Hypopigmentation: Types, Causes, Diagnosis, Treatment

Hypopigmentation occurs when cells that produce melanin change due to genetic mutations or damage. When melanocytes do not produce enough melanin, the skin lacks color and appears white or lighter than the surrounding skin. 

Several factors can cause problems with melanin production. Genetic conditions may cause hypopigmentation. Other possible causes include injuries, infections, or chronic skin conditions.

Possible causes of hypopigmentation include:

• Albinism: This genetic condition causes a loss of pigment in the skin, hair, and eyes. Albinism is an inherited condition that is present at birth. 
• Vitiligo: This chronic condition causes patches of lighter skin. The exact cause is unknown. 
• Pityriasis alba: This skin condition may be related to eczema. It causes patches of red, scaly skin that lose their pigment over time. It is possible to outgrow this type of hypopigmentation.
• Pityriasis versicolor: This fungal infection occurs when yeast overgrows on the skin. People who live in warm climates or sweat excessively may be at increased risk. 
• Lichen sclerosus: This chronic inflammatory skin disorder causes a loss of pigment, most commonly in the groin area. It may also affect the torso and limbs. The exact cause is unknown, but researchers believe it may be related to an autoimmune condition. 
• Chronic skin conditions: Eczema and psoriasis are skin conditions that cause inflammation and may lead to lighter skin over time. 
• Skin injuries: Scars and burns may appear lighter than the surrounding skin as they heal. 

See your primary healthcare provider if you notice lighter patches of skin or suspect you may have hypopigmentation. In addition to taking your medical history and performing a thorough physical exam, your provider may recommend the following tests:

• Skin biopsy: Your provider may take a skin sample and send it to the lab to look for signs of infection.
• Wood’s lamp: Your provider may use a special ultraviolet (UV) lamp tool to inspect the skin and diagnose vitiligo.
• Electrodiagnostic testing: Your provider may measure the signals between the eyes and the brain with small electrodes to test for albinism. 

The goal of hypopigmentation treatment is to treat the underlying cause. Many treatment options are available, and the options vary depending on the cause, the areas affected, and your overall health. 

Temporary causes of hypopigmentation, such as injuries or burns, usually do not require treatment. As the skin heals, the pigment naturally returns over time. 

Many common causes of hypopigmentation, including genetic disorders, are not curable. In these cases, treatment aims to manage the condition and protect the skin from damage. Treatment and management options vary depending on the underlying cause:

• Albinism: Sun protection 
• Vitiligo: Light therapy and steroid creams 
• Pityriasis alba: Prescription anti-inflammatory cream
• Pityriasis (tinea) versicolor: Antifungal pills or creams and a medicated cleaner
• Lichen sclerosus: Prescription anti-inflammatory cream

Some health conditions that cause hypopigmentation may also raise the risk of cancer.

People with albinism are at an increased risk of skin cancer because their skin is more vulnerable to the sun’s ultraviolet (UV) rays. Good sun protection, including sunscreen, hats, and long-sleeved shirts, can help lower the risk. People with lichen sclerosus may also be at an increased risk of skin cancer. 

People with albinism may experience problems with their vision. The eye’s retina contains melanin. Without a sufficient amount of melanin, eyesight may be affected. 

The prognosis for hypopigmentation varies depending on the cause. Many common causes, including albinism and vitiligo, do not have a cure. Tips for living with hypopigmentation include:

• Protect your skin from the sun with sunscreen, hats, and full-coverage clothing
• Use a gentle moisturizer on dry skin
• Consider meeting with a therapist or support group if the skin color changes cause you anxiety or emotional distress