Hyperpigmentation#Diseases and conditions

File:BlackChicken.jpg (rooster shown) chicken breed is due to hyperpigmentation, with the bird's feathers, skin, beak, and internal organs all being affected.]]

Hyperpigmentation can be caused by sun damage, inflammation, or other skin injuries, including those related to acne vulgaris.{{cite web | url = https://www.aocd.org/skin/dermatologic_diseases/hyperpigmentation.html | title = Hyperpigmentation | publisher = American Osteopathic College of Dermatology | work = Dermatalogic Disease Database | access-date = 2006-03-08}}{{cite book |author=Rapini, Ronald P. |author2=Bolognia, Jean L. |author3=Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |isbn=978-1-4160-2999-1 }}James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. {{ISBN|0-7216-2921-0}}.{{rp|854}} People with darker skin tones are more prone to hyperpigmentation, especially with excess sun exposure.{{cite journal|last1=Chandra|first1=M|last2=Levitt|first2=J|last3=Pensabene|first3=CA|title=Hydroquinone therapy for post-inflammatory hyperpigmentation secondary to acne: not just prescribable by dermatologists|journal=Acta Dermato-Venerologica|date=May 2012|volume=92|issue=3|pages=232–5|doi=10.2340/00015555-1225|pmid=22002814|doi-access=free}}

Many forms of hyperpigmentation are caused by an excess production of melanin. Hyperpigmentation can be diffuse or focal, affecting such areas as the face and the back of the hands. Melanin is produced by melanocytes at the lower layer of the epidermis. Melanin is a class of pigment responsible for producing color in the body in places such as the eyes, skin, and hair. The process of melanin synthesis (melanogenesis) starts with the oxidation of {{sm|l}}-tyrosine to L-DOPA by the enzyme tyrosine hydroxylase, then to L-dopaquinone and dopachrome, which forms melanin.{{cite journal | last1=Kim | first1=Ji Hye | last2=Kang | first2=Nam Joo | title=Potent whitening effects of rutin metabolites | journal=Korean Journal of Food Preservation | volume=22 | issue=4 | date=2015-07-14 | issn=2287-7428 | doi=10.11002/kjfp.2015.22.4.607 | pages=607–612 | url=http://www.ekosfop.or.kr/archive/view_article?pid=kjfp-22-4-607 | language=la | access-date=2022-03-15| doi-access=free }}

As the body ages, melanocyte distribution becomes less diffuse and its regulation less controlled by the body. UV light stimulates melanocyte activity, and where concentration of the cells is greater, hyperpigmentation occurs. Another form of hyperpigmentation is post-inflammatory hyperpigmentation. These are dark and discoloured spots that appear on the skin following acne that has healed.[https://www.beskinformed.com/skin-conditions/how-to-treat-hyperpigmentation/ Hyperpigmentation on Face (Acne Scars) ] Hyperpigmentation, Dark Spots, Acne Scars, Meladerm.

Hyperpigmentation is associated with a number of diseases or conditions, including the following:

• Addison's disease and other sources of adrenal insufficiency, in which hormones that stimulate melanin synthesis, such as melanocyte-stimulating hormone (MSH), are frequently elevated.
• Cushing's disease or other excessive adrenocorticotropic hormone (ACTH) production, because MSH production is a byproduct of ACTH synthesis from proopiomelanocortin (POMC).
• Acanthosis nigricans—hyperpigmentation of intertriginous areas associated with insulin resistance.
• Melasma, also known as 'chloasma' or the “mask of pregnancy,” when it occurs in pregnant women.— It is a common skin problem that causes dark discolored patchy hyperpigmentation. It typically occurs on the face and is symmetrical, with matching marks on both sides of the face. The condition is much more common in women than men, though men can get it too. According to the American Academy of Dermatology, 90 percent of people who develop melasma are women.{{cite web | url = https://www.aad.org/public/diseases/color-problems/melasma | title = Melasma | publisher = American Academy of Dermatology, Inc.}}
• Post-acne marks from post-inflammatory hyperpigmentation.
• Linea nigra—a hyperpigmented line found on the abdomen during pregnancy.
• Peutz–Jeghers syndrome—an autosomal dominant disorder characterized by hyperpigmented macules on the lips and oral mucosa and gastrointestinal polyps.
• Exposure to certain chemicals such as salicylic acid, bleomycin, and cisplatin.
• Smoker's melanosis
• Coeliac disease
• Cronkhite–Canada syndrome
• Porphyria
• Tinea fungal infections such as ringworm.
• Haemochromatosis—a common but debilitating genetic disorder characterized by the chronic accumulation of iron in the body.
• Mercury poisoning—particularly cases of cutaneous exposure resulting from the topical application of mercurial ointments or skin-whitening creams.
• Aromatase deficiency
• Nelson's syndrome
• Graves' disease
• Schimke immunoosseous dysplasia (SOID).{{Cite web|url=https://rarediseases.info.nih.gov/diseases/4984/schimke-immunoosseous-dysplasia|title=Schimke immunoosseous dysplasia {{!}} Genetic and Rare Diseases Information Center (GARD) – an NCATS Program|website=rarediseases.info.nih.gov|access-date=2019-03-13|archive-date=2017-10-25|archive-url=https://web.archive.org/web/20171025181658/https://rarediseases.info.nih.gov/diseases/4984/schimke-immunoosseous-dysplasia|url-status=dead}}
• As a result of tinea cruris.
• Due to B12 deficiency.{{Cite journal| title=Cutaneous lesions and vitamin B12 deficiency: An often-forgotten link, Rajendran Kannan, MB BS MD| year=2008| pmc=2294086| last1=Kannan| first1=R.| last2=Ng| first2=M. J.| journal=Canadian Family Physician| volume=54| issue=4| pages=529–532| pmid=18413300}}
• Atopic dermatitis as a result of inflammation.{{Citation |last1=Lawrence |first1=Elizabeth |title=Postinflammatory Hyperpigmentation |date=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK559150/ |work=StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32644576 |access-date=2022-03-27 |last2=Al Aboud |first2=Khalid M.}}

Hyperpigmentation can sometimes be induced by dermatological laser procedures.

• Skin examination including Wood's lamp examination.
• Viewing medical history.

There are a wide range of depigmenting treatments used for hyperpigmentation conditions, and responses to most are variable.{{cite journal|last1=Gupta|first1=AK|last2=Gover|first2=MD|last3=Nouri|first3=K|last4=Taylor|first4=S|title=The treatment of melasma: a review of clinical trials.|journal=Journal of the American Academy of Dermatology|date=December 2006|volume=55|issue=6|pages=1048–65|pmid=17097400|doi=10.1016/j.jaad.2006.02.009}}

Most often treatment of hyperpigmentation caused by melanin overproduction (such as melasma, acne scarring, liver spots) includes the use of topical depigmenting agents, which vary in their efficacy and safety, as well as in prescription rules.{{Cite web|url=https://www.aad.org/media/news-releases/variety-of-options-available-to-treat-pigmentation-problems|title=Variety of options available to treat pigmentation problems {{!}} American Academy of Dermatology|website=www.aad.org|access-date=2017-02-12}}

Many topical treatments disrupt the synthesis of melanin by inhibiting the enzyme tyrosine hydroxylase.

Several are prescription only in the US, especially in high doses, such as hydroquinone, azelaic acid,{{Cite journal|last1=Mazurek|first1=Klaudia|last2=Pierzchała|first2=Ewa|date=2016-09-01|title=Comparison of efficacy of products containing azelaic acid in melasma treatment|journal=Journal of Cosmetic 🥰Dermatology|volume=15|issue=3|pages=269–282|doi=10.1111/jocd.12217|issn=1473-2165|pmid=27028014|s2cid=25303091}} and kojic acid.{{Cite journal|last1=Monteiro|first1=Rochelle C.|last2=Kishore|first2=B. Nanda|last3=Bhat|first3=Ramesh M.|last4=Sukumar|first4=D.|last5=Martis|first5=Jacintha|last6=Ganesh|first6=H. Kamath|date=2013-03-01|title=A Comparative Study of the Efficacy of 4% Hydroquinone vs 0.75% Kojic Acid Cream in the Treatment of Facial Melasma|journal=Indian Journal of Dermatology|volume=58|issue=2|pages=157|doi=10.4103/0019-5154.108070|issn=1998-3611|pmc=3657227|pmid=23716817 |doi-access=free }} Some are available without prescription, such as niacinamide,{{Cite journal|last1=Hakozaki|first1=T.|last2=Minwalla|first2=L.|last3=Zhuang|first3=J.|last4=Chhoa|first4=M.|last5=Matsubara|first5=A.|last6=Miyamoto|first6=K.|last7=Greatens|first7=A.|last8=Hillebrand|first8=G.G.|last9=Bissett|first9=D.L.|date=2002-07-01|title=The effect of niacinamide on reducing cutaneous pigmentation and suppression of melanosome transfer|journal=British Journal of Dermatology|volume=147|issue=1|pages=20–31|doi=10.1046/j.1365-2133.2002.04834.x|pmid=12100180|s2cid=39489580}}{{Cite news|url=https://www.futurederm.com/spotlight-on-niacinamide/|title=Spotlight On: Niacinamide - FutureDerm|date=2007-10-30|newspaper=FutureDerm|access-date=2017-02-12|language=en-US}} {{sm|l}}-ascorbic acid,{{cn|date=March 2022}} retinoids such as tretinoin,{{cite journal |last1=Callender |first1=Valerie D. |last2=Baldwin |first2=Hilary |last3=Cook-Bolden |first3=Fran E. |last4=Alexis |first4=Andrew F. |last5=Stein Gold |first5=Linda |last6=Guenin |first6=Eric |date=2021-11-09 |title=Effects of Topical Retinoids on Acne and Post-inflammatory Hyperpigmentation in Patients with Skin of Color: A Clinical Review and Implications for Practice |journal=American Journal of Clinical Dermatology |publisher=Springer Science and Business Media LLC |volume=23 |issue=1 |pages=69–81 |doi=10.1007/s40257-021-00643-2 |issn=1175-0561 |pmc=8776661 |pmid=34751927}} or cysteamine hydrochloride.{{Cite journal|last1=Mansouri|first1=P.|last2=Farshi|first2=S.|last3=Hashemi|first3=Z.|last4=Kasraee|first4=B.|date=2015-07-01|title=Evaluation of the efficacy of cysteamine 5% cream in the treatment of epidermal melasma: a randomized double-blind placebo-controlled trial|journal=The British Journal of Dermatology|volume=173|issue=1|pages=209–217|doi=10.1111/bjd.13424|issn=1365-2133|pmid=25251767|s2cid=21618233}}{{Cite news|url=http://www.scientispharma.ch/product/cysteamine-cream/|title=Cysteamine Cream® -- New Hyper Intensive Depigmenting Treatment|newspaper=Scientis Pharma|access-date=2017-02-12|language=en-US|archive-date=2016-12-24|archive-url=https://web.archive.org/web/20161224031421/http://www.scientispharma.ch/product/cysteamine-cream/|url-status=dead}} Hydroquinone was the most commonly prescribed hyperpigmentation treatment before the long-term safety concerns were raised,{{Cite journal|last=Draelos|first=Zoe Diana|date=2007-09-01|title=Skin lightening preparations and the hydroquinone controversy|journal=Dermatologic Therapy|volume=20|issue=5|pages=308–313|doi=10.1111/j.1529-8019.2007.00144.x|issn=1529-8019|pmid=18045355|s2cid=24913995|doi-access=free}} and the use of it became more regulated in several countries and discouraged in general by WHO.{{Cite book|title=Hyrdoquinone Guidance published under the joint sponsorship of the United Nations Environment Programme, the International Labour Organisation, and the World Health Organization|hdl = 10665/39218|isbn = 9789241571579|publisher = World Health Organization|year = 1994}} For the US, only 2% is at present sold over-the-counter, and 4% needs prescription. In the EU hydroquinone was banned from cosmetic applications.{{Cite web|url=https://echa.europa.eu/information-on-chemicals/evaluation/community-rolling-action-plan/corap-table/-/dislist/details/0b0236e1807e3dff|title=Hydroquinone - Substance evaluation - CoRAP - ECHA|website=echa.europa.eu|language=en-GB|access-date=2017-02-12}}

Oral medication with procyanidin plus vitamins A, C, and E also shows promise as safe and effective for epidermal melasma. In an 8-week randomized, double-blind, placebo-controlled trial in 56 Filipino women, treatment was associated with significant improvements in the left and right malar regions, and was safe and well tolerated.{{Cite journal|last=Handog|first=Evangeline|date=2009-07-20|title=A randomized, double-blind, placebo-controlled trial of oral procyanidin with Vitamins A, C, E for melasma among Filipino women|journal=International Journal of Dermatology|volume=48|issue=8|pages=896–901|doi=10.1111/j.1365-4632.2009.04130.x|pmid=19659873|s2cid=28886093|doi-access=free}} Other treatments that do not involve topical agents are also available, including fraction lasers{{Cite web|url=http://skinwhiteningnews.org/laser-skin-whitening-advantages-and-disadvantages/|title=Laser Skin Whitening - Advantages and Disadvantages {{!}} Skin Whitening News|website=skinwhiteningnews.org|language=en-US|access-date=2017-02-12|date=2014-04-05|archive-date=2021-09-19|archive-url=https://web.archive.org/web/20210919172154/https://skinwhiteningnews.org/laser-skin-whitening-advantages-and-disadvantages/|url-status=dead}} and dermabrasion.

Laser toning using YAG lasers{{cite journal | last1=Kim | first1=Young Jae | last2=Suh | first2=Hyun Yi | last3=Choi | first3=Myoung Eun | last4=Jung | first4=Chang Jin | last5=Chang | first5=Sung Eun | title=Clinical improvement of photoaging-associated facial hyperpigmentation in Korean skin with a picosecond 1064-nm neodymium-doped yttrium aluminum garnet laser | journal=Lasers in Medical Science | publisher=Springer Science and Business Media LLC | volume=35 | issue=7 | date=2020-04-17 | issn=0268-8921 | doi=10.1007/s10103-020-03008-z | pages=1599–1606| pmid=32300974 | s2cid=215794622 }} and intense pulsed light have been used to treat hyperpigmentation such as melasma and post-inflammatory hyperpigmentation.{{cite journal | last1=Arora | first1=Pooja | last2=Sarkar | first2=Rashmi | last3=Garg | first3=Vijay K | last4=Arya | first4=Latika | title=Lasers for Treatment of Melasma and Post-Inflammatory Hyperpigmentation | journal=Journal of Cutaneous and Aesthetic Surgery | volume=5 | issue=2 | date=2022-01-27 | pages=93–103 | pmid=23060704 | doi=10.4103/0974-2077.99436 | pmc=3461803 | doi-access=free }}

• Drug-induced pigmentation
• Hypopigmentation
• List of skin conditions

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{{Medical resources

| DiseasesDB = 24638

| ICD10 = L81.0-L81.4

| ICD9 = {{ICD9|709.0}}

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| MeshID = D017495

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{{Commons category|Hyperpigmentation}}

{{Pigmentation disorders}}

Category:Dermatologic terminology

Category:Medical signs

Category:Pigmentation