Melasma, Chloasma in face

What is Melasma/Chloasma?

A patchy brown or dark brown skin discoloration that usually occurs on face and may result from hormonal changes, as in pregnancy and during the administration of estrogen containing oral contraceptives.

It is generallly found on sun-exposed areas of the face. Melasma often fades over several months after stopping oral contraceptives or hormone replacement therapy(HRT) or after delivering a child. It may return with additional pregnancies or use of these medications. The patches gradually fade over many months. In some people, the discoloration never entirely disappears. However, this condition develops spontaneously in some women who are neither pregnant, taking oral contraceptives, nor HRT medications.

Causes, incidence, and risk factors for Melasma/Chloasma

§ Melasma is a very common skin disorder. Though it can affect anyone, young women with brownish skin tones are at greatest risk. Chloasma is especially common in women aged 20-40. It is more common in dark skins than in fair skins.

§ Melasma is often associated with the female hormones estrogen and progesterone. It is especially common in pregnant women, women who are taking oral contraceptives ("the pill"), and women taking hormone replacement therapy during menopause.

§ Sun exposure is also a strong risk factor for melasma. It is particularly common in tropical climates.

§ Melasma develops due to a combination of genetic, hormonal and sun related factors

§ Melasma has been referred to as the mask of pregnancy because it often develops during pregnancy. Because of melasma’s relation to pregnancy and oral contraceptives, it is thought that estrogen contributes to its development in predisposed persons.

§ Estrogen is not essential to the development of melasma, however, as men may also be affected.

§ A factor that does seem to be essential to the development of melasma is sunlight.

§ Both ultraviolet A (UVA) and ultraviolet B (UVB) are believed to contribute to the formation of melasma in predisposed persons.

§ It may develop in association with menopause, hormonal imbalance and ovarian disorders.

§ Melasma may also be triggered by a medication called Dilantin (phenytoin).

§ It is thought that female sex hormones causes melanocytes or the pigment-producing cells to produce and deposit excess pigments.

§ Chloasma usually affects women but occasionally is seen in young men who use after-shave lotions, scented soaps, and other toiletries.

§ Chloasma is more pronounced during the summer months as a result of sun exposure. It usually fades a few months after delivery. Repeated pregnancies, however, can intensify the pigmentation.

§ Chloasma also occurs as a side-effect of taking contraceptive pills and injected depot contraceptive preparations. It may also be noticed in apparently healthy, normal, non-pregnant women where it is presumed to be due to some mild and harmless hormonal imbalance.

§ Sun exposure, following the use of deodorant soaps, scented toiletries, and various cosmetics can also produce this mottled pigmentation. This is called a phototoxic reaction and is due to ultraviolet radiation being absorbed by the chemical substance on the skin.

§ Deficiency of Folic Acid during pregnancy can also lead to development of Melasma.

Melasma during pregnancy is relatively common. Sometimes it is called the "mask of pregnancy." The dark patches typically last until the pregnancy ends. Despite the strong connection to hormones, no one knows exactly what causes the skin discoloration.

Other factors that make it more likely that a person will get melasma include using medications that make you sensitive to the sun (photosensitizing). These can include some cosmetics and medicines used to treat ovarian or thyroid problems. If you are already susceptible to melasma, exposure to the sun increases your risk. For example, women who are pregnant or who take a hormone medication and avoid the sun are less likely to develop melasma than are those who spend a lot of time in the sun.

Symptom Pictore of Chloasma / Melasma: 

§ Tan, dark brown patches

§ Irregular in shape

§ These patches usually develop on the upper cheek, upper lip and forehead.

Picture of Chloasms, Melasma

Pigmentation seen on cheeks and nose.

§ The dark patches often appear on both sides of the face in a nearly identical pattern. The darker-colored patches of skin can be any shade, from tan to deep brown.

§ Rarely, these dark patches may appear on other sun-exposed areas of the body.

§ The dark patches often appear on both sides of the face in a nearly identical pattern.

§ The darker-colored patches of skin can be any shade, from tan to deep brown.

§ Rarely, these dark patches may appear on other sun-exposed areas of the body.

Melasma doesn't cause any other symptoms besides skin discoloration but may be of great cosmetic concern.

Diagnosis

Diagnosis is simply done by skin examination.

Doctor may use a special lamp [Wood’s lamp] that gives off ultraviolet light; it allows the doctor to see patterns and depth of skin discoloration more clearly.

Medical history will help to determine any factors that may have caused the disorder

Conventional Treatment

§ Creams containing tretinoin, kojic acid, and azelaic acid have been shown to improve the appearance of melasma. Occasionally, doctor may recommend chemical peels or topical steroid creams.

§ In severe cases, laser treatments can be used to remove the dark pigment.

HOMEOPATHY TREATMENT & HOMEOPATHIC REMEDIES

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution etc. A miasmatic tendency (predisposition/suceptability) is also often taken into account for the treatment of chronic conditions. The medicines given below indicate the therapeutic affinity but this is not a complete and definite guide to the treatment of this condition. None of these medicines should be taken without professional advice.

Reportorial rubrics:

[Kent] skin, discoloration, brown, liver spot

[Kent] skin, discoloration, brown, chloasma

[Murphy] skin, chloasma

[Boericke] skin, chloasma, liver spots, moth patches

[Boenninghausen’s] Skin, Spots, Liver (brown, liver-colored, chloasma)

Homeopathy Therapeutics

Sulphur, Lycopodium clavatum, Sepia offincinalis, Thuja occidentalis, Argenticum nitricum, Cadmium sulphuratum, Copaiva offincinalis, Guarana, Caulophyllum, Thalictroides, Plumbum metallicum, Curare.

Homeopathic Remedies:

Sulphur

Skin affection after local medication. Old looking. Spotted face. Skin dry, rough, wrinkled, scaly; Itching, violently at night. Scrofulous diathesis. Liver spots. Unbreakable itching, especially from warmth. Dirty, filthy people, prone to skin affection. 

Lycopodium Clavatum

Grayish-yellow discoloration of the face, with blue circles around the eyes. Brown spot on face and nose. Carbo nitrogenoid constitution. Craves everything warm.

Sepia Offincinalis

Chloasma; yellow spots [moth spots] the on the face, and a yellow saddle across the upper part of cheeks and nose. Suited to patient with having dark hair, rigid fibre. Ailments during pregnancy.

Thuja Occidentalis

Dry skin with brown spot. Hydrogenoid constitution. skin looks dirty. Face, pale, waxy, shiny; dark under eyes; spiderlets on.

Argenticum Nitricum

Face looks sunken, old, pale and bluish. Brown liver spot; irregular blotches. Skin is brown, tense and hard. A prematurely aged look. Irregular blotchesCadmium sulphuratum

Chloasma, yellowish stains on nose and cheeks; worse from exposure to sun and wind.

Copaiva Offincinalis

Brown spot; circumscribed, lenticular patches with itching. Mottled appearance.

Guarana

Chloasma on temples and arms. intellectual excitement; uncontrollable sleepiness.

Caulophyllum Thalictroides

Discoloration of skin in women with menstrual and uterine disorders.

Plumbum metallicum

Yellow, corpse like dark brown liver spots; cheeks sunken. Skin of face is greasy, shiny. Face pale cachetic.

Curare

Red face. Dirty looking skin. Melasma.

Prevention of Chloasma, Melasma.

Avoiding the sun and using sunscreen are key to preventing melasma.

Avoid irritating the facial skin- No strong soaps or abrasive cleaners - use only a mild soap or cleanser for washing.

Increase intake of foods high in folic acid, dark green leafy vegetables, wheat germ, asparagus, broccoli, potatoes, whole grains, fruits and vegetables.

Discoloration of Skin on Face

Discoloration of skin on the face, though unsightly, may require medical attention to get to its root cause. Through this article we will discuss the causes of skin discoloration on face and other parts of the body.

Skin problems are quite common among individuals of all age groups. Normal skin has an even tone and is smooth to touch. But in the presence of skin disorders, the skin may appear to be patchy, dry and the skin tone may also be uneven. Over exposure to the sun, pollutants, make up and leading an unhealthy lifestyle are all contributing factors of discoloration of skin on the face and other parts of the body. In some cases, skin discoloration can be signs of some underlying health condition. Whatever be the reason, this skin condition can be quite annoying and people tend to try out various methods to get rid of it and restore the normal tone of the skin.

Causes of Facial Skin Discoloration

Skin discoloration on face can be categorized as skin darkening and skin lightening. There can be many reasons for the appearance of discoloration of skin on the face. Some of them may be due to superficial factors, like exposure to the sun or pollution. This condition may also appear due to some medical reasons.

One of the main causes of skin darkening is the over secretion of melanin from the cells. This can appear as dark patches on the skin, specifically on the forehead and cheeks. This condition is also known as hyperpigmentation.

White discoloration of the facial skin may be due to a skin condition called vitiligo. This condition is characterized by white colored spots on the face, which may spread till the neck and other parts of the body. Though this is not harmful, it can be quite distressing.

Red discoloration on face may be due to the appearance of skin rash as a sign of allergic reactions. Eczema, psoriasis and other skin conditions can lead to reddish coloration on the face.

Another causative factor is melasma. This skin condition is mostly observed in pregnant women and women who are on birth control pills, as a result of hormonal changes in the body. However this condition is also seen in other individuals.

Other causes can be due to age spots, deficiency of iron and other essential nutrients, damage to the skin due to acne, burns, suntan, and blisters etc.

Remedies for Discoloration of Skin on Face

Facial skin discoloration can be quite unsightly since it mars the appearance of a person. The good news is that this condition is completely curable. You just need to follow a proper skin care regimen, teamed with a nutritious diet, to help reduce these signs.

Make a paste of dried orange peel powder, milk cream, honey and a few drops of lemon juice. Apply this paste on the face and neck and leave it on for about 15 minutes before washing it off.

Prepare a fruit mask out of mashed apricot, papaya and cucumbers. This fruit pulp, if applied, can reduce the signs of discoloration and make the skin more radiant.

Potato juice is also quite effective when it comes to reduce pigmentation and hide blemishes. This is because potato juice has bleaching properties, which treats discoloration.

Another promising remedy to get rid of this skin problem is almonds. Take 6 to 8 almonds and soak them overnight in water. Peel the skin and grind them into a paste. Mix a tablespoon of honey and apply this pack on the face. wash it off with lukewarm water. Repeating this twice a day for at least a week yields visible results.

Exfoliation is an excellent method to remove dead cells from the skin's surface. For this you can scrub your face with ground almonds in a circular motion for about 10 minutes. You can also undergo microdermabrasion, which is the clinical method to exfoliate your face.

There are also several treatment options that can reduce these signs. But you must undergo these treatments only after consulting a dermatologist.

And finally, including fruits and vegetables that are rich sources of Vitamin E and other nutrients required by the skin is a natural way to restore that lost glow. Drinking plenty of water and fluids will flush the toxins from the body and keep the skin hydrated, supple and blemish-free.

Facial skin discoloration may be a reason of cosmetic concern, but it is also necessary to determine its underlying cause. Since this condition may also be an inherent sign of some health disorder, it is advisable to consult a dermatologist or a health care provider.

About Skin Disorders of the Face

Angry red skin. Painful, sometimes burning itchiness. Inflamed blemishes. Scaly patches. These are just a few of the symptoms that people with skin disorders of the face - such as acne vulgaris, eczema, psoriasis and rosacea - suffer with regularly. These conditions affect people of all ages, and most disorders will not go away without treatment; some can become so severe as to cause excruciating discomfort. Beyond the discomfort, the appearance of these skin disorders - especially in extreme conditions- can cause acute embarrassment for the sufferer.

Types

Acne vulgaris, or acne, can appear anywhere on the body, but mostly on the face, neck, back and chest. Acne can range from a mild case, with just a few blemishes, to severe cases, with hundreds of blemishes, as well as large painful cysts.

Eczema - also known as contact dermatitis - manifests as an itchy spot on the skin. If left untreated, it can produce an inflamed redness, a bumpy rash and sometimes small blemishes.

Psoriasis is a chronic skin condition that looks like thick itchy patches of skin that range in color from white, silvery or red. It can also produce flaking skin.

Rosacea is an inflammatory condition that causes several different kinds of rashes, mostly red, appearing around the center of the face. It is sometimes known as acne rosacea, although it has no relation to acne.

Geography

People who live in in areas with higher levels of pollution have an increased risk for eczema. Also, extreme temperatures can aggravate the disorder. Some people who suffer from eczema will have flare-ups when the weather is dry and humid, causing severe itchiness, while others will have increased problems when the winter weather dries out the skin, reducing its moisture.

Rosacea is also aggravated by extremes in temperature. Staying out of the sun and using a sunscreen will help.

Features

Acne is caused when the skin's pores are clogged from oil, dirt and dead skin cells, causing whiteheads, blackheads or the red - and sometimes inflamed - blemishes. It is generally worse in adolescent years, when oil production in the skin is greater. Contrary to popular thought from previous generations, acne is not caused by what you eat.

The cause of eczema is not completely known, but several factors, such as allergies to perfume, dye, soap and other chemicals found in skin-care products, as well as stress and genetics, can trigger eczema flare-ups.

Psoriasis is caused from an immune-system response in which overactive T cells cause an increased production of healthy skin cells and T cells. The healthy cells move to the outer layer faster than normal and cannot be sloughed off quickly enough. This causes the buildup of thick scaly patches on the body.

It is unknown what causes rosacea, although hormones, infections, genetics, and environmental conditions are thought to be involved. Sun exposure can worsen the condition.

Prevention/Solution
When treating skin conditions, good hygiene is very important. Use the mildest product available. Exederm products were awarded the Seal of Acceptance from the National Eczema Association and are made without dyes, fragrances, soaps, or other known irritants. The Association also publishes a list of ingredients to avoid (in all products used on the skin) on the Eczema and Sensitive Skin Education website.

As uncomfortable as the itchy rash can be, try to avoid scratching the skin or opening blemishes. Keeping the skin clean and moisturized helps alleviate the discomfort and prevents scarring or spreading the condition. Gold Bond Medicated Cream helps soothe itchy skin on the body. Shower filters reduce the amount of harsh chemicals on the skin. Use perfume/dye-free laundry detergents and dryer sheets when washing clothing, bed and bath linens.

If any of these conditions appear around the eye, seek medical help.

Warning

Most skin disorders of the face appear similar, sometimes causing a delay in diagnosis or inaccurate home treatments. Eczema can produce acne-like blemishes, and psoriasis and eczema can have flaking skin. Rosacea, eczema and psoriasis can cause red patches on the skin. Seek medical advice if the home treatment is not alleviating the problem
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Vitiligo

On this page 

• Understanding the skin 
• What is vitiligo and what causes it? 
• Who gets vitiligo? 
• What areas of skin are affected with vitiligo? 
• How does vitiligo progress? 
• What are the symptoms of vitiligo? 
• What are the treatment options for vitiligo? 
• Skin camouflage 
• Treatments that aim to reverse the changes in the skin 
• Treatment to de-pigment the skin completely 
• Sunblock 
• Are there any complications of vitiligo? 
• Further help and information 
• References 

Understanding the skin

To understand the cause of vitiligo, it is useful to have a basic understanding of the skin. The skin has two layers - the epidermis and the dermis. Beneath the dermis is a layer of fat, and then the deeper structures such as muscles and tendons.






There are cells called melanocytes in the bottom of the epidermis which make a pigment called melanin. The melanin is passed to the nearby skin cells, which colours the skin and protects them from the sun's rays. Melanin causes the skin to tan in fair-skinned people. Dark-skinned people have more active melanocytes. The melanocytes are stimulated to make more melanin when exposed to sunlight.

What is vitiligo and what causes it?
Vitiligo is a condition where pale white patches develop on the skin. It is due to a lack of pigment (colour) in the affected areas of skin. Vitiligo does not make you feel ill. However, the appearance of vitiligo can be distressing. This is particularly so for darker-skinned people where white patches are more noticeable.

Areas of skin with patches of vitiligo have no or very few melanocytes. The melanocytes are either damaged or destroyed in the body. Therefore, melanin cannot be made and the colour of the skin is lost. It is not known why the melanocytes go from affected areas of skin. They may be destroyed by the immune system or self-destruct for reasons not yet known. It is thought to be an autoimmune condition. This means that the immune system (which normally protects the body from infections) does not work properly. Antibodies are produced that can destroy your skin cells that make melanin.

Who gets vitiligo?
About 1 in 100 people develop vitiligo. Men and women are equally affected. It can develop at any age. However, it begins before the age of 20 in about half of cases. There is some genetic factor involved and vitiligo may run in the family. About 1 in 3 affected people have some other family member who is also affected. Vitiligo is not infectious and you cannot catch it from affected people. It is not more common in any racial or ethnic groups.

What areas of skin are affected with vitiligo?



Any area of skin can be affected. However, the most common sites involved are the face, neck, and scalp. Other common sites include the backs of hands, front of knees, elbows and genitals.

It is often symmetrical in that patches may appear on similar places on each arm or leg. In the areas of the scalp that are affected, the hair too is affected, causing it to become grey or white.

Very rarely, vitiligo can affect your whole body. This is called universal or complete vitiligo.

How does vitiligo progress?

Small areas of milky-white skin usually develop first. The contrast between the vitiligo skin and normal skin varies. In fair-skinned people it may only be noticeable in summer when normal skin tans. The contrast is more noticeable in darker-skinned people.

The course and severity of vitiligo varies from person to person. Sometimes a few small patches develop slowly and progress no further. Sometimes a number of patches develop quite quickly and then remain static for months or years without changing. However, it is quite common for the white patches gradually to become bigger and for more patches to appear on other parts of the body. Large areas of the skin may eventually be affected.

There is no way of predicting how much of the skin will eventually be affected when the first patch develops. The white patches are usually permanent. Rarely, some patches of vitiligo may re-pigment and return to normal.

What are the symptoms of vitiligo?
People with vitiligo are usually well. Vitiligo is not sore or itchy. However, the appearance of the skin can be distressing, particularly if the face or the hands are affected. There is no natural protection from the sun in affected areas of skin. This means that skin affected by vitiligo burns much more easily than normal skin if exposed to sunlight.

What are the treatment options for vitiligo?
Although there is no cure for vitiligo, there are now treatments available which can slow down vitiligo and also improve it. Some people may not be concerned about the white patches of skin if they are in areas not noticeable to others. In fair-skinned people, avoiding tanning of normal skin can make patches of vitiligo much less noticeable.

Treatment options generally fall into four groups:
Skin camouflage - measures to cover or camouflage the affected skin.
Treatments that aim to reverse the changes in the skin.
Treatment to de-pigment the skin completely.
Sunblock and other means to protect the pale skin. 

Skin camouflage
Skin camouflage uses special coloured cover creams that are put on the white patches of vitiligo. Skin camouflage does not alter the disease but improves the skin's appearance. The aim is to find a colour to match the colour of your skin. Some special cover creams can be prescribed on the NHS. The creams can disguise vitiligo very well which may greatly increase self-confidence. The British Red Cross provides a free Skin Camouflage Service (see below).

There are also self-tanning lotions available from pharmacies. These may also hide the vitiligo and can last several days before needing to be reapplied. However, they often do not provide an exact match for each skin colour. They may be most useful for large areas of vitiligo where matching the colour exactly to nearby skin is not needed so much. Fake tans can also be useful for areas where camouflage is less effective (for example, the back of the hands).

Treatments that aim to reverse the changes in the skin
Some treatments have been shown to slow down the progression of vitiligo, and some treatments cause affected skin to regain pigment and colour in some cases. No single treatment for vitiligo works well in all cases. The response to the various treatments is variable and can depend on the type of vitiligo. Your doctor will advise on treatments that may be worth trying. The following just gives a brief overview of current treatment options.

Steroid cream
This is sometimes prescribed for a limited period of time (initially 4-6 weeks) when a small patch of vitiligo first develops. It may prevent a smaller patch from getting bigger. Occasionally, skin colour may return over a treated area. Steroids work partly by suppressing the immune system (which probably attack the melanocytes). Long-term use of steroid creams can cause side-effects which include thinning of the skin and stretch marks. Steroid creams are not usually recommended to use on your face.
Tacrolimus cream


This can be used as an alternative to steroid cream. It has been shown to restore skin colour to some people with vitiligo. Tacrolimus also works by suppressing cells of the immune system in the skin. It seems to be most effective for vitiligo on the face. It can also be used on the skin of children.
PUVA treatment


PUVA stands for psoralen and ultraviolet A light. It involves taking a special medicine (a psoralen) which makes the skin very sensitive to light. The skin is then treated with ultraviolet A (UVA) light from a special machine in hospital. This treatment is very time-consuming. Treatment is needed twice a week for 6-12 months or more. PUVA may cause side-effects such as sunburn-type reactions or skin freckling. If colour does return to the white patches there is still a chance that it may go white again at a later stage.
Narrowband UVB phototherapy


This is another light treatment which is now used more commonly than PUVA. It uses ultraviolet B (UVB) light. As with PUVA, treatment is twice weekly but you do not need to take a medicine to sensitise the skin and the treatment sessions are much shorter. It is less damaging to the skin than PUVA.
Laser treatments


Laser treatment for vitiligo is currently not available under the NHS as it has not yet been shown to be an effective treatment in clinical trials.
Skin grafting
Grafting of normal skin to small patches of vitiligo has been tried. It is time-consuming and not always successful or available.
Complementary treatments
There is currently insufficient evidence to recommend any complementary treatments for vitiligo.

Treatment to de-pigment the skin completely
In some people with extensive vitiligo, a treatment may be considered to make the remaining normal areas of skin go white. This makes all the skin an even white colour. This is done only after a full discussion with a specialist. The removal of all the skin pigment is permanent and it takes about a year to complete.

Note: the use of sun beds is not recommended. The ultraviolet radiation from sun beds can damage your skin and people who use tanning devices are much more like to develop skin cancer (melanoma) than average.

Sunblock

A high-protection sunblock (factor 30 or above) should be applied to all areas of vitiligo exposed to sunlight. Sunburn can easily occur if the skin is not protected. Some brands of sunblocks are available on NHS prescription. It is also important to cover affected areas of skin when the sun is strong, especially in the middle of the day. For example, by wearing a wide-brimmed hat and long-sleeved clothing.

Are there any complications of vitiligo?
Vitiligo itself does not develop into any other condition. However, other autoimmune disorders (diseases caused by the immune system) are slightly more common in people with vitiligo. For example, thyroid problems, diabetes and pernicious anaemia. Most people with vitiligo do not have these but your doctor may suggest a blood test to rule them out.

Some people with vitiligo are embarrassed about their condition. This can lead to low self-esteem and even depression. Some people find that counselling can be beneficial.

Joining a local support group can be a useful way to help you understand more about this condition.

WHAT ARE DARK SKIN BLOTCHES ON THE FACE?

Dark skin occurs when your body experiences an increase in the production of melanin, the pigment that colors your skin. This darkening can occur on any part of your body, including your face, and in any size. Many causes are behind these blotches, leading people to try several treatment methods before a response is noted. Understanding the cause of your dark spots can help you and your physician reach a method of treatment sooner.

BENIGN CAUSES OF DARK SKIN BLOTCHES

Your dark splotches might be melasma, a common skin disorder that usually occurs after pregnancy, hormonal changes or sun exposure. It can also appear suddenly without these occurrences. However, melasma usually fades somewhat or completely after a few months, according to the website Homeopathy for Everyone. Sun damage can also cause your dark splotches. These are called age spots, liver spots or solar lentigines, and are typically noncancerous. However, they do remain for long periods. Other causes may be acne scars, marks from injury or surgery, or genes. The latter is the cause for freckles, according to MedlinePlus.

Dark blotches can also be caused by Addison's disease, which is a condition in which the adrenal glands are damaged and cannot produce the needed amounts of certain hormones. Other serious causes include Cushing's disease, another adrenal gland disorder. Speak with your physician to determine the cause of your dark spots and a treatment method that is right for you.

TREATMENT FOR DARK BLOTCHES

Treatments for dark blotches typically include a topical ointment. These should contain a melanin-inhibiting ingredient, such as tretinoin and hydroquinone, says the Health Central site. These work by inhibiting the enzyme tyrosinase, which triggers the production of melanin. These ingredients stop the enzyme before it can trigger the increase, says the site. You can find tretinoin in prescriptions such as Renova, Avita and Retin-A, and hydroquinone in topical non-prescription commercial products. Use these together for fading your dark spots. Also, use sunscreen every day and limit your sun exposure, according to Dailyglow.com.

PROCEDURES FOR DARK BLOTCHES

Some procedures can fade your dark spots. These treatments are generally recommended by a physician in severe cases of dark spots. Such procedures include laser treatments or chemical peels that will strip away the uppermost layer of skin, the darkened layer, to reveal a new layer. However, depending on the underlying cause of your dark blotches, your physician might recommend a different treatment method.

WARNING

Topical ointments can cause skin irritation or even an allergic reaction. Symptoms of such irritation or include but are not limited to itching and redness. Symptoms of allergic reactions can range from mild, such as nausea, diarrhea, swelling of the face, itchiness, redness and hives, to severe, such as anaphylactic shock. If you suspect irritation or an allergic reaction, discontinue use and consult your doctor

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Causes Wrinkles

Normal Skin LayersThe skin is made up of 3 layers - the epidermis, dermis, and subcutaneous tissue.

EpidermisThe epidermis is the outer layer and functions as a barrier to the external environment. The cells of the epidermis, keratinocytes, move from the bottom layer of the epidermis to the top layer building up a large amount of keratin and developing a tough outer shell. Once these cells reach the top layer, they flake off. If this process becomes abnormal the skin can look scaly.

DermisThe second layer of skin is the dermis, which contains the structural elements of the skin, the connective tissue. There are various types of connective tissue with different functions. For example, collagen gives the skin its strength, proteins called glycosaminoglycans give the skin its turgor, and elastin fibers give the skin its elasticity or spring.

Dermal-Epidermal JunctionThe junction between the dermis and the epidermis is an important structure. The dermal-epidermal junction interlocks forming fingerlike projections called rete ridges. The cells of the epidermis receive their nutrients from the blood vessels in the dermis. The rete ridges increase the surface area of the epidermis that is exposed to these blood vessels and the needed nutrients.

Subcutaneous TissueThe bottom layer of skin is the subcutaneous tissue containing fat cells. These fat cells provide insulation to the body and make the skin look plump or full.

Chronological Aging and WrinklesAs a person ages the epidermal cells become thinner and less sticky. The thinner cells make the skin look noticeably thinner. The decreased stickiness of the cells decreases the effectiveness of the barrier function allowing moisture to be released instead of being kept in the skin. This causes dryness. The number of epidermal cells decreases by 10% per decade and they divide more slowly as we age making the skin less able to repair itself quickly.

The effects of aging on the dermal layer are significant. Not only does the dermal layer thin, but also less collagen is produced, and the elastin fibers that provide elasticity wear out. These changes in the scaffolding of the skin cause the skin to wrinkle and sag. Also, sebaceous glands get bigger but produce less sebum, and the number of sweat glands decreases. Both of these changes lead to skin dryness.

The rete-ridges of the dermal-epidermal junction flatten out, making the skin more fragile and making it easier for the skin to shear. This process also decreases the amount of nutrients available to the epidermis by decreasing the surface area in contact with the dermis, also interfering with the skin's normal repair process.

In the subcutaneous layer the fat cells get smaller with age. This leads to more noticeable wrinkles and sagging, as the fat cells cannot "fill in" the damage from the other layers.

Aging Effects of the Sun and WrinklesExposure to ultraviolet light, UVA or UVB, from sunlight accounts for 90% of the symptoms of premature skin aging. Most of the photoaging effects occur by age 20. The amount of damage to the skin caused by the sun is determined by the total lifetime amount of radiation exposure and the person's pigment protection.

Sunlight Effects on the EpidermisChanges in the epidermis caused by the sun include thinning of the epidermis and the growth of skin lesions such as actinic keratoses, basal cell carcinomas, and squamous cell carcinomas.

Sunlight Effects on the DermisIn the dermis, sun effects cause collagen to break down at a higher rate than with just chronologic aging. Sunlight damages collagen fibers and causes the accumulation of abnormal elastin. When this sun-induced elastin accumulates, enzymes called metalloproteinases are produced in large quantities. Normally, metalloproteinases remodel sun-injured skin by manufacturing and reforming collagen. However, this process does not always work well and some of the metalloproteinases actually break down collagen. This results in the formation of disorganized collagen fibers known as solar scars. When the skin repeats this imperfect rebuilding process over and over wrinkles develop.

Free Radicals and WrinklesFree radicals are unstable oxygen molecules that have only one electron instead of two. Because electrons are found in pairs the molecule must scavenge other molecules for another electron. When the second molecule looses its electron to the first molecule, it must then find another electron repeating the process. This process can damage cell function and alter genetic material. Free radical damage causes wrinkles by activating the metalloproteinases that break down collagen. There are several factors that start this cascading process including exposure to even small amounts of UV radiation in sunlight, smoking, and exposure to air pollution.

Hormone Effects and WrinklesIt is likely that there are skin changes as a result of the hormonal effects of menopause or decreased estrogen production. However, studies in humans have not documented which skin changes are specific to decreased estrogen and which skin changes are a result of sun exposure or just normal chronological aging. In animal experiments lack of estrogen can cause a decrease in collagen levels of 2% per year and a decrease in skin thickness of 1% per year.

Muscle Use and WrinklesHabitual facial expressions cause the skin to wrinkle as it looses elasticity. Frown lines between the eyebrows and crows feet radiating from the corners of the eyes develop as the tiny muscles in those areas permanently contract.

Gravity and WrinklesThe effects of gravity make the loosening of the skin more apparent as skin sags more. This causes jowls and drooping eyelids.

Syndrome of Sjogren

DefinitionSjogren's syndrome is an inflammatory disease. The immune system destroys cells in exocrine glands. It occurs most often the tear and salivary glands. It is a lifelong condition. There are two types:

• Primary Sjogren's syndrome—occurs alone
• Secondary Sjogren's syndrome—occurs with other rheumatic conditions such as rheumatoid arthritis,scleroderma, or systemic lupus erythematosus (lupus)

Causes

The causes of Sjogren's are unknown. Contributing factors may include:

• Viral infections
• Heredity
• Hormones

Risk
Factors that increase your risk for Sjogren's include:

• Sex: female
• Age: 40-60 years old
• Other rheumatic or autoimmune diseases

Symptoms

• Symptoms may include:
• Red, burning, itching, and/or dry eyes
• Dry mouth
• Difficulty swallowing
• Loss of taste and smell
• Dry skin, nose, throat, and/or lungs
• Swollen salivary glands
• Severe dental cavities caused by dry mouth
• Oral yeast infections
• Vaginal dryness
• Skin rashes
• Joint and muscle pain
• Fatigue

In some cases, other parts of the body are affected as well. These include:

• Blood vessels
• The nervous system
• Organs such as the lungs, liver, pancreas, kidneys, and thyroid

Anti Ro antibodies are often present with Sjogren's. These may cross to the baby during pregnancy. In some cases, they can cause neonatal lupus or infant heartblock.

Common Adult Skin Problems Slideshow

Got Skin Problems?
Is your skin itching, breaking out, covered in a rash, or playing host to strange spots? Skin inflammation, changes in texture or color, and spots may be the result of infection, a chronic skin condition, or contact with an allergen or irritant. You can learn to recognize common adult skin problems. Yet, while many are minor, they may signal something more serious, so always consult a doctor for proper diagnosis.



Shingles (Herpes Zoster)
Shingles starts with burning, tingling, or very sensitive skin. A rash of raised dots develops into painful blisters that last about two weeks. Shingles often occurs on the trunk and buttocks, but can appear anywhere. Most people recover, but pain, numbness, and itching linger for many -- and may last for months, years, or the rest of their lives. Treatment with antiviral drugs, steroids, antidepressants, and topical agents can help.

Hives (Urticaria)
A common allergic reaction that looks like welts, hives are often itchy, and sometimes stinging or burning. Hives vary in size and may join together to form larger areas. They may appear anywhere and last minutes or days. Medications, foods, food additives, temperature extremes, and infections like strep throat are some causes of hives. Antihistamines can provide relief.

Psoriasis
A non-contagious rash of thick red plaques covered with white or silvery scales, psoriasis usually affects the scalp, elbows, knees, and lower back. The rash can heal and recur throughout life. The cause of psoriasis is unknown, but the immune system triggers new skin cells to develop too quickly. Treatments include medications applied to the skin, light therapy, and medications taken by mouth, injection or infusion.



Eczema
Eczema describes several non-contagious conditions where skin is inflamed, red, dry, and itchy. Stress, irritants (like soaps), allergens, and climate can trigger flare-ups though they're not eczema's exact cause, which is unknown. In adults, eczema often occurs on the elbows and hands, and in "bending" areas, such as inside the elbows. Treatments include topical or oral medications and shots.

Rosacea

Often beginning as a tendency to flush easily, rosacea causes redness on the nose, chin, cheeks, forehead, even the eyes. The redness may intensify over time, taking on a ruddy appearance with visible blood vessels. In some cases, thickened skin, bumps and pus-filled pimples can develop. Rosacea treatment includes medications as well as surgical procedures such as laser therapy, dermabrasion, and electrocautery to reshape affected areas.




Cold Sores (Fever Blisters)
Small, painful, fluid-filled blisters on the mouth or nose, cold sores are caused by the herpes simplex virus. Lasting about 10 days, cold sores are very contagious. Triggers can include fever, too much sun, stress, or hormonal changes such as menstruation. Antiviral pills or creams can be used as treatment, but call your doctor if sores contain pus, there is spreading redness, you have a fever, or if your eyes become irritated.


Rash From Plants
Contact with the oily coating from poison ivy, oak, and sumac causes a rash in many people. It begins with redness and swelling at the contact site, then becomes intensely itchy with the development of blisters usually 12 to 72 hours after exposure. The typical rash is arranged as a red line on an exposed area, caused by the plant dragging across the skin. The rash usually lasts up to two weeks.




Soothe Itchy Plant Rashes
Prescription or over-the-counter medication may soothe the itching of mild rashes. Cool compresses and oatmeal baths may help with symptoms. For a severe rash, oral corticosteroid may be given. If the skin becomes infected, antibiotics may be necessary. Avoiding direct contact with the plants can prevent the rash, so learn to recognize poisonous plants. In general, poison oak grows west of the Rockies; poison ivy to the east.



Razor Bumps
Razor bumps are tiny, irritated bumps that develop after shaving. People with curly hair are most affected by them. The sharp edge of closely shaven hair can curl back and grow into the skin, causing irritation and pimples, and even scarring. To minimize razor bumps, take a hot shower before shaving, shave in the direction of hair growth, and don't stretch the skin while shaving. Rinse with cold water, then apply moisturizer.



Skin Tags
A skin tag is a small flap of flesh-colored or slightly darker tissue that hangs off the skin by a connecting stalk. They're usually found on the neck, chest, back, armpits, under the breasts, or in the groin area. Skin tags appear most often in women and elderly people. They are not dangerous and usually don't cause pain unless they become irritated by clothing or nearby skin rubbing against them. A doctor can remove a skin tag by cutting, freezing, or burning it off.



Acne
At the heart of acne lies a clogged pore from oil and dead skin cells that can become inflamed. When open, it is called a blackhead or open comedo; closed, a whitehead or closed comedo. Often seen on the face, chest, and back, acne can be triggered by hormones and bacteria. To help control it, keep oily areas clean and don't squeeze pimples (it may cause infection and scars).



Athlete's Foot
A fungal skin infection that can cause peeling, redness, itching, burning, and sometimes blisters and sores, athlete's foot is contagious, passed by direct contact, sharing shoes worn by an infected person, or by walking barefoot in areas such as locker rooms or near pools. It's usually treated with topical antifungal lotions or oral medications for more severe cases. Keeping feet and the inside of shoes clean and dry is important in treatment.



Moles
Usually brown or black, moles can be anywhere on the body, alone or in groups, and generally appear before age 20. Some moles (not all) change slowly over the years, becoming raised, developing hair, and/or changing color. While most are non-cancerous, some moles have a higher risk of becoming cancerous. Have a dermatologist evaluate moles that change, have irregular borders, unusual or uneven color, bleed, or itch.





Age or Liver Spots

These pesky brown or gray spots are not really caused by aging, though they do become more common as people age. They're the result of sun exposure, which is why they tend to appear on areas that get a lot of sun, such as the face, hands, and arms. Bleaching creams, acid peels, and light-based treatments may lessen their appearance. To rule out serious skin conditions such as melanoma, see a dermatologist for proper identification.

Pityriasis Rosea
A harmless rash, pityriasis rosea usually begins with a single, scaly pink patch with a raised border. Days to weeks later, a scaly rash appears on the arms, legs, back, chest, and abdomen, and sometimes the neck. The rash may appear "Christmas tree" shaped across the body. The rash, whose cause is unknown, isn't believed to be contagious and can be itchy. It often goes away in 6-8 weeks without treatment. Pityriasis rosea is most often seen between the ages of 10 and 35.




Melasma ('Pregnancy Mask')
Melasma (chloasma) is characterized by tan or brown patches on the cheeks, nose, forehead, and chin. Although usually called the "pregnancy mask," men can also develop it. Melasma occurs in half of all women during pregnancy. It may go away after pregnancy but, if it persists, can be treated with prescription creams and over-the-counter products. Use a sunscreen at all times if you have melasma, as sunlight worsens the condition.




Warts
In most cases, common warts appear on the fingers or hands. Caused by contact with the contagious human papillomavirus, warts can spread from person to person or via contact with something used by a person with the virus. You can prevent spreading warts by not picking them, covering them with bandages, and keeping them dry. In most cases, warts are harmless, painless, and go away on their own. If they persist, treatments include topical medications, freezing, burning, surgery, lasers, and chemicals.




Seborrheic Keratoses
Noncancerous growths that may develop with age, seborrheic keratoses can appear on many areas of the skin either alone or in groups. They may be dark or multicolored, and they usually have a grainy surface, though they can be smooth and waxy. No treatment is necessary unless irritation develops or their appearance is a concern. Because seborrheic keratoses may be mistaken for moles or skin cancer, see a dermatologist for proper diagnosis.

What is Scleroderma?

Scleroderma is a chronic disease that affects the skin and, in some people, may also affect internal organs. Scleroderma causes the body to produce too much collagen. Collagen is a protein which consists of connective tissues such as skin. Too much collagen can cause the skin to stretch, harden and thicken. It can also cause damage to internal organs like the heart, lungs and kidneys.

There are 2 types of scleroderma: localized and systemic. Localized scleroderma affects only the skin. Systemic scleroderma affects the blood vessels and internal organs, besides the skin.

Who can have scleroderma?
Anyone can have scleroderma, but women are more likely to develop it. Systemic scleroderma is more common in African Americans and some Native Americans.

What is the cause of scleroderma?
Doctors do not know what the cause of scleroderma is. It is an autoimmune disease. Normally, antibodies produced by the immune system helps protect the body from viruses, bacteria and other foreign substances. If you have an autoimmune disease, the immune system produces antibodies that attack the tissues and organs.




How can my doctor determine if I have scleroderma?
Your doctor will ask about your symptoms and medical history. Perform a physical exam and pay attention to changes in skin appearance. Your doctor may want to extract a tiny sample of skin (biopsy) for examination under a microscope. He may also order a blood test to detect antibodies that suggest scleroderma or other tests to see if any internal organ has been affected.

How is scleroderma treated?
There is no cure for scleroderma. Localized scleroderma sometimes goes away by itself. The treatment usually focuses on relieving symptoms and preventing further damage to the skin and organs. Your doctor will choose the right treatment for you based on your symptoms. If scleroderma is causing damage to internal organs, your doctor may work with other specialists to treat your condition. For example, if scleroderma is affecting your heart, your doctor may want to work closely with a cardiologist.

It is also possible that your doctor may recommend physical and occupational therapy to help manage the pain.

Sometimes, cosmetic surgery can help minimize the effects of scleroderma skin.

kinds of Scleroderma

Scleroderma literally means "hard skin", derived from the Greek words sklerosis which means hardness and derma which means skin. Referred to often as a single disease, scleroderma is actually a symptom of a group of diseases complicated by an abnormal growth of connective tissue which supports the skin and internal organs.

Some types of scleroderma have a limited abnormal process, making the skin hard and tight. Other types are more complicated and affect blood vessels and internal organs such as the:

• heart
• lungs
• kidneys

Scleroderma is considered both a rheumatic disease(conditions characterized by inflammation and/or pain in the muscles, joints, or fibrous tissue) and a connective tissue disease (affects the major substances in the skin, tendons, and bones.)

There are two main classes:

• localized scleroderma (affects only certain parts of the body)
• systemic sclerosis (affects the whole body)

Localized Scleroderma
Localized types of scleroderma affect the skin and related tissues, and sometimes the muscle below. Internal organs are not affected. Localized scleroderma can never progress to the systemic type of the disease. Localized types can improve over time, but the skin changes occuring when the disease is active can be permanent. It can be serious and disabling. Two types exist: Morphea and Linear.

Morphea
Reddish patches of skin that thicken into firm oval-shaped areas are distinctive of the morphea type of localized scleroderma. The center of the patches are ivory, with violet borders that can occur on the:

• chest
• stomach
• back
• face
• arms
• legs

The patches typically sweat little and have little hair growth. Morphea too can be localized (limited to one or several patches, ranging from half-inch to 12 inches in diameter) or generalized (skin patches are hard and dark and spread over larger areas of the body.) Morphea generally fades out in 3 to 5 years but people can have dark skin patches and sometimes, though rare, muscle weakness can remain.

Linear

A distinctive single line or band of thickened and/or abnormally colored skin. The line typically runs down an arm or leg but can run down the forehead.
Systemic Sclerosis

This type of scleroderma not only affects skin but also involves blood vessels and major organs.

CREST

• People with systemic sclerosis often have symptoms of all of the following which are known asCREST:
• Calcinosis (formation of calcium deposits in the connective tissue)
• Raynaud's phenomenon (small blood vessels of hands and/or feet contract in response to cold or anxiety. Hands or feet turn white, cold, then blue)
• Esophageal dysfunction (impaired function of esophagus occuring when smooth muscles in the esophagus lose normal movement)
• Sclerodactyly (thick and tight skin on fingers resulting from deposits of excess collagen within skin layers)
• Telangiectasias (small red spots on the hands and face caused by swelling of tiny blood vessels)

Systemic sclerosis is broken into two categories, diffuse and limited.
Limited Scleroderma
Limited scleroderma typically has gradual onset and is restricted to certain areas of the skin such as:

• fingers
• hands
• face
• lower arms
• legs

Raynaud's phenomenon is often experienced for years before skin thickening is evident. Others experience skin problems over much of the body, which shows improvement over time, leaving only the face and hands with tight, thickened skin. Calcinosis and telangiectiasias often follow. Limited scleroderma is sometimes referred to as CREST syndrome because of the predominance of CREST symptoms in these patients.

Diffuse Scleroderma
Diffuse scleroderma typically has sudden onset. Skin thickening is quick and covers much of the body, typically in a symmetric pattern. Major internal organs can be damaged. Symptoms common with diffuse scleroderma can include:

• tiredness
• loss of appetite/weight
• joint swelling
• joint pain

Skin can swell, appear shiny, and feel tight and itchy. The damage of diffuse scleroderma occurs over a period of a few years.

After about 3 to 5 years patients tend to stabilize, a phase when progression seems little and symptoms subside, but gradually skin changes begin again. A phase recognized as softeningoccurs, during which less collagen is made and the body rids itself of excess collagen. The last areas thickened are reversibly softened. Some patients skin returns to what seems like normal while the skin of others becomes thin and fragile. Diffuse scleroderma patients face the most critical prognosis if they develop complications in the:

• kidneys
• lungs
• heart
• digestive tract

Less than one-third of patients with the diffuse type of scleroderma develop these complications.

Sine Scleroderma
Some recognize sine scleroderma as a third category of systemic sclerosis, different from limited or diffuse systemic sclerosis by not affecting the skin.

Solar keratoses

Rough scaly spots on sun-damaged skin are called solar keratoses. They are also known as actinic keratoses. They should be distinguished from other kinds of keratosis (scaly spot) such as seborrhoeic keratosis, porokeratosis and keratosis pilaris.

What are solar keratoses?

Solar keratoses are a reflection of abnormal skin cell development due to exposure to ultraviolet radiation. They are considered precancerous.

  


 

They appear as multiple flat or thickened, scaly or warty, skin coloured or reddened lesions. A keratosis may develop into a cutaneous horn.

They are very common on sites repeatedly exposed to the sun especially the backs of the hands and the face, most often affecting the nose, cheeks, upper lip, temples and forehead. On the lips they are often called actinic or solar cheilitis. They are especially common in fair-skinned persons or those who have worked outdoors for long periods without skin protection. Sun-damaged skin is also dry, discoloured and wrinkled.

  

Are solar keratoses dangerous?

Solar keratoses themselves are harmless, but they can be uncomfortable and unsightly.

The main concern is that solar keratoses can give rise to a type of skin cancer called squamous cell carcinoma. The risk of squamous cell carcinoma occuring in a patient with more than ten solar keratoses is about 10 to 15%.

Solar keratoses are usually removed because they are unsightly or uncomfortable, or because of the risk that skin cancer may develop in them. If a solar keratosis becomes thickened or ulcerated get it checked; it may have become a skin cancer. Squamous cell cancers often look like volcanoeserupting within the skin.

People with keratoses should visit their doctor regularly for examination as they are also at risk of developing basal cell carcinoma and malignant melanoma. Referral to a dermatologist may be necessary.

Treatment

Treatment of a solar keratosis requires removal of the defective skin cells. New skin then forms from deeper cells which have escaped sun damage.

It is not practical to remove all keratoses in those with very extensive sun damage; in such cases it is important to get rid of thickened or tender lesions as these are the ones at greatest risk of progressing to skin cancer.

Treatments may include:

• Cryotherapy 
• Freezing with liquid nitrogen causes blistering and shedding of the sun damaged skin. Keratoses treated on the face peel off after about 10 days, those on the hands in about 3 weeks, but those on the legs can take as long as twelve weeks to heal. A light freeze usually leaves no scar, but longer freeze times (necessary for thicker lesions or early skin cancers) result in a pale mark or scar. The lesions may recur in time, in which case they may be retreated by the same or a different method.
• Curettage & cautery 
• Curettage & cautery may be preferred with thicker keratoses, and is a common method of removing early squamous cell cancers. A specimen is sent for pathological examination. Curettage is the removal of a lesion by scraping it with a sharp instrument. Cautery or diathermy burns the keratoses off and prevents bleeding. A scab forms which heals over a few weeks, leaving a small scar.
• Excision 
• Cutting the lesion out (excision biopsy) makes sure the lesion has been completely removed, confirmed by pathological examination. This is sometimes important if a lesion may be cancerous. Usually the surgical wound is sutured (stitched). The sutures are removed after a few days, the time depending on the size and location of the lesion. The procedure leaves a permanent scar.
• 5-Fluorouracil cream 
• 5-Fluorouracil cream (5-FU, Efudix) is most useful when there are many keratoses on the face. The cream is applied onto facial skin once or twice daily for two to four weeks. The treated areas become red, raw and uncomfortable. Healing starts when the cream is discontinued, and the eventual result is usually excellent.
• Imiquimod 
• Imiquimod is an immune response modifier in a cream base. It is applied to areas affected by solar keratoses two or three times weekly for four to sixteen weeks. It causes an inflammatory reaction, which is maximal at about three weeks and then gradually settles down with continued use. The results are variable, but generally excellent.
• Photodynamic therapy 
• Photodynamic therapy (PDT) involves applying a photosensitizer (a porphyrin chemical) to the affected area prior to exposing it to a strong source of visible light. The treated area develops a burn and then heals over a couple of weeks or so. Metvix PDT is available in New Zealand.
• Diclofenac gel 
• Diclofenac in hyaluran gel has been used successfully to treat solar keratoses, and is well tolerated. This product is not available in New Zealand (August 2005).
• Ingenol mebutate gel Ingenol mebutate gel was registered by the FDA (USA) in 2012 to treat actinic keratoses.

Prevention of keratoses

Solar keratoses may be prevented by protecting skin from ultraviolet radiation. If already present, keratoses may even improve with regular application of broad spectrum sunscreen to affected areas every day. Sun protection is vital for all fair skinned people working or enjoying themselves outdoors.