February 07, 2007

Other Skin Related Problems



Hyperpigmentation is a common, usually harmless condition in which patches of skin become darker in color than the normal surrounding skin. This darkening occurs when an excess of melanin, the brown pigment that produces normal skin color, forms deposits in the skin. Hyperpigmentation can affect the skin color of people of any race.

Age or "liver" spots are a common form of hyperpigmentation. They occur due to sun damage, and are referred to by doctors as solar lentigines. These small, darkened patches are usually found on the hands and face or other areas frequently exposed to the sun.

Melasma or chloasma spots are similar in appearance to age spots but are larger areas of darkened skin that appear most often as a result of hormonal changes. Pregnancy, for example, can trigger overproduction of melanin that causes the "mask of pregnancy" on the face and darkened skin on the abdomen and other areas. Women who take birth control pills may also develop hyperpigmentation because their bodies undergo similar kind of hormonal changes that occur during pregnancy. If one is really bothered by the pigment, the birth control pills should be stopped.

Changes in skin color can result from outside causes. For example, skin diseases such as acne may leave dark spots after the condition clears. Other causes of dark spots are injuries to the skin, including some surgeries. Freckles are small brown spots that can appear anywhere on the body, but are most common on the face and arms. Freckles are an inherited characteristic.

Freckles, age spots, and other darkened skin patches can become darker or more pronounced when skin is exposed to the sun. This happens because melanin absorbs the energy of the sun's harmful ultraviolet rays in order to protect he skin from overexposure. The usual result of this process is skin tanning, which tends to darken areas that are already hyperpigmented. Wearing a sunscreen is a must. The sunscreen must be "broad spectrum" (i.e. it blocks both ultraviolet A and B). A single day of excess sun can undo months of treatment,

Most prescription creams used to lighten the skin contain hydroquinone. Bleaches lighten and fade darkened skin patches by slowing the production of melanin so those dark spots gradually fade to match normal skin coloration. Prescription bleaches contain twice the amount of hydroquinone, the active ingredient, as over-the-counter skin bleaches. In more severe cases prescription creams with tretinoin and a cortisone cream may be used. These may be somewhat irritating to sensitive skin and will take 3-6 months to produce improvement.

There are now several highly effective laser treatments. The q-switched ruby and other pigmented lesion lasers often remove pigment without scarring. A test spot in an inconspicuous place will need to be done as they sometimes make things worse instead of better.

Adapted from: American Osteopathic College of Dermatology

Incontinentia Pigmenti (IP)

Incontinentia pigmenti (IP) is one of a group of gene-linked diseases known as neurocutaneous disorders. These disorders cause characteristic patterns of discolored skin and also involve the brain, eyes, nails, and hair. In most cases, IP is caused by mutations in a gene called NEMO (NF-kappaB essential modulator). Males are more severely affected than females. Discolored skin is caused by excessive deposits of melanin (normal skin pigment). Most newborns with IP will develop discolored skin within the first two weeks. The pigmentation involves the trunk and extremities, is slate-grey, blue or brown, and is distributed in irregular marbled or wavy lines. The discoloration fades with age. Neurological problems include cerebral atrophy, the formation of small cavities in the central white matter of the brain, and the loss of neurons in the cerebellar cortex. About 20% of children with IP will have slow motor development, muscle weakness in one or both sides of the body, mental retardation, and seizures. They are also likely to have visual problems, including crossed eyes, cataracts, and severe visual loss. Dental problems are also common, including missing or peg-shaped teeth. A related disorder, incontinentia pigmenti achromians, features skin patterns of light, unpigmented swirls and streaks that are the reverse of IP. Associated neurological problems are similar.

Is there any treatment?
The skin abnormalities of IP usually disappear by adolescence or adulthood without treatment. Diminished vision may be treated with corrective lenses, medication, or, in severe cases, surgery. A specialist may treat dental problems. Neurological symptoms such as seizures, muscle spasms, or mild paralysis may be controlled with medication and/or medical devices and with the advice of a neurologist

Adapted from: National Institute of Neurological Disorders and Stroke

Liver Spots and Aging Hands
Time Leaves its Mark

As people age, unsightly blemishes, commonly called liver spots, can appear on the face and on the back of the hands. Another upsetting change for many mature adults is the loss of smoothly contoured hands. Dermatologic surgeons can improve both of these distressing conditions safely and effectively with excellent results.

What Are Liver Spots?

Liver spots, also called lentigines or lentigos, are sharply defined, rounded, brown or black, flat patches of skin. The epidermis (top surface layer) is expanding with more pigment, developing what looks like a large freckle. One may appear by itself, or as a few clustered together.
Many people have a hereditary predisposition to them. While liver spots may develop at an early age, even in childhood, they are more common in older people, especially those who have spent too much time in the sun.

Are Liver Spots Cancerous?

The spots are not cancerous, nor do they lead to cancer. However, on skin exposed to the sun, they may be accompanied by precancerous scaly, red elevations of the skin called actinic keratoses. Dark spots, which might be cancerous, may also appear to be lentigines. All of these blemishes should be evaluated by a dermatologic surgeon.

Can Liver Spots Be Prevented?

Although nothing can be done about the role heredity plays, excessive exposure to the sun should be avoided - a precaution that will diminish the threat of skin cancer as well as protect your skin from sun-damage. To moderate exposure, the skin should be protected by a sunscreen having minimum SPF of 15.

How Are Liver Spots Treated?

Treatment of liver spots is usually performed by the dermatologic surgeon in the office or other outpatient facility. Results can be permanent if a sunscreen is used continuously after removal.
Following are common treatment approaches:


The simplest treatment to protect the skin from further damage and worsening of the spots is use of a sunscreen. Sunscreen is also important after other treatment methods so the spots will not recur.

Bleaching Creams, Tretinoin, and Alpha-hydroxy Acids

These are topical applications prescribed by the physician to fade small spots. Treatment normally takes anywhere from two months to a year or longer.


The dermatologic surgeon freezes the skin tissue with liquid nitrogen to remove liver spots and skin growths.


A chemical solution is applied to peel away the blemished skin. The face and hands usually heal in one to two weeks.


The skin is sanded lightly with a special instrument to remove the spot. Upon healing, which normally takes a week or so, the liver spot is gone. View the Dermabrasion fact sheet for more information.

Laser Surgery

New techniques with various lasers are used to remove the spots. A beam of laser light is directed at the liver spots to selectively eliminate the damaged skin.

How Are Youthful Contours Restored to the Hands?

The skin of the backs of the hands can be improved by a technique called microlipoinjection, a form of soft tissue filler. The dermatologic surgeon uses a tiny syringe to remove a small amount of a patient's own fat from another part of the body, such as the buttocks or the thigh. The fat is then injected into the back of the hands and molded to restore a youthful contour.

Since one's own fatty tissue is used, there is little risk of the body's rejecting it, as can sometimes occur when a foreign substance is used. Some patients have long-lasting results; others need re-treatment periodically.

Adapted from: American Society for Dermatologic Surgery