Pigment loss can be worrisome. It's sometimes limited to small patches of skin but may be more generalized. Understanding the nature of the pigment loss is key to determining the most appropriate next steps. Common causes of pigment loss include skin conditions like vitiligo, inflammation, wound healing with scarring, infection and a variety of other conditions that a person may be born with or acquire.
Vitiligo and Pityriasis Alba
Two of the most common skin disorders associated with pigment loss have causes that are not completely understood. Vitiligo typically occurs during the first 3 decades of life and is characterized by smooth, white patches of skin. Pityriasis alba, which is most often observed in young children, may first appear as a red scaly rash, typically on the face and arms. The rash often resolves spontaneously but leaves dry, white patches as it heals. These patches eventually disappear, causing no permanent pigment loss.
Several types of infection can cause pigment loss. Tinea versicolor, due to a fungus, is characterized by dry, scaly patches that may be lighter or darker than the surrounding skin and may itch. It may appear anywhere on the body and may be just a few spots or widespread. Pigment loss can also occur after certain viral infections like chickenpox.
Inflammation and Scarring
Pigment loss may occur after skin inflammation caused by disorders like psoriasis, lupus, seborrheic dermatitis and eczema. In all of these disorders, the pigment loss appears as irregular patches of poorly defined whitening, and there may be scaling if the underlying disorder is scaly. Pigment loss may also occur with scarring. This can make scars not only more noticeable but also susceptible to damage from ultraviolet radiation, leading to sunburns and possibly skin cancer.
Chemical Exposure and Topical Medicines
Exposure to certain chemicals can cause skin color changes. For example, an antioxidant used in rubber manufacturing -- monobenzyl ether of hydroquinone -- was one of the first chemicals noted to be associated with occupation-related pigment loss. Certain compounds used in antioxidants or germicidal disinfectants can also produce pigment loss. Likewise, some medicines applied to the skin, such as corticosteroids and tretinoin, have the potential to produce lighter areas.
Congenital and Genetic Conditions
Nevus depigmentosus is something akin to a freckle or mole that has no color. It's considered a congenital condition that a person is born with, but it has no known pattern of inheritance. Albinism is a group of genetic conditions associated with reduced pigment affecting the eyes and other areas, such as the skin and hair. Piebaldism, another genetic condition, usually results in a patch of white hair near the forehead, or a white forelock. There may also be areas of unpigmented skin on the forehead, trunk, arms and legs.
Other Causes and Follow-Up
Inadequate intake of copper or selenium can cause generalized pigment loss, usually beginning on the face and sometimes also affecting the hair. This may occur in a person receiving long-term intravenous feeding or in instances of severely insufficient nutrient intake.
If you notice any pigment loss, see your doctor to help identify the cause and determine the most appropriate next steps. The pigment loss may be simply a part of a normal process, such as wound healing, but it may represent something more sinister, such as a melanoma changing from dark brown to flesh color.