Skin discoloration can have many causes. Sometimes, it's annoying but nothing to worry about. However, it can also signal a more dangerous condition.
Types of Skin Discoloration
Normal skin is smooth and uniform in color. You'll see darker, tanned skin in sun-exposed areas, of course, and the palms and soles are usually lighter than the rest of the skin. Sometimes discolored areas appear, however. You might see:
- Areas of darker skin (hyperpigmentation) which may be dry or rough
- Flat patches of lighter skin
- Reddened areas on the face
- Lighter or darker areas left by cuts, scratches, acne scarring, or other injuries
Skin darkening or hyperpigmentation can have many causes. Diagnosis depends on where it appears, what the skin surface looks like, whether it's itchy or painful, and what other conditions the person has. Possible causes include:
- Venous stasis: The term "venous stasis" describes a decrease in blood flow in the veins, usually in the legs. It tends to occur in people with congestive heart failure and may also appear in people with varicose veins. Its effect on the skin is called "stasis dermatitis." Symptoms and signs include leg swelling, the development of sores and deep ulcers, and a gradual thickening and darkening of the skin. The ankles are a common site for this discoloration. Treatment options include compression hose that may reduce swelling; you can also exercise more and keep your legs elevated when sitting.
- Melasma: Melasma is a darkening of facial skin. It often accompanies pregnancy, and sometimes it appears in women taking birth control pills. Young women with dark skin and people who live in sunny climates are also at higher risk, but anyone can develop melasma. Treatment includes sun protection and gentle bleaching creams.
- Birthmarks: A life-long patch of darkened skin may be a birthmark. Café au lait spots are the color of coffee with cream. They can appear anywhere on the body and are usually harmless. However, multiple café au lait spots can signal a genetic problem and should be checked by a doctor.
Common causes of lighter skin discoloration include infection and aging. Some types of skin lightening aren't well understood. Causes of light patches include:
- Vitiligo: Vitiligo is a skin disorder involving the gradual lightening of patches of skin. It may involve just one small area, large patches, or even most of the body. It's not dangerous, but the discoloration can be upsetting. Doctors think the cause may be a problem with the immune system. Treatments include steroids, special lights, and creams to calm the immune reaction.
- Tinea versicolor: This condition may look like vitiligo, but it's caused by a fungal infection. The fungus prevents skin from tanning normally, so that lighter patches appear; as the yeast grows, the patches may join and become larger in tinea versicolor. Antifungal creams and prescription anti-fungal pills can help treat this condition.
Reddened skin usually signals skin irritation, damage, or an allergic rash. Staying away from the irritant and allowing skin to heal usually makes the redness go away. However, some causes of red skin discoloration are more difficult to treat.
- Rosacea: This common skin disorder is most common in fair-skinned people, but anyone can develop it. Rosacea begins as increased facial flushing-like a deep blush-and proceeds to permanent reddening, sometimes with prominent blood vessels and thickened, bumpy skin. Treatment includes avoiding triggers (such as spicy foods, certain lotions, or extremes of temperature), wearing sunscreen, and using both prescription and over-the-counter medicines. Oral antibiotics like tetracycline or doxycycline or topical antibiotics like metronidazole may help the rosacea; stronger medications like Retin A may also be prescribed as well.
- Red Birthmarks: Several types of birthmarks cause red or wine-colored skin. "Stork bites" are pale red patches on the back of the neck. They often disappear in childhood, but can remain into adulthood, too. Similar marks can appear on the forehead and eyelids; these usually fade by age two. Port-wine stains, red or dark purple marks caused by improperly formed blood vessels, are lifelong. They sometimes signal underlying diseases, so they should be discussed with a doctor.
Skin damage can lead to patches that are lighter or darker than surrounding skin. Blisters, burns, and acne can all leave skin discoloration.
- Burns: First and some milder second degree burns may cause skin discoloration as they heal - second and third degree burns typically require more intensive therapy like skin grafting. Using antibiotic ointments and keeping the area clean can help the burn heal and avoid infection, which can make discoloration or scarring worse. These areas may be sensitive to the sun and will require sunscreen for up to 18 months after the burn. The discoloration will often improve on its own over time, but after the wound has healed, you can use a camouflage makeup to cover the scar. Other treatments like laser resurfacing, microdermabrasion, or chemical peels may also be an option to help the skin return to its normal color. Your doctor will advise you on the best option for you.
- Acne Scarring: Acne develops when the pores of your skin get clogged. More severe outbreaks - including the development of acne cysts - can lead to acne scarring on the face, back, and chest. There are several options to manage acne scarring like acne scar surgery, laser skin resurfacing, fillers, chemical peels, microdermabrasion or dermabrasion, injections, or cryotherapy. Your doctor will want to treat any active acne before dealing with any acne scarring.
- Sun Damage: Excessive exposure to the sun (or tanning booth) without sunscreen or sunblock can lead to discolored skin as well. Sun damage can lead to skin freckles, mottled skin, and telangiectasias or dilated blood vessels. Frequent severe sunburns -- especially before age 18 -- can lead to melanoma at an older age. Lots of unprotected skin exposure can lead to squamous cell or basal cell cancer in your later years.
Some of these patches are permanent scars, which may fade but will never disappear. Luckily, the damage is often temporary or may be camouflaged.
When to See a Doctor
Trying to determine whether or not to seek professional care for discolorations can be difficult, but it's always better to err on the side of seeking medical help if you are unsure of your condition.
- Injuries to the skin like burns should be evaluated by a health care professional when they occur; other conditions like venous stasis should also be followed by a physician because there is a risk for the development of skin infections.
- Many people try to manage conditions like acne or rosacea at home. Mild cases may be successfully dealt with at home but moderate to severe cases of both diseases may require a doctor's evaluation and treatment with prescription medications to improve them. Dealing with residual discoloration may also require additional medical attention.
- Birthmarks may not typically need much treatment unless there is a change in appearance or increase in size. Other new changes in the pigment of the skin -- like vitiligo -- often should be evaluated because there may be a treatment that could cure the condition or prevent it from getting worse.
The good news is that most types of skin discoloration are harmless, temporary, and respond well to treatment. However, any change in the skin is reason to check with a doctor, especially if it doesn't go away or causes discomfort.