Skin color, patchy

Considerations:
Melanin is a pigment produced in the skin cells that causes skin coloration. An amino acid, tyrosine, is converted to melanin through a series of complex chemical steps in the skin cells. This process may be affected by heredity, heat, trauma, solar or ionizing radiation, heavy metals, and other factors. Pigment production and distribution in the body is regulated in part by hormones. Changes in any of these factors can result in hyperpigmentation (increase in pigment production), hypopigmentation (decrease in pigment production), or both. The changes may be temporary or permanent. Pigment changes can be primary (existing as a separate disorder) or secondary to other disorders.

A person's degree of skin pigmentation determines, to some extent, the various dermatological diseases to which a person may be susceptible. Lighter-skinned people are more sensitive to sun exposure and damage and the subsequent development of skin cancer ( basal cell carcinoma , squamous cell carcinoma and malignant melanoma ). Excessive sun exposure is a risk factor even for darker-skinned people.

Generally, pigmentary changes are cosmetic and do not affect physical health. However, psychological stress can occur because of pigmentary changes. Some pigment changes may indicate a risk for other disorders.

Common Causes:

Note: There may be other causes of patchy skin color. This list is not all inclusive, and the causes are not presented in order of likelihood. The causes of this symptom can include unlikely diseases and medications. Furthermore, the causes may vary based on age and gender of the affected person, as well as on the specific characteristics of the symptom such as location, quality, time course, aggravating factors, relieving factors, and associated complaints. Use the Symptom Analysis option to explore the possible explanations for patchy ski color, occurring alone or in combination with other problems.

Home Care:
Spontaneous return of normal skin color may occur in some cases. Patience is the most effective measure for loss of skin color.

Exposure to sun or ultraviolet (UV) light, especially after sensitization with an oral medication (psoralens), may increase pigmentation. This is effective for about 60% of hypopigmentation lesions if done 2 to 3 times a week for 2 or 3 years, but it may have side effects and may increase the risk for skin cancer .

Lotions that bleach or lighten the skin, such as benoquine or hydroquinone lotions, may be used to reduce hyperpigmented skin or to even the skin tone where hypopigmented areas are large or conspicuous.

Selsun blue or Tolnaftate (Tinactin) lotion can help in treating tinea versicolor. Apply as directed to the affected area daily until the lesions disappear. Unfortunately, tinea versicolor often returns no matter what type of treatment is used.

Cosmetics or skin dyes may be used to disguise pigmentary changes. Make-up can help hide mottled skin but will not cure the underlying problem.

Avoid excessive sun exposure and use sun block because hypopigmented skin sunburns easily.

Call Your Healthcare Provider If:

  • the skin is mottled at the elbows and knees, or all over, and is pale , cool, and clammy. This may indicate hypovolemic shock , which requires immediate medical attention.
  • there is any change in skin pigmentation that occurs without an obvious cause and is persistent.
  • you notice a new mole or other growth, or an existing one has changed color, size, or appearance.



What to Expect:
The medical history will be obtained and a physical examination performed.

Medical history questions documenting patchy skin color in detail may include:

  • time pattern
    • When did it develop?
    • Did it develop slowly or suddenly?
    • Is it getting worse? How fast?

  • quality
    • Is it a loss of pigment?
    • Is it a problem with the blood vessels?
    • What color is the affected area?
    • What is the normal skin color?

  • location
    • Exactly where is the skin color changed?
    • Is it in more than one location?

  • aggravating factors
    • Have you had any trauma to the skin (including sunburn or frequent sun tans)?
    • Are you pregnant ?
    • What medications do you take?
    • What medical treatments have you had?

  • other
    • What other symptoms are also present?

A detailed examination of the skin will be performed.

Diagnostic tests that may be performed include:

Patients may be encouraged to have regular examinations and to avoid tight clothing and overexposure to cold or heating devices, such as hot water bottles and heating pads.

After seeing your health care provider:
You may want to add a diagnosis related to patchy skin color to your personal medical record.


The classical appearance of cafe-au-lait (light brown) spots in neurofibromatosis (NF-1). This child had multiple cafe-au-lait spots as well as axillary (armpit) freckling.



Acanthosis nigricans is a skin condition associated with excessive amounts of pigment (hyperpigmentation) and wart-like growths that occur in skin folds such as the axilla (armpit - as seen here), neck, and other areas. In adults it may be associated with certain types of cancer.



Spotty loss of pigmentation in the skin may follow diseases such as chickenpox. When the individual lesions heal, there may be decreased production of pigment in that area. This condition may improve with several seasonal tanning cycles.



This photograph demonstrates the hyperpigmented, brownish, velvety plaques 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.



This photograph demonstrates brownish, hyperpigmented, velvety plaques overlying the joints of the hands (metacarpal and interphalangeal joints).



People with neurofibromatosis are at least 5 years old with more than 6 light brown spots (cafe-au-lait spots) larger than 1.5 centimeters. They also have axillary freckles "Crowe's sign" and brown or skin colored nodules (neurofibromas) that are raised above a narrow stock (pedunculated). Networks of nerve-cell tumors that are droopy, soft, doughy masses (plexiform neuromas) are also common. This is a picture of a giant cafe-au-lait spot on a person with neurofibromatosis.



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.



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 is a common phenomena 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.