Hypopigmentation is a decrease in normal skin, hair, mucous membrane, or nail color resulting from deficiency, absence, or abnormal degradation of the pigment melanin.
This sign may be congenital or acquired, asymptomatic or associated with other findings. Its causes include genetic disorders, nutritional deficiency, chemicals and drugs, inflammation, infection, and physical trauma.
Causes of hypopigmentation: Albinism:This genetically inherited disease involves alterations of the melanin pigment system that affects skin, hair, and eyes. There are various forms of albinism, all of which are present at birth. Skin and hair color vary from snow white to brown, but the universal finding of iris translucency confirms the diagnosis. Associated eye findings include nystagmus, decreased visual acuity, decreased pigmentation of the retina, and strabismus.
Burns: Thermal and radiation burns can cause transient or permanent hypopigmentation. Inflammatory and infectious disorders: Skin disorders, such as psoriasis, and infectious disorders, such as viral exanthemas or syphilis, can cause transient or permanent hypopigmentation. Tinea versicolor:
This benign fungal skin infection produces scaly, sharply defined lesions that usually appear on the upper trunk, neck, and arms. The lesions range from hypopigmented patches in dark-skinned patients to hyperpigmented patches in fair-skinned patients.
Tuberculoid leprosy: This chronic disorder affects the skin and peripheral nervous system. Erythematous or hypopigmented macules have decreased or absent sensation for light, touch, and warmth. Associated effects may include very painful, palpable peripheral nerves; muscle atrophy and contractures; and ulcers of the fingers and toes.
Vitiligo: This common skin disorder produces sharply defined, flat white macules and patches ranging in diameter from 1 to over 20 cm. The hypopigmented areas commonly have hyperpigmented borders. Usually bilaterally symmetrical, lesions appear on sun-exposed areas; in body folds; around the eyes, nose, mouth, and rectum; and over bony prominences. Patches of vitiligo may coalesce to form universal lack of pigment and may involve the hair, eyebrows, and eyelashes. Spontaneous repigmentation can occur. Hypopigmented patches may surround pigmented moles. Drugs: Topical or intralesional administration of corticosteroids causes hypopigmentation at the treatment site. Chloroquine, an antimalarial drug, may cause depigmentation of hair including eyebrows and lashes and poor tanning 2 to 5 months after therapy begins. Investigations: •Skin lesion examination •Routine hematological examination •Blood culture for drugs Management:
1. Advise patients to use corrective cosmetics to help hide skin lesions, and to use a sunblock because hypopigmented areas may sunburn easily.
2. Encourage regular examinations for early detection and treatment of lesions that may become premalignant or malignant.
3. Advise patients with associated eye problems, such as albinism, to avoid the midday sun and to wear sunglasses.
4. Refer patients for counseling if lesions cause stress.
Arsenicum : This is the most homoeopathic of all remedies to this disease. Both the disease and drug have nerve depression, gastric irritation, general debility, feeble heart action and tendency to vomit. The skin symptoms have also a curious similarity; both the burning and the discoloration have been found in several cases of poisoning by Arsenic.
Hydrocotyle: Great dryness and desquamation of the epidermis. Hyppigmented skin lesions with severe itching Its special field is in psoriasis
Berberis aquifolia: Scaly pustular eruptions on the face. It is one of the most reliable remedies in the cure of psoriasis.
Oleander: Skin eruptions with gastro-energetic troubles; the skin is very sensitive, slight friction causes chafing and soreness, especially about the neck, scrotum and thighs.
There is great itching; scartching relieves at first but the parts become very sore. It will be all the more strongly indicated if gastro-enteric symptoms be present.
Viloa tricolor: In this remedy the skin is pale in patches and there is severe irritation at the affected sites It has crusts with a copious exudation and it is accompanied with offensive urine.
Hypopigmented patches or spots on the skin. Herpetic conditions about the knees and ankles,in the bends of joints and behind the ears, at first dry, it becomes moist and discharges copiously.
Yellow spots, liver spots; urticaria worse from warmth of bed.
Sulphur: The great characteristic of this remedy is the aggravation from washing; this, with scratching, makes the parts burn intensely.
The skin is rough, coarse and measly, and there is much soreness in the folds of the skin and a tendency to pustular eruptions.
Dryness and heat of scalp, with intense itching, especially at night, and scratching causes soreness; wetting makes it burn.