What causes skin darkening?

Recently I have been deluged with inquiries about facial pigmentation.

Dark pigmentation in the skin can be embarrassing. How much more if it occurs on one’s face?

Human skin pigmentation is actually one common skin disorder that many people suffer from, whether it’s on the face or somewhere else in the body. The word “pigmentation” is characterized as the coloring on people’s skin. When people are at their healthy state, their skin color will appear normal.  However, hyper-pigmentation can occur. This skin pigmentation may be isolated to small spots or cover large areas like the entire face or be generalized, which means arms or legs or torso might be affected, too.

Dark skin pigmentation is coupled with overproduction of melanin, but this may not be as simple as it seems. Several factors can cause excess melanin production. While it may be frustrating to deal with these dark spots, understanding the cause of one’s hyper-pigmentation may help determine the best options for removal.

Sun exposure

One of the main causes of dark pigmentation in the skin is sun damage. Dark spots form (as in melasma, freckles, etc.) because melanin pigments become concentrated in certain areas. Individuals who use sunscreen with an SPF of at least 30 on a daily basis minimize the amount of ultraviolet rays that penetrate the skin, which helps prevent dark sunspots.

Other factors that cause inflammation and pigmentation of the face or skin include:

• Accutane (medicine) increase skin’s sensitivity to sunlight leading to inflammation and pigmentation.

• Fabric dyes, plant-derived irritants, non-steroidal medications, topical retinoids and chemotherapeutic drugs.

• Skin conditions such as eczema

• Acne vulgaris

• Physical trauma such as chemical burns, exposure to extreme temperatures resulting in burns, surgeries, laser resurfacing treatments and other types of trauma could also cause hyperpigmentation.

Hormones

Many women experience darkening in skin pigmentation during pregnancy, referred to as a pregnancy mask. It occurs due to hormone fluctuations. Birth control pills or hormone replacement therapy may cause similar darkening because they affect hormone levels, as well.

Illnesses that affect hormones, such as Addison’s disease, also are often accompanied by hyperpigmentation.  Adrenal glands are two small, flattened bodies of a yellowish color, immediately above and in front of the upper end of each kidney. Addison’s disease is a disorder that occurs when your body produces insufficient amounts of certain hormones produced by your adrenal glands. In Addison’s disease, your adrenal glands produce too little cortisol and aldosterone as well.  Also called adrenal insufficiency, Addison’s disease occurs in all age groups and affects both sexes. Addison’s disease can be life threatening. Addison’s disease symptoms usually develop slowly, often over several months, and may include:  extreme fatigue, weight loss and decreased appetite, darkening of your skin (hyperpigmentation), low blood pressure, even fainting, salt craving, low blood sugar (hypoglycemia), nausea, diarrhea or vomiting, pain in your lower back, abdomen, joints or legs, irritability, depression, body hair loss or sexual dysfunction in women. Causes includes: autoimmune (the body attacks itself), tuberculosis, other infections of the adrenal glands, spread of cancer to the adrenal glands, bleeding into the adrenal glands, which may present as adrenal crisis without any preceding symptoms and diseased pituitary gland.

Diseases and deficiencies

Vitamin B12 deficiency. Cutaneous manifestations associated with vitamin B12 deficiency are skin hyperpigmentation, vitiligo, angular stomatitis, and hair changes. A diagnosis of vitamin B12 deficiency is often overlooked in its early stages because these signs are not specific to vitamin B12 deficiency alone. Niacin deficiency is well known to cause pellagra in which sunlight-exposed areas show scaly hyperpigmented patches.  A similar picture is reported in folic acid deficiency.

There are so many autoimmune diseases, but worthy of mention here are diabetes and lupus. Diabetes can affect every part of the body, including the skin. In fact, discoloration are sometimes the first sign that a person has diabetes. Bronzing of skin in diabetics is secondary to a defect in iron metabolism (hematochromatosis — the disorder can cause diabetes via damage to the pancreas).  With the kidneys affected too, skin darkening tends to develop in areas of skin exposed to sunlight. Pallor due to anemia, hypoglycemia and anti-diabetic drug side effects may also occur.  Luckily, most skin conditions can be prevented or easily treated if caught early. Hyperpigmentation is also considered to be one of the symptoms of lupus. Surprisingly, in lupus, the invasion is not from any bacteria or viruses but from the immune system itself. It attacks the tissues of the joints and the skin, which gives rise to a rash that makes a butterfly-shaped pattern in the affected area. This condition is notorious for causing dark patches on the skin.

Alcohol-related liver disease (ARLD) is caused by damage to the liver from years of excessive drinking. Years of alcohol abuse can cause the liver to become inflamed and swollen. This damage can also cause scarring known as cirrhosis. Cirrhosis is the final stage of liver disease. Some people with ARLD don’t have symptoms until the disease is advanced. Others start showing signs earlier. Symptoms of ARLD include: nausea, loss of appetite, jaundice, fatigue, abdominal discomfort, increased thirst, swelling in the legs and abdomen, weight loss, darkening or lightening of the skin, red hands or feet, dark bowel movements, fainting, unusual agitation, mood swings, confusion, bleeding gums, and enlarged breasts (in men).

Metabolic processes play an essential role in the development and physiolocal function of human skin. Thus, human skin cells contain hormone-specific receptors and are targets of several hormones exerting various effects.  Metabolic causes includes hyperthyroidism, hemochromatosis, cirrhosis of liver, porphyria, chronic renal failure, malnutrition, pregnancy.

Medication may also cause dark pigmentation in the skin the likes of amiodarone, amitriptyline, arsenic, bleomycin, clofazimine, clophosphamide, minocycline, zidovudine etc. Plus other medications to treat seizures, malaria, infections that may increase melanin.

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