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Hypopigmentation disorders include vitiligo, pityriasis alba, tinea versicolor, and postinflammatory hypopigmentation. Patients with stable, self-limited vitiligo may be candidates for surgical grafting techniques, whereas those with extensive disease may be candidates for depigmentation therapy to make skin tone appear more even. Other hypopigmentation disorders may improve or resolve with treatment of the underlying condition. Treatment consists of topical (e.g., hydroquinone, retinoids) and ablative (e.g., chemical peels, cryotherapy, intense pulsed light, lasers) therapies.
Pigmentation disorders are commonly diagnosed, evaluated, and treated in primary care practices. Typical hyperpigmentation disorders include postinflammatory hyperpigmentation, melasma, solar lentigines, ephelides , and café au lait macules. These conditions are generally benign but can be distressing to patients. Appropriate dermatologic history, skin examination, and skin biopsy, when appropriate, can help exclude melanoma and its precursors. In addition to addressing the underlying condition, hyperpigmentation is treated with topical agents, chemical peels, cryotherapy, light or laser therapy, or a combination of these methods. Café au lait macules are treated with surgical excision or laser therapy if treatment is desired.
Pruritis is one of the common symptoms of skin allergies along with rash, hives, and swelling. In the United States, hydrocortisone is the only topical steroid sold over the counter under brand names like Cortizone, Equate, Exederm, and others.
High-potency topical corticosteroids (betamethasone 0.1% or fluocinonide 0.05% ointment) and topical calcineurin inhibitors (tacrolimus and pimecrolimus ) are mainstays for localized treatment of limited vitiligo. Systemic therapies such as psoralen and ultraviolet A, narrowband ultraviolet B , and systemic corticosteroids are useful for more widespread or treatment-resistant disease. Vitiligo is an immune-mediated skin condition resulting in a loss of pigmentation . It affects all skin types and is generally considered a cosmetic condition, but it can cause significant psychological distress, particularly in black patients, prompting requests for treatment. Pigmentation disorders of the skin are commonly encountered in primary care practice.
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Inflammatory conditions of the skin can cause loss of pigment. Tinea versicolor, atopic dermatitis, pityriasis alba, psoriasis, and guttate parapsoriasis may affect pigment production or transport. Treatment of the underlying condition may improve hypopigmentation over time. Dermabrasion, chemical peels, cryotherapy, and intralesional corticosteroids can also reduce pigment locally, and these risks should be discussed with patients before treatment.
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