Dyschromia is patchy skin discoloration or skin mottling that is often caused by accumulated sun exposure or other factors such as:
- Acanthosis nigricans
- Café-au-lait spots
- Cuts, scrapes, wounds, and insect bites
- Dermal melanocytosis
- Melasma (chloasma)
- Moles (nevi), bathing trunk nevi, or giant nevi
- Photosensitivity due to certain drugs
- Pityriasis alba
- Radiation therapy
- Sunburn or suntan
- Skin infections
- Tinea versicolor
- Unevenly applying sunscreen
Many factors can increase or decrease melanin production and lead to hyperpigmentation (increase in pigment production) and/or hypopigmentation (decrease in pigment production):
- Genetic makeup
- Injury to the skin
- Exposure to sun and heat
- Exposure to radiation
- Exposure to heavy metals
- Changes in hormone levels
- Skin conditions such as vitiligo
Skin discoloration is usually a cosmetic problem and does not affect physical health. However, in some cases skin mottling may increase the risk of other medical problems.
How is dyschromia treated?
The color of your skin may return to normal over time even without treatment. You can also use medicated creams that lighten the skin in areas of hyperpigmentation.
Protection from exposure to the sun is recommended during treatment because the sun can damage and delay improvement. Before using any cream or product, however, consult your dermatologist.
- Topical bleaching agents (hydroquinone): These can be effective for reducing hyperpigmented patches from several skin conditions including acne, freckles, infection and resolved skin trauma. In some people, these can help even out the skin tone of a large patch. Hydroquinone prevents melanin formation in the skin and lightens darkened patches. It is the oldest and most proven topical treatment. However, there are some safety concerns with its use and should not be used by pregnant women.
- Topical treatments derived from natural ingredients: Several natural ingredients such as kojic acid, mitracarpus scaber extract, bearberry extract, licorice extract, beta-carotene, gluconic acid, azelaic acid, paper mulberry and vitamin C can reduce the appearance of darkened patches. These work like hydroquinone.
- Topical antifungals: Topical antifungals such as Selsun blue (selenium sulfide), ketoconazole or Tinactin (tolnaftate) lotion can help treat hypopigmented patches caused by tinea versicolor, which is a fungal infection that can appear as hypopigmented patches. Apply the product as directed to the patch until the skin tone becomes even.
- Laser treatment: Photorejuvenation is a laser or light-based treatment that delivers pulses of light deep into the skin. It works by first injuring and then repairing collagen. Because it does not injure the outer layer of skin, visible signs after the procedure are minimal. Photorejuvenation can be effective in reducing the appearance of discolored patches, freckles, sun damage, fine wrinkles, aging, and other conditions.
- Chemical peels: Chemical peels are useful for blotchy pigmentation and have a similar effect to laser resurfacing. It can improve the appearance and texture of mild to severe sun-damaged skin.
- Fractional resurfacing: Fractional resurfacing is a type of noninvasive laser procedure that partially resurfaces the skin by computer-aided technology.
When to contact a doctor for dyschromia
Contact your doctor if you notice:
- Persistent changes in skin color without a known cause
- New mole or other growth
- Changes in color, size, or appearance of existing mole or growth
During an examination, your doctor will:
- Carefully examine your skin
- Ask about your medical history
- Ask you when you first noticed symptoms
- Ask whether you have had any recent skin trauma
- Ask about your current medications and supplements
Tests that may be ordered include:
- Scrapings of skin lesions
- Skin biopsy
- Wood lamp (ultraviolet light) skin examination
- Blood tests
Your doctor will recommend treatment based on your diagnosis.
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Kang SJ, Davis SA, Feldman SR, McMichael MJ. Dyschromia in skin of color. J Drugs Dermatol. 2014 Apr;13(4):401-406.
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