Skin discoloration refers to any change in the color of an area of skin compared to the rest of the skin. The color may vary depending on the underlying cause. The discolored patch or splotch may be small or cover a larger area.
In most cases, skin discoloration is harmless; however, in some cases, it may be a symptom of a serious skin condition, such as skin cancer.
While there are a few over-the-counter treatments that may be helpful in fading some of these skin discolorations, it is also important to know the real cause behind them.
Table of Contents
Overview
Skin discoloration can occur for a number of reasons. It may appear at birth, during a young age, or later in life. Some types of skin discolorations, such as rosacea, may affect only the face, while others, like eczema, may be more widespread.
The underlying causes can be genetics, autoimmune processes (when our own immune cells start fighting against our skin cells), outside elements, or environmental factors.
The different causes that can lead to patches of discolored skin can be categorized as follows:
- Pigmentation disorders: Vitiligo, melasma, post-inflammatory hyperpigmentation, age spots
- Birthmarks: Congenital melanocytic nevus, infantile hemangiomas, café au lait spots, port-wine stains, salmon patches
- Chronic inflammatory skin conditions: Rosacea, psoriasis, seborrheic dermatitis, perioral dermatitis, lupus, atopic dermatitis
- Skin infections: Bacterial, viral, and fungal infections
- Allergies and other reactions: Hives and contact dermatitis
- Precancerous lesion: Actinic keratosis
- Skin cancer: Squamous cell carcinoma, basal cell carcinoma, melanoma
- Other causes: Medication or treatment side effects, trauma, thermal injuries
Below, you will find details about each of these, along with pictures and treatment options.
Pigmentation disorders
Our skin gets its color from melanin pigment, which is formed by special cells called melanocytes present in our skin.
Some disorders can result in an increase in the amount of melanin production, resulting in hyperpigmentation, while others can lead to a decrease in melanin pigment, resulting in hypopigmentation.
- Vitiligo: Vitiligo leads to patches of pigment loss in the skin. It usually starts as a small patch that can become larger over time. The exact cause behind it is not clear; however, there are several theories – such as our immune cells destroying the melanocytes, melanocytes destroying themselves, or some genetic factors. The pattern of distribution can depend on the type of vitiligo.
- Melasma: Melasma is a very common skin condition that is predominantly seen in females. It leads to symmetrical gray or brown patches of discolored skin on the face, with the most commonly affected areas being the nose and the cheeks. Melasma is strongly associated with hormones and sun exposure. It often appears for the first time during pregnancy and may disappear after the baby is born; however, in some cases, it can be persistent.
- Post-inflammatory hyperpigmentation: Post-inflammatory hyperpigmentation refers to excess melanin pigment formation in response to skin inflammation, leading to patchy skin. This can occur due to any inflammatory process or injury, such as burns, picking at the skin, after an acne breakout, or as a result of skin rash.
- Age spots: Age spots, also known as liver spots, are hyperpigmented spots that usually appear on areas exposed to the sun, such as the face, hands, chest, arms, and legs. These are often seen in individuals over 50 years of age.
Treatment of pigmentation disorders
While there is no cure for vitiligo, certain treatments can be helpful, such as topical steroids and calcineurin inhibitors (which affect our immune cells). Light therapy can also be useful. In some cases, surgery with skin grafting may be done.
Melasma, post-inflammatory hyperpigmentation, and age spots are characterized by excessive melanin pigment formation.
Treatment for these conditions, aimed at fading these skin spots, often includes topicals that prevent or decrease the formation of melanin pigment or help in the faster turnover of skin cells.
Commonly used topical treatments include hydroquinone, retinoids (like tretinoin), azelaic acid, arbutin, niacinamide, and tranexamic acid. In addition, it is important to have a gentle skincare routine to avoid further damage to the skin barrier.
Protection from the sun is another crucial element of the treatment. UV rays and visible light from the sun can worsen hyperpigmentation.
So, make sure to use broad-spectrum sunscreen or wear sun-protective clothing. Sunscreens or makeup products containing iron oxides can provide protection from visible light or blue light.
Birthmarks
Birthmarks are areas of skin discoloration that can be present at birth or can appear shortly after birth. They can be either due to excess melanin pigment or abnormal blood vessels.
- Congenital melanocytic nevus: Congenital melanocytic nevus is a pigmented birthmark formed by melanocytes; in simple words, it’s a mole present at birth. They can form a round or oval patch of discoloration, and the color and size can vary. The ones that are large or giant have a risk of developing a type of skin cancer called melanoma.
- Infantile hemangiomas: These are common types of birthmarks that occur due to abnormal blood vessels. Depending on their location, they can be of two types: Superficial hemangiomas sit just under the skin and can be red, dark red, or dark violet in color. These are also called strawberry hemangiomas. Deep hemangiomas are located deeper in the skin and may take months before you notice them. They can give a bluish discoloration to the skin.
- Café au lait spots: Café au lait spots are flat light to dark brown patches on the skin. They can darken over time due to sun exposure, especially on the face. In some cases, especially when there are six or more of these spots, they can be a symptom of a genetic disorder.
- Port-wine stains: Port-wine stains are patches or splotches of pink, red, or purple discoloration on the skin, which are usually seen on the face, neck, scalp, arms, and legs. They may become darker with age, and the surface may become rough over time. These stains occur due to malformed capillaries under the skin.
- Salmon patches: Salmon patches are pink or red patches that can appear on the back of the head or face. They are due to dilated capillaries close to the skin. On the face, they can appear on eyelids or between the eyes and are often referred to as angel’s kisses. These patches may fade as the child grows.
Treatment of birthmarks
Most birthmarks do not require any treatment other than for cosmetic reasons. However, some birthmarks can grow in size or carry the risk of developing cancer, so they may require medical intervention.
The most commonly used treatments are:
- Steroids
- Beta-blockers
- Lasers
- Surgery
Chronic inflammatory skin conditions
There are several chronic skin conditions that can result in patches of discolored skin. The underlying causes of each may vary.
- Rosacea: Rosacea is a chronic skin condition characterized by flushing and redness. It is classified into four types – erythematotelangiectatic, papulopustular, phymatous, and ocular. In the papulopustular type, one can see papules and pustules on a red background. The exact cause is not clear; however, genetics, abnormal immune response, and sensitivity to Demodex mites are some theories. It can be triggered by sun exposure, heat, stress, certain foods, and harsh skincare products.
- Psoriasis: Psoriasis is an autoimmune skin condition in which our skin cells turn over too fast, resulting in the buildup of dead skin cells. This leads to red raised spots or plaques with silvery scales. In people with darker skin tones, these may appear as dark-red to violet patches of discolored skin. Psoriasis can be triggered by dry and cold climates, stress, infection, injury, and smoking.
- Seborrheic dermatitis: Seborrheic dermatitis is a chronic skin condition that results in scaly red patches on the face, commonly occurring on the nose and between the eyebrows, scalp, chest, and upper back. It is thought to occur due to the Malassezia fungus, skin barrier dysfunction, and excessive oiliness of the skin.
- Perioral dermatitis: Perioral dermatitis results in a red skin rash with red papules, usually appearing around the mouth. It is very commonly seen in young females and is strongly associated with the use of topical steroids.
- Lupus: Lupus is an autoimmune condition that can affect various organs in our body. The skin on the face is commonly affected by this condition, resulting in a red rash in a butterfly pattern involving the cheeks and the nose. The exact cause is not clear; however, genetics, hormones, and environmental factors are associated with it.
- Atopic dermatitis: Atopic dermatitis is a chronic inflammatory skin condition that results in red, itchy areas on the skin. Genetics and environmental factors are commonly associated with it.
Treatment of chronic skin conditions
The treatment will depend on the type of skin condition. In general, it is important to have a gentle skincare regimen, including a low pH or pH-balanced cleanser, moisturizer, and sunscreen.
- Rosacea is often treated with topicals like metronidazole, ivermectin, brimonidine, and azelaic acid, as well as oral antibiotics.
- Seborrheic dermatitis is treated with anti-dandruff shampoos, topical steroids, or antifungals.
- Psoriasis is treated with topicals and shampoos containing salicylic acid or coal tar, topical steroids, vitamin A derivatives, Vitamin D derivatives, and light therapy.
- Perioral dermatitis is treated with topical and oral antibiotics.
- Lupus is often treated with steroids, immunosuppressants, or anti-malarial drugs.
- Atopic dermatitis is usually treated with skin barrier-repairing moisturizer and steroids.
Skin infections
Various infections can lead to discolored patches on the skin. These include:
- Bacterial infections: The skin can become secondarily infected after injuries, trauma, burns, etc. This can result in patches of discoloration, which may be associated with swelling and discharge.
- Viral infections: Some viral infections can lead to patches of discolored skin. These include shingles (due to the varicella-zoster virus), cold sores/fever blisters (usually caused by herpes simplex virus type 1), and warts (caused by the human papillomavirus – HPV). Cold sores or fever blisters, shingles, and cold sores can result in red or brown discoloration with blisters, which may eventually heal with scabbing.
- Fungal infections: These include tinea versicolor, ringworm, or other yeast infections. Tinea versicolor, which usually involves the chest, back, or upper shoulders, can result in dry white or brown patches on the skin. Meanwhile, ringworm can lead to red discoloration on the skin with scaly edges. Yeast infections can affect skin folds, such as those under the breasts, in the armpits, or in the groin region
Treatment of skin infections
The treatment will depend on the type of infection.
- Bacterial infections may be treated with topical or oral antibiotics.
- Fungal infections may be treated with antifungal washes, antifungal creams, or oral pills.
- Some viral infections may resolve on their own while some require treatment with antiviral medications.
Allergic and other skin reactions
Exposure to allergens can result in a variety of reactions on the skin. Allergens can be external elements like exposure to plants, dust, mold, metals, or certain cosmetics, or they can be substances ingested.
- Hives: A very common reaction is a skin rash with red discoloration, often accompanied by itching and a burning sensation. It can lead to hives, which are red itchy skin bumps.
- Contact dermatitis: This occurs when our skin comes in contact with an irritant or an allergen. Common irritants include surfactants in cleansing products, dyes, fragrances, and essential oils, while common allergens are dust, mold, pollens, urushiol found in poison ivy, and certain metals like nickel. Contact dermatitis can result in red discoloration, burning, itching, oozing, and dryness.
Treatment of skin reactions
Most skin reactions may resolve once the irritant or allergen is removed. The application of a cool compress may reduce symptoms. Antihistamines and steroids may be prescribed in some cases.
Benign skin growths
These include non-cancerous skin lesions in which there is an abnormal growth of skin cells or tissues, but they do not spread in our body like cancerous skin growths.
- Moles: Moles are formed by a collection of melanocytes. They can be round or oval and vary in color – brown, blue, red, tan, and more. They usually appear in the age group of the 20s and 30s; however, sometimes they are present at birth. If you notice a mole that is changing shape or is irregular, it’s best to get it examined by a doctor.
- Seborrheic keratosis: Seborrheic keratosis can appear as tan, brown, or black spots of discoloration with a waxy, stuck-on appearance. Due to their characteristic appearance, they are also called skin barnacles.
- Skin cysts: Skin cysts, such as epidermal cysts, appear as lumps under the skin. The overlying skin may look yellowish, white, or, in some cases, red if they are inflamed.
Treatment of benign skin growths
The above-mentioned skin growths do not require treatment unless for cosmetic reasons or if they cause discomfort. One should always check moles for any abnormal change or sudden increase in size.
Skin cancer
Rarely, a patch of discolored skin can be due to a precancerous lesion or skin cancer. Different types of skin cancers can present differently.
- Actinic keratosis: Actinic keratosis is a precancerous skin lesion that can appear as dry, scaly, rough patches on areas frequently exposed to the sun, such as the face, scalp, forearms, and hands. They can be pink, red, dark tan, brown, gray, or a combination of different colors. In some cases, if left untreated, actinic keratosis can lead to squamous cell carcinoma, a type of skin cancer.
- Squamous cell carcinoma: Squamous cell carcinoma occurs due to DNA damage in squamous cells, which are the top layer of the skin. It can present as red, scaly patches, open sores that won’t heal, firm raised growths, or raised areas with a central depression.
- Basal cell carcinoma: Basal cell carcinoma is the most common skin cancer. It can present in various ways: as a shiny growth that is pearly, tan, pink, or dark in color; an open sore that bleeds; a small pink growth with central indentation; or a white or yellow scar-like area. In some cases, it may be pigmented and appear brown or black, especially in darker skin tones.
- Melanoma: Melanoma is a skin cancer of melanocytes, the cells that produce the melanin pigment. It can occur in preexisting moles or normal skin. Melanoma lesions can appear as pink, red, blue, light brown, dark brown, or black. They can be easily confused with benign moles.
Treatment of cancerous lesions
Actinic keratosis can be treated with topical medications, excision, or cryotherapy (freezing the pre-cancerous cells, causing them to slough off).
The treatment of skin cancer will depend on the size of the lesion and whether it has spread to lymph nodes or other parts of the body. The treatment may include local excision, removal of lymph nodes, chemotherapy, or radiation therapy.
Other causes
- Medication or treatment side effects: Certain oral medications like antibiotics or non-steroidal anti-inflammatory drugs can make our skin more sensitive to sunlight or result in excess pigment formation, resulting in patches of discoloration. Radiation therapy can also result in red or dark discoloration of the skin.
- Procedures: Medical procedures such as lasers, chemical peels, and microdermabrasion can result in alterations in pigment, leading to hyper or hyperpigmentation and blotchy skin.
- Trauma: Any trauma to the skin can result in inflammation or secondary infection, leading to red discoloration, swelling, and visible discharge.
- Thermal injuries: Exposure to extremes of temperatures, such as frostbite, sunburns, burns from hot fluids or objects, or electrical injuries, can lead to patches of discolored skin.
- Bleeding into the skin: Injury to the tiny blood vessels in the skin can result in red blood spots.
- Telangiectasia: Broken blood vessels may appear as red lines on the skin and are usually seen on the face and legs. Sometimes, the broken vessels can make the skin appear blotchy or uneven. These can be due to underlying skin conditions like rosacea, sun damage, or injury.
- Systemic diseases: Certain systemic diseases involving the thyroid, adrenal, or pituitary glands can result in discolored patches on the skin.
Diagnosis
The diagnosis of skin discoloration can be made by examining the skin and reviewing the patient’s medical history.
The doctor may inquire if the discolored area appeared in response to any topicals, medication, trauma, etc. Family history may also be important in some cases.
Some cases may require additional testing for a definite diagnosis, such as:
- Skin scrapings: Skin cells are scraped off and examined under a microscope to look for any fungus.
- Wood lamp examination of the skin: It can help in identifying several skin conditions like pigmented lesions or infections.
- Skin biopsy: A small sample of the lesion is taken and examined under a microscope by a pathologist to identify the condition.
Warning signs and when to see a doctor
Any sudden appearance of a discolored area on the skin that is painful, looks unusual, has a visible discharge, or is accompanied by other systemic symptoms should be examined immediately by a healthcare provider.
In addition, some skin marks or discolorations can be due to cancer, making it important to get a proper diagnosis and treatment.
The following features (ABCDEs) can help in identifying melanoma, a type of skin cancer:
- Asymmetry between the two halves of the lesion.
- Border irregularity or ill-defined borders.
- Color variation (such as red, tan, or dark brown).
- Diameter usually 6 mm or more (about the size of a pencil eraser).
- Evolving, which means the spot is changing over time.
Prevention
In some cases, it is not possible to control the factors that lead to patches of discolored skin; however, simple preventative measures can help avoid some types of skin discoloration.
- Be gentle with your skin and avoid using abrasive scrubs or washcloths.
- Use a pH-balanced cleanser to maintain the skin’s acid mantle, which is important for the proper functioning of the skin barrier.
- Moisturize your skin to replenish lost skin barrier lipids.
- Protect your skin from the sun using sunscreen and sun-protective clothing.
- Avoid contact with known irritants and allergens.
- Limit spending long hours in direct sunlight.
- If you have any chronic inflammatory skin condition, make sure to follow your treatment plan.
Key points
Skin discoloration can have various causes, ranging from a rash or injury to serious skin conditions like skin cancer. The color and size of the affected area will depend on the underlying cause.
Most skin discolorations are harmless; however, some require medical attention for proper diagnosis and treatment.
The treatment for any skin discoloration will largely depend on the underlying cause. In some cases, just removing the offending medication or irritant can result in improvement of skin discoloration, while in other cases, prescription topicals or in-office procedures may be needed.
References
- WebMD Editorial Contributors. Port-Wine Stain Birthmarks.
- Stork Bite. Cleveland Clinic.
- Vitiligo. Mayo Clinic.
- Basal Cell Carcinoma Warning Signs. The Skin Cancer Foundation.
- Melanoma. Mayo Clinic.
- Hassan S, Zhou X. Drug Induced Pigmentation. [Updated 2022 Jul 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
Disclaimer: This blog post is for information purposes only and does not replace medical advice.