Nivedha, 28, was all set to marry in a few months. With D-Day fast approaching, she had planned a beauty regimen to look her best. One weekend, as she took a close look at herself after a shower, she was horrified to find dark patches on her upper thigh and abdomen. Getting dressed invariably in a hurry, and worse, without wearing her spectacles, was probably why she had missed it. Doubts assailed her. Would her skin return to normal? How would her husband-to-be react when he came to know?
Dr. Mukta Sachdev, professor and consultant dermatologist, Manipal Hospital, Bangalore, says, “Darkening of the skin is medically referred to as hyperpigmentation or melanosis (it can be restricted to one part of the body such as the face or distributed throughout).
There are numerous causes for hyperpigmentation, ranging from hormonal (post-pregnancy and menopause) and medicine-related (oral contraceptives and anticonvulsants being commonly implicated) to specific conditions such as lichen planus pigmentosus (chronic recurring rash) or ashy dermatosis (a chronic hyperpigmentary disease). Sun exposure is also an aggravating factor. Sensitivity to hair dyes, cosmeceuticals and fragrances causes a particular pigmentation. We also have post-inflammation hyperpigmentation not only due to trauma and injury but also sometimes due to laser toning.”
Dr. Maya Vedamurthy, consultant dermatologist, RSV Skin and Laser Centre, and Apollo Hospitals, Chennai, adds, “Apart from genetic causes, there are marks that develop later in life, perhaps due to metabolic conditions such as liver disease, hormonal disorders, exposure to chemicals such as arsenic, nutritional deficiencies such as B12 deficiency, and following skin diseases or tumours which may be benign or cancerous.”
Who does it affect?
Dr. Mukta explains, “Some pigmentary conditions are more common in women because of more frequent exposure to some chemicals and cosmetics. Also hormonal conditions such as post-pregnancy and menopause are specific to women.”
Interestingly, although hyperpigmentation affects both men and women, doctors point out that it is the women who are more likely to seek medical help.
Explains Dr. Maya, “Pigmentation occurring mainly on the face affects women around menopause. It also affects women in the reproductive age group, especially during pregnancy, and those taking oral contraceptive pills. Some hormonal diseases such as hyperthyroidism, Cushing’s syndrome and Addison’s syndrome can also produce hyperpigmentation.”
While hyperpigmentation is usually a gradual process, it could, depending on the cause, appear suddenly, triggering stressful reactions. Sometimes patients try home remedies, or just wait it out, presuming it will fade away on its own. Like with most health conditions, delaying a visit to the doctor is not a good idea.
What is the treatment?
According to Dr. Maya, “It varies from person to person based on the underlying cause, gender, genes, age and lifestyle. What is most important is identifying the cause. Skin lightening agents may be administered either topically or orally. If these simple measures fail, there are special interventional procedures such as chemical peels, microdermabrasion and lasers, which will help remove excess pigmentation. Avoiding sun exposure and using external and oral sunscreen agents are fundamental to the management of the condition.”
It is important to take note of what goes into the creams prescribed. As Dr. Mukta notes, “Many of the lightening or bleaching creams contain ingredients such as hydroquinone in varying percentages, which should not be prescribed for prolonged use. There are several alternative lightening agents. Further, most pigmentation creams these days are often available in a combination of three or more ingredients.”
Is the condition curable?
“A complete cure is possible if the cause is identified and treated properly. However, enormous patience and perseverance are required on the part of the patient, as it may sometimes take months or even years for the skin to return to normal,” says Dr. Maya.
Dr. Mukta says, “Some superficial pigmentation and post-inflammatory hyperpigmentation can be improved significantly, but if it is extensive and deep, then a complete cure cannot be achieved, and the skin may not return to normal.”
But all hope is not lost. Dr. Mukta assures, “A critical part of treatment is cosmetic camouflage or the use of makeup and cosmetics to cover the affected areas. This should be part of the initial treatment along with sunscreens and lightening agents. Many patients are not well-versed with make-up techniques, or are not comfortable with the idea of using it regularly, and the guidance of an expert is appreciated.”
While doctors focus primarily on treating the disease, it is also important to pay attention to the emotional needs of an individual. As Dr. Maya notes, “Hyperpigmentation affects the psyche of the person deeply when patches are visible and people point out the problem to them. They shy away from social gatherings. In addition, some types of pigmentation such as melasma, which occurs on the face, is associated with a lot of myths, and in some Asian cultures, facial pigment abnormalities are associated with bad luck.”
Corroborating this, Dr. Mukta concludes, “Hyperpigmentation could lower an individual’s self-esteem. Numerous scientific studies using measurement tools and indices documenting the effects of pigmentation especially melasma, have proven that there is a reduction in the quality of life. Therefore, proper treatment of the condition is important.”
