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Skin color - patchy

Definition

Patchy skin color is areas where the skin color is irregular. Mottling or mottled skin refers to blood vessel changes in the skin that cause a patchy appearance.

Alternative Names

Dyschromia; Mottling

Considerations

Irregular or patchy discoloration of the skin can be caused by:

  • Changes in melanin, a substance produced in the skin cells that gives skin its color
  • Growth of bacteria or other organisms on the skin
  • Blood vessel (vascular) changes

The following can increase or decrease melanin production:

  • Your genes
  • Heat
  • Injury
  • Exposure to radiation (such as from the sun)
  • Exposure to heavy metals
  • Changes in hormone levels

Exposure to sun or ultraviolet (UV) light, especially after taking a medicine called psoralens, may increase skin color (pigmentation). Increased pigment production is called hyperpigmentation.

Decreased pigment production is called hypopigmentation.

Skin color changes can be their own condition, or they may be caused by other medical conditions or disorders.

How much skin pigmentation you have can help determine which skin diseases you may be more likely to develop. For example, lighter-skinned people are more sensitive to sun exposure and damage, which raises the risk of skin cancers. But even in darker-skinned people, too much sun exposure can lead to skin cancers.

Examples of skin cancers are basal cell carcinoma and melanoma.

Generally, skin color changes are cosmetic and do not affect physical health. However, mental stress can occur because of pigment changes. Some pigment changes may be a sign that you are at risk of other medical disorders.

Causes

Causes of pigment changes may include any of the following:

Home Care

In some cases, normal skin color may return on its own.

You may use lotions that bleach or lighten the skin to reduce discoloration or to even the skin tone where hypopigmented areas are large or very noticeable. Follow the instructions on the package about how to use such products.

Selenium sulfide (Selsun Blue), ketoconazole, or tolnaftate (Tinactin) lotion can help treat tinea versicolor. Apply as directed to the affected area daily until the discolored patches disappear. Tinea versicolor often returns, even with treatment.

You may use cosmetics or skin dyes to hide skin color changes. Makeup can also help hide mottled skin, but it will not cure the problem.

Avoid too much sun exposure and use sunblock with an SPF of at least 30. Hypopigmented skin sunburns easily, and hyperpigmented skin may get even darker. In darker-skinned people, skin damage may cause permanent hyperpigmentation.

When to Contact a Medical Professional

Contact your doctor if:

  • You have any lasting skin color changes that do not have a known cause
  • You notice a new mole or other growth
  • An existing growth has changed color, size, or appearance
What to Expect at Your Office Visit

The doctor will carefully examine your skin and ask about your medical history. You will also be asked about your skin symptoms, such as when you first noticed your skin color change, it if started suddenly, and if you had any skin injuries.

Tests that may be done include:

Treatment will depend on the diagnosis of your skin problem.

References

Bolognia JL, Orlow SJ. Melanocyte biology. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 65.

Yohn J. Disorders of pigmentation. In: Fitzpatrick JE, Morelli JG, eds. Dermatology Secrets Plus. 4th ed. Philadelphia, PA: Elsevier Mosby; 2010:chap 18.

Acanthosis nigricans - close-up
This photograph demonstrates the hyperpigmented, brownish, velvety lesions of acanthosis nigricans. This skin condition may occur in skin folds such as the axilla (armpit - pictured here), neck, and other areas. In adults, it may be associated with hormonal problems, internal malignancy, obesity, and drugs.
Acanthosis nigricans on the hand
This photograph demonstrates brownish, hyperpigmented, velvety plaques overlying the joints of the hands (metacarpal and interphalangeal joints).
Neurofibromatosis, giant cafe-au-lait spot
People with neurofibromatosis often have more than 6 light brown spots (cafe-au-lait spots) larger than 1.5 centimeters. This is a picture of a giant cafe-au-lait spot on a person with neurofibromatosis.
Vitiligo, drug induced
The white spots on this person's face have resulted from drug-induced vitiligo. Loss of melanin, the primary skin pigment, occasionally occurs as a result of medications, as is the case with this individual. The typical vitiligo lesion is flat (macular) and depigmented, but maintains the normal skin texture.
Vitiligo on the face
This is a picture of vitiligo on the face. Complete loss of melanin, the primary skin pigment, occurs for unknown reasons. The resulting lesions are white in comparison to the surrounding skin. Vitiligo may occur in the same areas on both sides of the face (symmetrically) or it may be patchy (asymmetrical). The typical vitiligo lesion is flat (macular) and depigmented, but maintains the normal skin texture. The dark areas around the eyes are this person's normal skin color.
Cutis marmorata on the leg
Cutis marmorata is a common phenomenon in newborn infants. It consists of alternating areas of dilated and constricted blood vessels, which gives the skin a red and white marbled appearance. It is most obvious when the skin is cool.
Halo nevus
A halo nevus occurs when the body develops an immune response to the pigment cells around a nevus. The pigment disappears and the area becomes white. Often in the process, the nevus itself disappears, leaving a circular white spot (macula).

Review Date: 7/30/2014
Reviewed By: Richard J. Moskowitz, MD, Dermatologist in private practice, Mineola, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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