Pigmentary Disorders

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UT Southwestern Medical Center is at the forefront of research and clinical care for people with pigmentary disorders, such as melasma and vitiligo. Our skilled dermatologists have extensive expertise in the latest diagnostic and treatment methods to restore a more natural appearance to the skin.

Exceptional Care for Pigmentary Disorders

Pigmentary disorders result from a problem with melanin, a pigment produced by melanocytes that helps determine the color of the skin, hair, and eye iris. Increased melanin causes darker pigmentation, whereas decreased or missing melanin causes a lighter or white appearance. Pigmentary disorders mostly affect the skin – those that affect the hair and iris are rarer.

UT Southwestern dermatologists have been studying pigmentary disorders for decades, leading international research studies that have resulted in new treatment advances. Our dermatologists offer the most advanced methods for diagnosing and treating conditions such as vitiligo and melasma, and we continue to develop improved procedures to teach physicians worldwide. For example, UT Southwestern offers cellular suspension grafting, a groundbreaking procedure offered in only four centers in the U.S.

Types of Pigmentary Disorders

Some commonly known pigmentary disorders include:

  • Albinism: In this group of disorders, the body cannot produce or distribute melanin. People with albinism have either patches of missing skin color, lighter than normal hair and skin color, or no color in their hair, skin, or eye iris.
  • Melasma: In some women, estrogen, progesterone (female hormones), and sun exposure can cause patches of dark skin on the face.
  • Postinflammatory hyperpigmentation: Dark patches of skin can develop during healing of inflammatory skin conditions, such as acne or eczema, or after trauma to the skin, such as surgery or certain cosmetic or dermatological procedures.
  • Vitiligo: Uneven white patches, which is be due to an immune system response targeting melanocytes, develop on the face, elbows, hands, knees, feet, genitals, or more extensive areas.

Causes of Pigmentary Disorders

Pigmentary disorders can result from a variety of factors, depending on the type of disorder. Sometimes, the exact causes are unknown. Among the known causes are:

  • Autoimmune disorder in which the immune system mistakenly attacks healthy melanocytes
  • Genetic defects that can be inherited (passed down) through families
  • Increased estrogen and progesterone levels caused by pregnancy, birth control pills, or hormone replacement therapy (HRT) in menopause
  • Inflammation of the skin due to acne, eczema, psoriasis, or other skin conditions
  • Surgery or certain cosmetic or dermatological procedures, such as chemical peels or microdermabrasion
  • An adverse reaction to a medication

Symptoms of Pigmentary Disorders

The main symptom of pigmentary disorders is abnormally white, light, or dark areas of skin, which may or may not have sharp borders or be symmetrical. Albinism includes other symptoms, such as white skin and hair, and pink or red eyes.

Diagnosis of Pigmentary Disorders

Our experienced dermatologists are skilled at evaluating symptoms to confirm a diagnosis. We begin with a thorough evaluation that includes a:

  • Physical exam
  • Review of personal and family medical history
  • Discussion of symptoms

Often, we can confirm a diagnosis based on the appearance of the patient’s skin, hair, or eyes. We sometimes order further testing to confirm a diagnosis or guide treatment planning. Tests can include:

  • Blood tests to check levels of hormones, glucose (sugar), and vitamin B12
  • Eye exam to examine the retina for issues related to albinism
  • Genetic testing to check for genetic defects that cause albinism
  • Skin biopsy to remove of a small sample of affected skin and examine it under a microscope to rule out other causes of abnormal pigmentation
  • Wood lamp examination uses a special ultraviolet lamp to evaluate skin color changes
  • Dermoscopy uses a microscope-like handheld device to detect small structures on the skin

Treatment for Pigmentary Disorders

UT Southwestern dermatologists offer the latest treatments for pigmentary disorders to relieve symptoms and prevent complications. Some of the treatment options we commonly recommend include:

  • Discontinuing of medications such as birth control pills or HRT can fade melasma patches.
  • Topical (applied to skin) treatments, such as creams, lotions, gels, or liquids, can either lighten dark areas or restore skin color to light or white areas. Hydroquinone and tretinoin are some options for lightening. Immunosuppressants can help restore color, and corticosteroids are options for both lightening and re-coloring skin.
  • Cosmetic procedures such as chemical peelsdermabrasion, and laser resurfacing 
  • Phototherapy can treat light-colored patches, such as vitiligo lesions
  • Skin grafts transplant areas of normal-colored skin to light or white areas. UT Southwestern offers cellular suspension grafting, a groundbreaking procedure offered in only four centers in the U.S. It uses small pieces of donor skin that are processed into a cellular suspension and transplanted into much larger areas of vitiligo.

Our dermatologists typically also recommend minimizing sun exposure through lifestyle changes such as:

  • Applying sunscreen with a sun protection factor (SPF) of 30 or higher
  • Wearing sun-protective clothing
  • Avoiding sun exposure between 10 a.m. and 4 p.m.

Clinical Trials

Our team is active in clinical research to improve treatments for patients with pigmentary disorders. We are currently involved in a multicenter study for patients with non-segmental vitiligo. Talk to one of our doctors to learn more.  

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