depends on the degree of melanisation
of melanosomes → their number, distribution
• Others →
 degree of vascularity
 relative amount of oxidized and reduced hemoglobin
 presence of carotenoids
 thickness of the horny layer
• Genetic factors, amount and wavelength of received UV light,
amount of secreted melanocyte-stimulating hormone (MSH)

4. Disturbances in skin color
Disorders of melanin pigmentation
• increased pigmentation (hyperpigmentation)
• decreased pigmentation (hypopigmentation)
• absence of melanin (amelanosis)
Dyschromias
• endogenous or exogenous pigments deposited in
the skin

5. Hyperpigmentation
• Hyperpigmentation causes patches of skin to become darker
than the surrounding skin.
• It occurs when the skin produces excess melanin, the pigment
that gives skin its color.
• It can affect any skin type and is more likely during pregnancy,
with older age, or after an injury.

6. Hyperpigmentation
Hyperpigmentation is very common on skin of color, as darker skin tones
already have a higher melanin content. Burns, bruises, acne, rashes, or other
trauma to the skin can cause it to produce more melanin and lead to dark
spots.
Types of hyperpigmentation include:
age spots, also called “liver” spots
melasma
post-inflammatory hyperpigmentation

7. The most common types of hyperpigmentation and
their symptoms:
Type Symptoms Where on the body? Who can it affect?
age spots, also called
liver spots or solar
lentigines
brown, tan, or black
spots that appear on
the skin with sun
overexposure
commonly on the face
and hands or on sun-
exposed areas of the
body
usually older adults or
those with extended
sun exposure
melasma, also called
chloasma or “the
mask of pregnancy”
large patches of
darkened skin
often on the
forehead, face, and
stomach
usually women,
people who are
pregnant or
taking birth
control pills, and
those with medium to
darker skin
post-
inflammatory hyperpi
gmentation
spots or patches of
darkened skin that
appear after an
inflammatory skin
condition, such as
acne or eczema
anywhere on the
body
people who have had
inflammation or an
injury to the skin

8. Age spots
Solar lentigines are harmless patches of darkened skin that are
caused by exposure to ultraviolet (UV) radiation.
They are also known as age spots, liver spots, senile freckles, or
senile lentigo.

9. Age spots
Solar lentigines are small, flat, smooth areas of skin that appear
on sun-exposed areas of the body, like the face, hands,
shoulders, and arms.
They are larger and more defined than freckles.
Solar lentigines are very common, especially in people over the
age of 40.
They arise in middle age and result from sun damage.

10. Age spots
Treatments for solar lentigines include:
• Physical therapy,
• Topical therapy,
• Cryotherapy,
• Laser surgery.
• Trichloroacetic acid,
• Topical tretinoin, Bleaching agents such as hydroquinone,
Noninvasive topical creams,, can lighten lentigines after
several months of application.

11. melasma
Melasma is a common skin problem caused by brown to gray-
brown patches on the face.
Most people get it on their cheeks, chin, nose bridge, forehead,
and above the upper lip.
It is more common in women than men. Pregnancy is a common
cause of melasma.
It also affects woman taking oral contraceptives and hormones.

13. melasma
Melasma can be caused by:
Prolonged sun exposure
Pregnancy
Malnutrition
Liver disease
Vitamin B12 deficiency
Iron deficiency anemia

14. melasma
Differential Diagnosis(DifDg)
melasma
• A dermatologist can often diagnose melasma by looking
closely at your face and neck.
• To get a close-up look, dermatologist may use a specialized
device like a Wood’s lamp or dermatoscope.
• Placed on (or near) to skin, these devices help your
dermatologist see how deeply the darker pigment reaches
into the layers of skin.

15. melasma
• This knowledge is extremely helpful if you want to treat
melasma.
• Sometimes melasma can look like another skin condition.
• To rule this out, dermatologist may perform a skin biopsy,
which involves removing a small bit of skin.
• Dermatologist can safely and quickly perform a skin biopsy
during your office visit

16. melasma
Treatment for the melasma:
• The goals of treatment are to:
 Decrease how much pigment your body makes.
 Even out your skin tone, restoring it to your natural color.

17. melasma
To achieve these goals, a treatment plan often consists of:
Sun protection: Sunlight causes the skin to make more
pigment, which can darken existing melasma and cause new
patches.
This often involves wearing a wide-brimmed hat while outdoors,
seeking shade, and applying a broad-spectrum sunscreen (SPF 30
or higher) throughout the day.
For patients who have melasma, dermatologists often
recommend using a sunscreen that contains:
Zinc oxide
Titanium dioxide
Iron oxide

18. melasma
Medication and procedures: Dermatologist may prescribe a
medication that can decrease the excess pigment in your skin.
Most patients receive a prescription for medication that they
apply to their skin at home.
Dermatologist may prescribe one or more of the following:
Hydroquinone:
Tretinoin and a mild corticosteroid:
Triple combination cream:
Other medications:

19. melasma
• Hydroquinone: This is a common treatment for melasma. It is
applied to the skin and works to even out the skin tone.
Hydroquinone is no longer available in products that you can
buy without a prescription.
• Tretinoin and a mild corticosteroid: This combination
contains a retinoid and an anti-inflammatory, which can even
out skin tone.

20. melasma
• Triple combination cream: This cream contains three
medications — tretinoin (a retinoid), a corticosteroid to
reduce inflammation, and hydroquinone to even out your skin
tone.
• Other medications: Your dermatologist may prescribe a
medication that’s gentler on your skin like azelaic acid, kojic
acid, or vitamin C.

21. melasma
To improve your results, dermatologist may add one or more of
the following to treatment plan:
• Using pigmentation-reducing creams with ingredients like
kojic acid and vitamin C
• Getting chemical peels
• Microneedling
• Getting laser treatments
• Platelet-rich plasma

22. melasma
• Chemical peel: During this procedure, your dermatologist
applies a chemical solution to the melasma. This can help
remove excess pigment.
• Microneedling: This minimally invasive procedure creates
microscopic tears in your skin. As the skin heals, it tends to
have a more even skin tone.

23. melasma
• Laser and light treatments: A few studies have found that
adding a laser or light treatment can improve results for
patients who are already applying medication to their skin
and protecting their skin from the sun.
• Platelet-rich plasma: This procedure involves taking a small
amount of your blood, placing the blood into a machine that
separates the blood into layers, and then injecting the layer of
blood known as plasma into the skin with melasma. This can
help even your skin tone.

24. The most common types of hypopigmentation and
their symptoms:
Type Symptoms Where on the body?
Vitiligo Patchy loss of skin color, anywhere on the body
Albinism
a rare genetic condition that
causes a lack of pigment in
skin, hair, and eyes.
skin, hair, and eyes
Pityriasis versicolor
a common, harmless fungal
infection of the skin. It's
caused by an overgrowth of
yeast that's usually found on
the skin.
neck, trunk, and
arms. Patches may be coppery
brown.
Pityriasis alba
round or oval, hypopigmented
lesions with fine scales.
Lesions on the face, especially
the cheeks and chin
Patches on the neck,
shoulders, and upper arms

25. Depigmentation
Vitiligo:
Vitiligo can affect anyone, regardless of race or skin color. It
can develop at any age, but about half of people with vitiligo
develop it before they turn 20.
For many people, vitiligo begins in childhood.

26. Depigmentation
Vitiligo
• Vitiligo is caused by a lack of melanin in the skin. Melanin is
produced by skin cells called melanocytes.
• In vitiligo, there are not enough working melanocytes to
produce enough melanin in your skin.
• Vitiligo is not life-threatening or contagious.
• It can be stressful or make you feel bad about yourself.
• The characteristic symptom of vitiligo is the appearance of
flat lighter-colored spots or patches on the skin.

27. Depigmentation
Types of Vitiligo

28. Depigmentation
Vitiligo
Acquiredpigmentary disorder of the skin and mucous
membrane,
any age, age 10-30 years, females more frequently affected
Etiology and pathogenesis
• Multifactorial, polygenetic disorder, family history (earlier age),
autoimmune endocrine disease
• Precise cause is unknown
• Absence of functional melanocytes, loss of melanocytes by
their
destruction - autoimmune mechanism, cytotoxic mechanism
• Itrinsic defects of melanocytes
• Oxidant-antioxidant mechanism
• Neural mechanism

30. Depigmentation
Vitiligo
• Autoimmune disorders associated with vitiligo
 hashimoto thyroiditis, Graves´s disease, Addison disease, diabetes
mellitus, alopecia areata
 inflammatory bowel disease
 Oxidant stress →accumulation of free radicals toxic to
melanocytes
→ leads to destruction
 Nerve injury → hypopigmentation or depigmentation in
denervated areas → segmental vitiligo in a dermatomal
pattern
 melanocytes may be present in depigmented lesion after years of onset and
still
respond to medical therapy under appropriate stimulation

31. Depigmentation
Vitiligo
Clinical features
• Acquiredwhite or hypopigmented
macules or patches
• Well demarcated; round, oval or linear
in
shape
• Enlarge cintrifugally over time at
unpredictable rate → mm - cm in size
• Most frequently→ hands, forearms,
feet and face, favoring perioral and
periocular area

32. Depigmentation
Vitiligo
Clinical features
• Localized or generalized (involving more than
one general area of involvement)
• Symetrical or asymetrical lesions on both sides
of the trunk
Repeated trauma
 bony prominences, dorsal aspects of hands, digital
phalanges, extensor forearms, ventral wrist
 around body orifices - lips, gingiva, areolas and
nipples
 Body hair are depigmented – localized patch of white or
grey hair
 Hair involvement → poor prognosis
 Koebner phenomenon in sites of trauma - cuts, burns,
abrasion

33. Depigmentation
Vitiligo
Diagnostic criteria
• Clinical findings
• Symptoms of hypothyroidism,
diabetes
mellitus
• Wood´s light examination
accentuates the
hypopigmented areas –
axillae, anus, genitalia
(frequently unrecognized)

34. Depigmentation
Vitiligo
DifDg
• nevus anemicus (a capillary vascular malformation or
birthmark. )
• piebaldism (partial albinism congenital patches
– melanocytes are
completely absent)
• postinflammatory hypopigmentation (atopic
dermatitis)

35. Depigmentation
Vitiligo
pityriasis versicolor
 early lesions in systemic sclerosis
 early lesions lichen sclerosus et atrophicus
• leukoderma – healed psoriasis, secondary syphilis;
exposure to
some chemicals

36. Depigmentation
Therapy
• Repigmentation - activation and migration of
melanocytes from melanocyte reservoirs located in
hair follicle → melanocytes divide rapidly after any
inflammatory process or following UV radiation
• Various therapy regimens – the response varies
from individual to
individual, treatment is individualized
 Systemic phototherapy in early or localized disease
 narrow-band UVB (311 nm) in generalized vitiligo – 1.choice
 UVB narrow - band microphototherapy – targeting at specific
small lesions
 PUVA- topical or systemic

37. Depigmentation
Therapy
 Laser therapy with monochromatic rays at 308
nm
 Topical agents
 tacrolimus (head, neck)
 vitamin D analogues (calcipotriol, tacalcitol)
 corticosteroids
 Systemic corticosteroids

38. Depigmentation
Therapy
 Surgical treatment in limited or localized
vitiligo→
 epidermal grafts
 grafting suction-blistered epidermis
 punch minigrafts
 transplantation of in vitro cultured epidermis bearing the
melanocytes

39. Depigmentation
Therapy
• Cosmetic camouflage
More than 40% involvement – to remove the
remaining normal skin
pigment with 20% monobenzone (destroys
melanocytes →
permanent procedure) patient will be sun-
sensitive → use of
sunscreens during sun exposure

41. Depigmentation
Albinism:
Albinism is an inherited condition that leads to someone
having very light skin, hair, and eyes.
It happens because they have less melanin than usual in their
body.
Melanin gives skin, hair, and eyes their color.
Except for vision problems, most people with albinism are just
as healthy as anyone else.

42. Depigmentation
Albinism:
Albinism is a rare genetic condition that causes a lack of
pigment in skin, hair, and eyes. It's caused by mutations in
certain genes that affect the amount of melanin produced by
the body. Melanin controls the color of skin, eyes, and hair.

43. Depigmentation
There is currently no cure for albinism. Treatment focuses
on:
Getting proper eye care
Monitoring skin for problems

44. Depigmentation
Pityriasis alba
Pityriasis alba is a common, benign skin disorder that causes
round or oval, hypopigmented lesions with fine scales.
It usually occurs in children and young adults.

45. Depigmentation
Symptoms of Pityriasis alba include:
• 1 to 20 patches or thin plaques
• Red or pink patches
• Lesions on the face, especially the cheeks and chin
• Patches on the neck, shoulders, and upper arms
• Pityriasis alba may be a minor manifestation of atopic
dermatitis. Most patients have a history of atopy.

46. Depigmentation
Treatment of Pityriasis alba include:
• Pityriasis alba usually goes away on its own with patches
returning to normal pigment over many months.
• It sometimes works itself out spontaneously and does not
always require treatment.
• A moisturizer cream or lotion may be recommended.

47. Depigmentation
Treatment of Pityriasis alba include:
• Moisturizing creams
• Topical steroid creams, such as hydrocortisone
• Nonsteroid creams, such as pimecrolimus
• Tacrolimus ointment 0.1%
• Pimecrolimus cream 1%
• These creams can help reduce discoloration and relieve
dryness, scaling, or itchiness.
• A primary care provider, nurse practitioner, dermatologist,
or specially trained nurse can manage pityriasis alba.

48. Depigmentation
Dyschromias
Endogenous or exogenous pigments other than melanin are deposited
in the skin
Endogenous
 hemosiderosis(iron-rich pigment from erythrocytes)
 bile pigments
 carotenemia
 ochronosis (bluish black discoloration - homogentisic acid in the skin, cartilage-
alkaptonuria)
Exogenous
• Argyria (silver salts –slate grey)
• Chrysiasis (gold salts –blue grey)
• Tatoo
• Medication-induced pigmentary changes
 antimalarials (quinacrine- yellow)
 amiodarone- photosensitivity of blue-grey discoloration
 minocycline –blue-black pigmentation in acne scars and sun-exposed skin

49. Depigmentation
Pityriasis versicolor
Pityriasis versicolor, also known as tinea versicolor, is a
common, harmless fungal infection of the skin.
It's caused by an overgrowth of yeast that's usually found on
the skin.
Pityriasis versicolor is not painful or contagious, but it can
cause emotional distress or self-consciousness.
It can also be mildly itchy.
Pityriasis versicolor usually affects the neck, trunk, and
arms. Patches may be coppery brown.

50. Depigmentation
Treatments for pityriasis versicolor include:
• Antifungal creams, lotions, or shampoos
• Ketoconazole 2% shampoo
• Selenium sulphide shampoo
• With treatment, the fungus usually clears up in 1–2
weeks. However, the skin patches may remain discoloured
for weeks or months.
• To make them less noticeable, you can use sunscreen to
prevent the skin from tanning or burning.