Pigment disorder - forms, causes and treatment

Pigment disorder - forms, causes and treatment

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If there is a pigment disorder, the color pigments form abnormally in the skin - either the pigmentation is too strong or too little. Examples of a disturbance in pigment formation are age spots, birthmarks, freckles or white spot disease (Vitiligo). In the following lines you will learn more about the different forms of pigment disorders, their causes and treatment options.


Certain cells, the melanocytes, are responsible for the pigmentation of the skin. These ensure the individual color of the skin. In the case of a pigment disorder, this natural coloring is changed. The melanocytes, stimulated by sunlight, form the pigment melanin, which ensures a natural tan of the skin. It offers protection from harmful UV light. In the event of a pigment disorder, the pigment-producing cells either produce too much or too little melanin, which changes the natural color of the skin. This can occur selectively, in small or large areas.


Pigment disorders are typically divided into two groups:

  • Disorders with an excess of melanin (hypermelanosis): Here the skin is more colored than normal, there is a so-called hyperpigmentation.
  • Disorders with a melanin deficiency (hypomelanosis): The skin is less colored than normal. If the melanin content is reduced, experts speak of "hypopigmentation", with "depigmentation" there is no melanin at all.

Pigment disorders - causes

There are various causes for a pigment disorder. These include

  • hormonal changes,
  • Cosmetics,
  • hereditary disposition,
  • mechanical influences,
  • Cold,
  • Warmth,
  • Sun exposure
  • and certain medications such as birth control pills.

Forms of pigment disorders

Pigment disorders occur in various forms. Well-known examples are birthmarks or liver spots, freckles, age spots, melasmas, the so-called white spot disease and bran fungus.


A birthmark is in the technical language "nevus" or "nevus cell nevus" (from Latin "naevus“For birthmark). As a rule, such a birthmark is benign and arises from an accumulation of pigment-forming cells, the melanocytes. This pigmentation disorder can appear anywhere on the body - either flat or raised, rough or smooth, or even hairy. Birthmarks are colored brown or black.

Even though the birthmarks are usually benign, as already mentioned, they should always be observed. Regular skin screening at the dermatologist is important. If a stain changes in size, color, height or starts to itch, this must be clarified by a doctor (see "Self-assessment with the ABCDE rule"). Unfortunately, a birthmark can degenerate in rare cases. Light-skinned people in particular often have birthmarks. It is essential to pay attention to sun protection with a high sun protection factor.

Pigment spots

Which skin is completely flawless? Almost everyone has lighter or darker spots on the skin. These spots, called pigment spots, can be congenital or develop only in the course of life. They are also called hyperpigmentation and are caused by concentrated melanin formation. The pigment spots include freckles and age spots.

A special form is the nevus pigmentosus, which is also known as a “café-au-lait spot” due to its appearance and has been present from birth. Here there are pigment spots of the skin of different sizes, which are reminiscent of milk coffee due to their uniform light brown color.

Another variant is the nevus spilus, which is also called "lapwing egg nevus". This is sharply defined, irregularly shaped and can be the size of a palm. It also has a café-aut-lait coloring and, over time, gets small brown to black-brown blasting.

Pigment spots - causes

A common cause of pigment spots is hormonal changes in the life of women. The so-called melasma, for example, is a form of hyperpigmentation that occurs primarily in connection with pregnancy. This pigmentation disorder, also known as a "pregnancy mask" or "chloasma", forms dark spots of different sizes on the face, but other parts of the body can also be affected.

Even in menopause, women often suffer from pigment disorders. These are found mainly on the upper lip, on the cheeks or on the forehead. Once the hormones are back in balance, the unsightly facial spots usually go away on their own.

Another cause is too much sun. The skin spots arise in places that have been exposed to the sun over and over again for years, such as the face, the back of the hand or the cleavage. Furthermore, fragrances and essential oils can lead to pigment spots. If you suffer from sensitive skin, you should definitely avoid fragrances in personal care products.

Other causes include metabolic disorders, tumors, folate and vitamin B12 deficiency, psoriasis, acne, shingles, syphilis and an existing gluten allergy or gluten intolerance (celiac disease). Alcohol, smoking and stress promote the development of skin changes.

St. John's wort is a great medicinal plant and also very effective. It is used for depressive moods and restlessness. In summer, however, treatment with St. John's wort should be avoided, as the medicinal plant may increase the sensitivity of the skin to light. In combination with the sun, brown spots can appear on the skin.

Treatment for pigment spots

A possible form of treatment is laser treatment, in which the pigment accumulations are destroyed. However, this therapy is quite expensive. Other options include cold therapy, the use of bleaching creams, the "abrasion" of the top layer of skin (microdermabrasion) and peels. All types of treatment mentioned should be carried out by an experienced doctor.


Freckles (ephelids) are harmless pigment spots. The small light brown spots mostly occur in light-skinned, red-haired or blond people. The freckles result from an increased production of melanin (hyperpigmentation) and occur mainly in areas such as the face, décolleté and arms that are often exposed to the sun. The first day of sunshine, the first sunbath in the year and these funny little spots are already sprouting. The number decreases again in the winter months and the remaining ones are less pigmented than in summer.

The predisposition to small skin spots is genetic and therefore cannot be influenced. But if you have freckles, you shouldn't be annoyed. In the meantime, there are even models who have these pretty pigment disorders and here this is not considered a "disorder", but rather pretty.

Age spots

Another form of pigment spots are the so-called age spots. As the name suggests, they do not occur at a young age, but only from the age of 40. Everyone over 60 usually has it. These spots also appear in areas such as the face, shoulders, arms and back of the hands that are often exposed to the sun. Accordingly, they are chronic skin damage due to too much sun. The epidermis thickens irregularly and stores the melanin there.

Another cause is lipofuscin. This is also called age pigment or wear pigment. It mainly forms in the skin. Age spots are light to dark brown, round, oval or irregular in shape and can also spread. In contrast to freckles, they hardly get lighter in winter. Age spots are absolutely uncritical, but they see many affected people, especially women, as an unattractive phenomenon. In technical language they will Lentigines seniles called, which does not necessarily make them more beautiful.

White spot disease (vitiligo)

The name speaks for itself - white spots (Vitiligo) cause white spots on the skin, isolated or heaped. In any case, those affected often suffer from it. The white spots are caused by a loss of the brown pigment melanin in places. The cause of the disease is not exactly known. Hereditary disposition, autoimmune events, severe sunburn, skin injuries (e.g. scars) and psychological stress play a role.

Vitiligo symptoms

This disease does not hurt nor is it contagious, but it is a major cosmetic problem for many people affected. Vitiligo most often begins between the ages of 10 and 30, but can affect all age groups as well as all skin types. Most often the first spots appear on the face, then on the hands and feet. Mucous membranes, hairy parts of the body, eye and inner ear can also be affected. Not every bright spot can be assigned to this disease. A skin fungal infection could also be behind this. Therefore, you should definitely have this clarified.

Vitiligo is either localized or generalized. The localized form is limited to individual areas of the skin, especially where there are scars or skin injuries. The generalized form that occurs most often is Vitiligo vulgaris called. It occurs across the body. Even the head, eyebrows and eyelashes can be involved. Another manifestation is Vitiligo acrofaszialis. This mainly affects the face, hands and feet.

Treatment for white spot disease

The doctor can identify the affected areas using a so-called Wood lamp. The Vitiligo stoves appear whitish-yellowish due to the ultraviolet light. A biopsy may be required. If there is a white spot disease, there is no melanin in the cells of the epidermis. A blood test is advisable. Any underlying disease, such as thyroid disease or diabetes mellitus, should be excluded or treated.

This pigment disorder is not curable. However, there are some therapeutic options to curb progression and promote the formation of new melanin in the bright areas, so that these unsightly areas become smaller. Most often, light therapy, so-called phototherapy, is used. The skin is irradiated with light that has a special wavelength. Another form of light therapy is so-called psoralen and UV-A phototherapy (PUVA). Psoralen, a natural substance (contained in essential oils), first sensitizes the skin or makes it more sensitive to the subsequent radiation.

Special laser therapy is also possible. Unfortunately, this is not covered by the statutory health insurance companies. The use of ointments containing cortisone or calcipotriol is also an option. A transplantation of melanocytes is also possible.

In any case, those affected should apply extremely intensive sun protection and try to reduce stress. Vitiligo is a mental problem for many patients. Outsiders regard them as if it were an infectious disease. Those affected must learn to deal with the disease. To hide the white spots, a camouflage make-up and suitable powder help. Let us advise you. Even a self-tanner can help to hide the bright spots.

Bran lichen (Pityriasis versicolor)

Another pigment disorder is the bran lichen (also called "bran fungus lichen"), which is called "Pityriasis versicolor" referred to as. This is a fungal disease that affects the upper layers of the skin. The culprit is the yeast Malassezia. The disease is not contagious and mainly affects younger adults. This shows brownish spots on the upper body, especially on the middle of the chest and back. The lichen can also spread to the side trunk, shoulders, neck, upper arms and thighs.

The above-mentioned fungus occurs naturally in the hair follicles and does not cause any problems. However, it can change into a different shape and form so-called mushroom beds that lie on the horny layer of the skin and show through a brownish pigmentation. Why the fungus undergoes this change has not yet been clarified. However, it is known that this is favored by a warm, humid climate, excessive sweating and the use of high-fat care lotions.

Bran lichen - symptoms

At the beginning of the disease, individual follicular openings are darkly framed. Then round, sharply delimited spots become visible. In the further course, these can spread out over a large area and irregularly shaped. The spots are light brown to reddish brown and show a slight scaling on the surface that is reminiscent of bran ("bran lichen"). On the other hand, light spots appear on dark or tanned skin.

Treatment for bran lichen

The doctor first looks at the affected areas with the naked eye. He / she strokes the affected areas with a wooden spatula, picks up the skin with an adhesive strip and puts them on a slide. The scales are softened in weak alkali. This makes the mushroom elements easier to see under the microscope.

The doctor prescribes an antifungal drug. This is a fungicidal agent that is applied externally. If the disease is severe, the antifungal can also be used in tablet form. Anything that could promote the growth of the yeast should be turned off. Conversely, this means wearing air-permeable clothing, showering immediately after sweaty activities, and not applying greasy skin care creams.

With an appropriate disposition, there can be a constant recurrence (recurrence) of the skin disease. Affected people should use a special medical shampoo that has an antifungal effect instead of a normal shampoo for a long time.

Prevent pigment disorders

In order to prevent pigment disorders, you should always think of adequate sun protection. The more sensitive the skin, the higher the sun protection factor. The sunscreen should not only protect against UVB rays but also against UVA rays and should not contain any preservatives or perfume. It is best to get advice on this. The sunscreen must always be renewed.

If you are very sensitive, it is best to wear a t-shirt or something similar as soon as you want to stay longer in the sun. A sun hat is definitely recommended. It is best to avoid the sun completely between 11 a.m. and 3 p.m. Sunglasses with suitable sun protection lenses are also important. To protect yourself from pigment disorders, you should also avoid visits to the solarium.

Beware of changes

As a rule, pigment disorders are harmless. However, these can degenerate. Therefore, regular skin screening at a dermatologist is advisable, especially for people who are fair-skinned and have many pigment spots. Spots that suddenly grow, take on a different shape or color and may also itch, must be checked with a doctor. The earlier skin cancer is recognized, the sooner it is curable.

Self-assessment with the ABCDE rule

Use the so-called ABCDE rule for orientation. It is important for the first assessment of pigment disorders. If at least one of the following features applies, you should definitely show the skin spot to your doctor:

  • A = asymmetry: A new dark spot on the skin is not evenly round, oval or elongated, but has an uneven shape. Or the shape of a longer-lasting stain has changed and is no longer symmetrical.
  • B = limitation: A mole has blurred, uneven or jagged edges and / or grows frayed in the surrounding skin area.
  • C = color (English: color): A pigment mark has different colors and / or the color is mixed with pink, gray or black dots.
  • D = diameter: The skin patch is larger than three to five millimeters at the widest point or has a hemispherical shape.
  • E = grandeur or evolution: The more times protrudes more than a millimeter above the skin level. The pigment spot has changed in the past three months.

Danger: Such changes do not necessarily mean something bad, but should definitely be taken seriously.

Home remedies for pigment disorders

The following home remedies are said to help you get rid of pigment spots or lighten them somewhat. The lemon is known to have brightening properties. So it is also used in home-made hair conditioners to make the hair a little blonder. In the case of pigment spots, lemon juice is regularly applied to the affected areas. Another citrus fruit that is recommended is blood orange juice, which is also used externally. But be careful - not everyone can tolerate the acid. The juices should never be used in conjunction with the sun. This could lead to further stains.

The papaya is also worth trying. The pulp is mashed, applied to the skin and washed off after a few minutes. The addition of garlic, dabbing with apple cider vinegar, cucumber juice or buttermilk should also help. Fresh parsley, chopped and applied to the pigmented areas, is also considered a home remedy for pigment spots.


Free radicals arise as an intermediate product of metabolism in every human cell. If the body is healthy and balanced, it can buffer these free radicals and does not harm itself. However, if this is not the case, so-called antioxidants must be supplied to the body from the outside. Free radicals that are not trapped can lead to diseases that age the skin and also produce pigment spots.

Therefore, a balanced diet that contains many basic foods and animal foods in small quantities is important. This includes sufficient drinking in the form of still water. Often, however, the diet is not enough and so-called nutritional supplements have to be added. Vitamins E, beta-carotene and C as well as the trace elements selenium and zinc are important. You should also pay attention to a solid vitamin D value. Get advice from a professional on the subject of nutritional supplements. (sw)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.


  • Rassner, Gernot: Dermatology: Textbook and Atlas, Urban & Fischer Verlag / Elsevier, 2009
  • Hofmann, U.B .: pigment disorders, in: Traupe, Heiko; Hamm, Henning: Pediatric dermatology, Springer Verlag, 2006, pages 593-612
  • Cancer information service of the German Cancer Research Center (DKFZ): Skin Cancer - Skin Cancer Early Detection: Detect abnormal changes (accessed: 3.2.2020), DKFZ
  • Bae, Jung Min; Jung, Han Mi; Hong, Bo Young et al .: Phototherapy for Vitiligo A Systematic Review and Meta-analysis, in: JAMA Dermatology, 153 (7): 666-674, July 2017, JAMA Network
  • Plensdorf, Scott; Livieratos, Maria; Dada, Nabil: Pigmentation Disorders, in: American Family Physician, 15; 96 (12): 797-804, December 2017, AAFP

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