Skin discolouration is too little or too much melanin, the pigment that gives our skin a tan or dark colour, and freckles and moles. The underlying cause of pigmentation changes in areas of the skin may be mysterious, but the outcome is obvious: patchy tone.
- Hypopigmentation means less than normal amounts of melanin, producing lighter or white skin, such as in vitiligo
- Hyperpigmentation means more than normal amounts of melanin, producing brown or dark brown spots, as in melasma
It is normal for skin to darken and lighten with the seasons and sun exposure; a clear example is getting a tan on sun-exposed areas in summer, such as arms and legs, which fades during the colder months.
Most discolouration is without consequence, but if you notice areas of skin emerging that are lighter or darker than other areas, it might be time to visit a dermatologist and be checked out.
What is vitiligo?
Vitiligo is a hypopigmentation condition whereby patches of skin, including on the scalp, inside the mouth or the eyes, can lose their colour. Vitiligo is much more apparent in those with darker skin but can happen to anyone.
Vitiligo can be distressing for some people, but it doesn’t cause physical pain or debilitating disease. Vitiligo is chronic but not life-threatening. 
What is melasma?
Melasma is a hyperpigmentation condition whereby grey-brown patches of skin appear on the face or body, usually where the skin sees the most sun. Melasma is much more common in women, thought to be related to hormones and pregnancy. Melasma is made worse by UV exposure.
Understanding skin discolouration in vitiligo
Melanin determines the colour of our hair and skin. In vitiligo, pigment disappears due to the loss of melanocytes – the pigment-producing cells in the skin – because the melanocytes have stopped functioning or have died. The patches get bigger over time, though treatment can sometimes restore colour to the affected areas. Still, treatment won’t prevent loss of pigment from spreading or returning. Vitiligo is not contagious.
The colour loss usually appears first on the face, hands and around openings in the body. Hair can prematurely lose colour and turn grey, including eyebrows, eyelashes, facial hair or head hair.
Mucous membranes in the mouth and genitals can also be affected. The white patches on the skin caused by vitiligo can start at any age, though most cases begin before 30.
Vitiligo can affect:
- Symmetrical body parts (both sides of the body, same body part)
- Asymmetrical body parts (just one side of the body)
- Just a few areas of the body
- Hands and face
- Body openings (eyes, nose, ears, mouth, vagina, anus, penis)
Can vitiligo spontaneously clear up?
Vitiligo sometimes disappears by itself, and colour will return to the skin. However, the more common outcome is that the loss of colour spreads across the body and the condition expands its reach. Each person is different in how their patches will appear and progress, and we can’t predict who will and won’t be more severely affected and who will spontaneously remit.
Causes of vitiligo – is vitiligo an autoimmune disease?
The cause of vitiligo’s white patches on the skin remains mysterious. It might be an autoimmune condition, genetic or set off by a stressful event to the skin or person (emotional stress, sunburn, chemical). Research into vitiligo continues.
Treatments for vitiligo
Vitiligo has no cure, but we have some workarounds available such as restoring or eliminating colour, achieved using camouflage techniques.
Vitiligo can result in some unexpected issues. Elements to look out for include emotional distress, sunburn and hearing loss. The emotional distress caused by vitiligo cannot be understated. While not everyone is affected emotionally or physically the same, the chronic nature of vitiligo can be challenging for some of us.
If you’re struggling with vitiligo, we can refer you to a psychologist who can help you through the more nuanced elements of chronic health concerns, particularly those that affect how you look. We understand how tricky it can be and support you in every way that we can.
Understanding how melasma is different to vitiligo
Melasma is a condition with too much pigmentation, while vitiligo is a condition with not enough pigmentation. These two conditions are a result of entirely different processes and are unrelated to one another.
What to do if you’re experiencing skin discolouration
It’s vital that if your skin is losing or gaining in melanin deposits, you see a dermatologist for assessment. You can usually get a referral through your GP to see a specialist, which Medicare may at least partially cover. Your GP may not have the expertise to diagnose you or treat you appropriately, so we recommend seeing a specialist.
At ENRICH Clinic in Melbourne, we are skin experts and can support you through pigmentation disorders.
Contact us to make an appointment.
ENRICH Clinic
