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Skin - abnormally dark or light

Definition

Skin that has turned darker or lighter than normal is usually not a sign of a serious medical condition.

Alternative Names

Hyperpigmentation; Hypopigmentation

Considerations

Normal skin contains cells called melanocytes. These cells produce melanin, the substance that gives skin its color.

Skin with too much melanin is called hyperpigmented skin.

Skin with too little melanin is called hypopigmented skin.

Pale skin areas are due to too little melanin or underactive melanocytes. Darker areas of skin (or an area that tans more easily) occurs when you have more melanin or overactive melanocytes.

Bronzing of the skin may sometimes be mistaken for a suntan. This skin discoloration often develops slowly, starting at the elbows, knuckles, and knees and spreading from there. Bronzing may also be seen on the soles of the feet and the palms of the hands. The bronze color can range from light to dark (in fair-skinned people) with the degree of darkness due to the underlying cause.

Causes

Causes of hyperpigmentation include:

  • History of skin inflammation (post-inflammatory hyperpigmentation)
  • Use of certain medications (such as minocycline)
  • Endocrine diseases such as Addison's disease
  • Hemochromatosis (iron overload)
  • Sun exposure

Causes of hypopigmentation include:

  • History of skin inflammation
  • Certain fungal infections (such as tinea versicolor)
  • Pityriasis alba
  • Vitiligo

Home Care

Over-the-counter and prescription creams are available for lightening the skin. If you use these creams, follow instructions carefully, and don't use one for more than 3 weeks at a time. Darker skin requires greater care when using these preparations. Cosmetics may also help cover a discoloration.

Avoid too much sun exposure. Always use sunscreen with an SPF of 30 or higher.

Abnormally dark skin may continue even after treatment. Experts recommend emotional support or counseling.

When to Contact a Medical Professional

Call your doctor for an appointment if you have:

  • Skin discoloration that causes significant concern
  • Persistent, unexplained darkening or lightening of the skin
  • Any skin sore or lesion that changes shape, size, or color may be a sign of skin cancer

What to Expect at Your Office Visit

Your doctor will perform a physical exam and ask about your symptoms, including:

  • When did the discoloration develop?
  • Did it develop suddenly?
  • Is it getting worse? How fast?
  • Has it spread to other parts of the body?
  • What medicines do you take?
  • Has anyone else in your family had a similar problem?
  • How often are you in the sun? Do you use a sun lamp or go to tanning salons?
  • What is your diet like?
  • What other symptoms do you have? For example, are there any rashes or skin lesions?

Tests that may be done include:

Your doctor may recommend creams, ointments, surgery, or phototherapy, depending on the type of skin condition you have. Bleaching creams can help lighten dark areas of skin. 

Some skin color changes may return to normal without treatment.

References

Ortonne JP, Passeron T. Vitiligo and other disorders of hypopigmentation. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 66.

Chang MW. Disorders of hyperpigmentation. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 67.


Review Date: 5/15/2013
Reviewed By: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial Team.
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