Pigment Disorder – Forms, Causes and Treatment

If there is a pigmentation disorder, the color pigments in the skin form abnormally – either the pigmentation is too strong or too little. Examples of pigmentation disorders 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.


  • definition
  • Expressions
  • Pigment disorders – causes
  • Forms of pigment disorders
  • Birthmarks
  • Pigment spots
    • Pigment spots – causes
    • Treatment for pigment spots
  • Freckles
  • Age spots
  • White spot disease (Vitiligo)
    • Vitiligo symptoms
    • Treatment for white spot disease
  • Bran (Pityriasis versicolor)
    • Branches Symptoms
    • Treatment for bran lichen
  • Prevent pigmentation disorders
  • Beware of changes
  • Self-assessment using the ABCDE rule
  • Home remedies for pigment disorders
  • Antioxidants


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 solar radiation, form the pigment melanin, which causes the skin to tan naturally. It offers protection from harmful UV light. In the case of a pigment disorder, the pigment-forming cells either produce too much or too little melanin, which changes the natural color of the skin. This can occur selectively, on a small or large scale.

The color changes can affect small areas of the skin as well as large areas – depending on the type of pigmentation disorder. (Image: Axel Bueckert / stock.adobe.com)


Pigment disorders are typically divided into two groups:

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

Pigment disorders – causes

There are various causes for a pigment disorder. These include

  • hormonal changes,
  • Cosmetics,
  • hereditary predisposition,
  • mechanical influences,
  • Cold,
  • Warmth,
  • Exposure to sunlight
  • and certain medications such as birth control pills.

Forms of pigment disorders

Pigment disorders occur in a wide variety of forms. Well-known examples are birthmarks or liver spots, freckles, age spots , melasma, the so-called white spot disease, and bran fungus.


A birthmark is called “nevus” or “nevus cell nevus” (from Latin “ naevus ” for birthmark). Usually such a birthmark is benign and is caused by a collection of pigment-forming cells, the melanocytes. This pigment disorder can appear anywhere on the body – either flat or raised, rough or smooth, or hairy. Birthmarks are brown or black in color.

Even if the birthmarks are usually benign, as mentioned earlier, they should always be monitored. Regular skin screening by the dermatologist is important. If such a stain changes in size, color or height, or if it starts to itch, this must be clarified by a doctor (see “Self-assessment with the ABCDE rule”). Unfortunately, in rare cases, a birthmark can degenerate. Fair-skinned people in particular often have moles. It is essential to use sun protection with a high sun protection factor.

Birthmarks can vary in size. Tiny dots are just as possible as spots with a diameter of up to 2.5 centimeters. (Image: PavelStock / stock.adobe.com)

Pigment spots

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

The nevus pigmentosus is a special form, which is also known as a “café-au-lait spot” due to its appearance and is present from birth. Here you can see differently sized, non-raised pigment spots on the skin, which are reminiscent of milk coffee due to their uniform light brown color.

Another variant is the nevus spilus, which is also known as the “Kiebitzei nevus”. This is sharply defined, irregularly shaped and can be the size of a palm. It also has a café-aut-lait coloration and over time it develops small brown to black-brown cracks.

Pigment spots – causes

A common cause of pigment spots is hormonal changes in a woman’s life. Melasma, for example, is a form of hyperpigmentation that occurs primarily in connection with pregnancy. This pigment disorder, also known as “pregnancy mask” or “chloasma”, forms dark spots of different sizes on the face, but other parts of the body can also be affected.

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

Another cause is too much sun. The skin spots appear in areas that have been repeatedly exposed to the sun over the years, such as the face, the back of the hands or the décolleté. Furthermore, fragrances and essential oils can lead to pigment spots. Anyone who suffers from sensitive skin should definitely avoid fragrances in personal care products.

Other causes include metabolic disorders, tumors, folic acid and vitamin B12 deficiency , psoriasis (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 states of restlessness. In summer, however, treatment with St. John’s wort should be avoided, as the medicinal plant may increase the skin’s sensitivity to light. In connection with the sun, this can cause brown spots on the skin .

Treatment for pigment spots

One 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, “grinding” the top layer of skin (microdermabrasion) and peeling. All of the types of treatment mentioned should definitely be carried out by an experienced doctor.

Freckles are a common pigment disorder that primarily affects people with very fair skin. (Image: olly / stock.adobe.com)


Freckles (ephelides) are harmless pigment spots. The small light brown spots mostly occur in light-skinned, red-haired, or blonde people. The freckles are caused by an increased production of melanin (hyperpigmentation) and occur mainly on areas such as the face, décolleté and arms that are often exposed to the sun. The first sunny day, the first sunbathing of the year and these funny little spots will sprout. In the winter months the number decreases again and the remaining ones are less pigmented than in summer.

The disposition for the small patches of skin is genetic and therefore cannot be influenced. But if you have freckles, you should definitely not get angry. In the meantime there are even models who have these pretty pigment disorders and this is not seen as a “disorder”, but as pretty.

Age spots

Age spots are another form of pigment spots . As the name suggests, they do not occur at a young age, but only from the age of 40. As a rule, everyone over 60 has it. These spots also show up on areas such as the face, shoulders, arms, and backs of the hands that are frequently exposed to the sun. Accordingly, they are chronic skin damage from 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 the freckles, they hardly get any lighter in winter. Age spots are absolutely uncritical, but many people affected, especially women, see them as an unsightly appearance. In technical terms, they are called lentigines seniles , which doesn’t necessarily make them more beautiful.

White spot disease (Vitiligo)

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

Vitiligo symptoms

This disease is neither painful nor contagious, but for many people it is a major cosmetic problem. Vitiligo most commonly begins between the ages of 10 and 30, but it can affect all age groups and all skin types. Most of the time, the first spots appear on the face, then on the hands and feet. Mucous membranes, hairy parts of the body, eyes and inner ear can also be affected. Not every bright spot can be assigned to this disease. This could also be due to a fungal skin infection. Therefore, you should definitely have this clarified.

Vitiligo is a chronic skin condition that causes white patches of skin to appear on different parts of the body. (Image: shurkin_son / stock.adobe.com)

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

Treatment for white spot disease

The doctor can determine the affected areas with the help of a so-called Wood lamp. The Vitiligo foci appear whitish-yellowish due to the ultraviolet light. A biopsy may be required. If there is 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, must be excluded or treated.

This pigment disorder cannot be cured. However, there are some therapeutic options to curb the progression and to promote the formation of new melanin in the light areas, so that these unsightly areas become smaller. Most often, light therapy, known as phototherapy, is used. The skin is irradiated with light that has a special wavelength. Another form of light therapy is the 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 subsequent radiation.

A 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 use extremely intensive sun protection and try to reduce stress . Vitiligo is a mental problem for many patients. Outsiders view it from a distance as if it were a contagious disease. Those affected must learn to deal with the disease. Camouflage make-up and suitable powder help to hide the white spots. Let us advise you. A self-tanner can also help to hide the light areas a little.

Bran (Pityriasis versicolor)

Another pigment disorder is bran (also called “bran fungus”), which is called ” pityriasis versicolor ” in technical terms . This is a fungal disease that affects the upper layers of the skin. The culprit is the malassezia yeast. The disease is not contagious and affects younger adults in particular. Brownish spots appear on the upper body, especially on the middle of the chest and back. The lichen can also spread to the lateral torso, shoulders, neck, upper arms and thighs .

The above 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 fungal lawns, which lie on the horny layer of the skin and show themselves through brownish pigmentation. Why the fungus undergoes this change is not yet clear. It is known, however, that this is favored by a warm and humid climate, excessive sweating and the use of high-fat skin care lotions.

The bran is caused by the yeast Malassezia. Characteristic are small to large spots converging, which appear light or dark depending on the tan of the skin. (Image: buraratn_100 / stock.adobe.com)

Branches Symptoms

At the beginning of the disease, individual follicle openings are framed in dark. Then round, sharply delimited spots become visible. In the further course, these can spread over a large area and irregularly. The spots are light brown to reddish brown and show a slight flaking 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 rubs a wooden spatula over the affected areas, picks up the flakes of skin with an adhesive strip and places them on a slide. The scales are softened in a weak lye. This makes the mushroom elements easier to see under the microscope.

The doctor will prescribe an antifungal drug. This is a fungicidal agent that is used topically. If the disease is severe, the antimycotic can also be used in tablet form. Anything that might encourage the yeast to grow should be turned off. Conversely, this means: wear air-permeable clothing, shower immediately after sweaty activities, no application of greasy skin care creams.

With the appropriate predisposition, the skin disease can continually recur (relapse). Affected people should use a special medicated shampoo that has an antifungal effect instead of a normal shampoo for a long time.

Prevent pigmentation disorders

To prevent pigmentation disorders, you should always think of adequate sun protection. The more sensitive the skin, the higher the sun protection factor. The sun cream should not only protect against UVB rays but also against UVA rays and contain neither preservatives nor perfume. It is best to seek advice on this. The sunscreen has to be renewed again and again.

If you are very sensitive, it is best to wear a T-shirt or something similar as soon as you plan to be in the sun for a longer period of time. 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 glasses are also important. To protect yourself from pigment disorders, you should also avoid visits to the solarium.

In order to avoid pigment spots, you should not spend too often or too long in direct sun and always protect your skin with the right sunscreen. (Image: sosiukin / stock.adobe.com)

Beware of changes

As a rule, pigment disorders are harmless. However, these can degenerate. That is why it is advisable to have regular skin screening by a dermatologist , 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 be itchy, must be checked by a doctor. The earlier skin cancer is detected, the sooner it is curable.

Self-assessment using the ABCDE rule

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

  • A = Asymmetry: A new dark spot on the skin is not evenly round, oval or oblong, but has an uneven shape. Or the shape of a long-standing spot has changed and is no longer symmetrical.
  • B = boundary: a mole has blurred, uneven or jagged edges and / or grows frayed into the surrounding skin area.
  • C = Color: A pigment mark has different colors and / or the color is mixed with pink, gray or black dots.
  • D = diameter: the skin spot is larger than three to five millimeters at the widest point or has a hemispherical shape.
  • E = sublimity or evolution: The time more protrudes more than a millimeter above the skin level. The pigment spot has changed in the last three months.

Warning: Such changes do not have to mean something bad, but they should definitely be taken seriously.

Home remedies for pigment disorders

The following home remedies are said to help get rid of pigment spots or lighten a little. The lemon is known to have lightening properties. It is also used in self-made hair conditioners to make the hair a bit more blonde. 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 must also never be used in conjunction with the sun. This could lead to more stains.

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


Free radicals are an intermediate product of metabolism in every human cell. If the body is healthy and in balance, it can buffer these free radicals and does not harm itself. If this is not the case, however, the body must be supplied with so-called antioxidants from the outside. Free radicals that are not caught can lead to diseases that age the skin and also cause pigmentation marks.

That is why a balanced diet, which contains many basic foods and animal products only in small amounts, is important. This includes drinking enough water in the form of still water. Often, however, the diet is insufficient and so-called nutritional supplements must be taken. Vitamins E, beta-carotene and C as well as the trace elements selenium and zinc are important. It is also important to ensure a solid vitamin D value. Get advice from a professional about dietary supplements. (sw


by Abdullah Sam
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