Causes of Skin Discoloration Around the Mouth

Skin discoloration around the mouth or corner of the lips may be due to :

• Medical conditions such as Addison’s disease, Cushing’s syndrome, digestive disorders ( biliary cirrhosis, porphyria) and iron-deficiency anemia.
• Injury or trauma to the area from fungal infections, chemical irritants, certain cosmetics, long term use of skin lightening creams and incorrectly performed skin procedures like dermabrasion.
• Excessive sun exposure that leads to sun burn can result in pigmentation around the mouth. This is more common in lighter skin complexions or those with sun sensitivity.
• Prolonged exposure to heat, common in beauty treatments with the use of procedures like long periods of facial steaming.
• Beauty treatments involving facial hair removal, such as waxing, threading or depilatory creams, can often leave the skin bruised and irritated, if performed incorrectly, done repeatedly in short periods or in more sensitive skin types. This can cause repeated trauma to the area resulting in the darkening of the skin.
• Hormonal changes such as menopause, puberty and pregnancy can contribute to dark skin discoloration around the mouth
• Melasma, which is a skin condition commonly occurring in females, results in the appearance of brown patches. This is occurs due to hormonal imbalances during pregnancy and menopause. Excessive sun exposure can aggravate melasma but does not usually cause the condition.
• Drug-induced pigmentation is hyperpigmentation that occurs as a side effect of certain drugs, like antimalaria drugs, antibiotics and certain oral contraceptives. However this is not a common side effect and occurs in only a small percentage of patients.
• Nutritional conditions such as carotenanemia (orange tinge of the skin due to over consumption of yellow food), malnutrition, malabsorption of food and pellagra may lead to hyperpigmentation of the skin.
• Hyperpigmentation can occur due to inflammatory conditions of eczema, systemic sclerosis, burns, healing of acne scars, blisters and photodermatosis.

Treatment and Management

• Avoid excessive sun exposure, especially if your skin is sensitive to the sun. Sun exposure aggravates most skin conditions, particularly when hyperpigmentation is a symptom of the specific condition. The use of a sunscreen  will assist with protection from the sun and it is advisable to use a protective cream with SPF 30 on a daily basis.
• Beauty procedures such as chemical peels, iontophoresis, intense pulse light therapy and laser surgery can help in the treatment of hyperpigmentation. However these procedures should be conducted by a reputable skin care professional as incorrectly performed procedures may aggravate the dark skin discoloration further.
• Topical cosmetic creams such as alpha hydroxy acid and hydroquinone are effective in treating hyperpigmentation but hydroquinone should be used cautiously as incorrect use can cause furthering darkening.
• Camouflage make up is often used in the concealment of pigmentation but this is not a solution to the problem.

Causes of Dark Circles Under the Eyes?

• Allergies such as hay fever can often result in dark under the eye circles as the allergens responsible for the hay fever results in inflammation of the eye lining, often experienced as itching, as well as inflammation of the skin around the eye. Nasal congestion that often occurs during the bout of an allergy and further contributes to the inflammation which leads to dark circle formation under the eye. This occurs due to the dilation of blood capillaries from the nose to the eyes.
• Hereditary. Fair skinned individuals with naturally deep seated eyes are often prone to developing dark circles under the eye as they get older. Dark eye circles can also develop due to genetic factors.
• Thinning of the skin around the eye occurs due to the loss of collagen and fat deposition  around the eye area as a result of ageing. Blood vessels become more distinct due to the decreased amounts of collagen and fat giving the appearance of dark eye circles. The development of puffy eyelids or hollows under the eyes occur due to the natural process of ageing
• Lack of sleep. Disturbances in the normal sleep cycle can result in the skin looking pale with development of circles under the eyes appearing darker in colour. A lack of sleep can also contribute to tired looking eyes that can often give the appearance of puffiness.
• Sun damage. The excessive amounts of sun exposure can cause the body to produce large amounts of melanin (pigment cells) to protect the skin against the harmful effects of the sun’s rays. This results in the weakening of skin tissue under the eyes contributing to dark eye circles.
• Lifestyle. The consumption of alcohol, caffeinated drinks and smoking results in the accumulation of toxins  in the body. This build up can often lead to the development of dark circles under the eye area.
• Dehydration. The decrease intake of water with the combination of alcohol and caffeinated beverages can lead to dehydration resulting in the appearance of dark circles under the eyes.
• Fluid retention in the body are commonly due to illness, excessive dieting, increased amounts of salt intake, smoking, medication, disorder’s of the heart, thyroid, kidney and liver. The above results in the dilation of the blood capillaries causing the eyes to appear engorged with dark circles under the eyes.

Treatment of Dark Circles

• Increase the amount of water intake to help detox the body of the accumulated toxins. The daily recommended allowance of water intake is approximately 6 to8 glasses.
• Decrease or eliminate the consumption of alcoholic and caffeinated beverages to prevent dehydration.
• The use of a sunscreen would help prevent the weakening of the skin’s tissue around the eyes.
• Laser therapy and chemical peels can decrease the discoloration around the eye area.
• Hollows that develop under the eye due to aging can be corrected with collagen injections.
• Decrease smoking and salt intake, and increase sleep and vitamin intake which will help minimise the appearance of dark circles under the eye.

How are stretch marks formed?

Stretch marks, also known as striae, occur when the dermis (middle layer of skin) over stretches to accommodate excess fat or body enlargement (as in pregnancy( resulting in the break down of elastin fiber, which is responsible for the skin’s firmness. The stretching causes tissue inflammation and bleeding of the micro-vessels resulting in the formation of the typical stretch mark on the surface of the skin. These bright streaks are characterized by pink, red or purple raised scars. Over time these marks may fade into a silvery white to dark brown color, although it is usuall a few shades lighter than the skin’s natural tone because of the disruption in the collagen and melanin (pigment cells) production.

Causes of Stretch Marks

• Pregnancy. In the late stage of pregnancy, as the growth of the fetus accelerates, stretching of the skin occurs around the abdomen,although the hips, thighs and breasts may also be affected. Pregnant women with large or multiple babies (for example twins) are more susceptible to the increased development of stretch marks.

• Puberty. During this stage of life adolescents undergo a growth spurt. To accommodate the increase in height and body development the skin stretches resulting in stretch marks.

• Obesity is a common condition responsible for the formation of stretch marks due to the increase in fat deposition thereby stretching the skin.

• Zinc. A deficiency in zinc often contributes to the development of stretch marks

• Weight lifters develop stretch marks as the skin stretches to accommodate the increased amount of muscle bulk. Some body builders use steroids to develop muscle bulk quickly which affects the blood cortisone levels.

• Medication. The use of both oral and topical medication such as contraceptive pills, chronic use of steroid creams and medication contribute to the formation of stretch marks.M

• Medical disorders and conditions such as Cushing’s syndrome, other adrenal gland disorder and hereditary disorders play a role in the development of stretch marks.

Treatment of Stretch Marks

The treatments for stretch marks are partly effective as these marks cannot be completely removed.

• Topical applications of preparations such as tretinoin creams improves the appearance of newly formed stretch marks of less than 6 weeks old and are still pink in colour. Tretinoin rebuilds collagen and elastin fibres making stretch marks less visible but it is not effective on old stretch marks.

• Pulsed laser and excimer laser are the 2 types of effective laser therapies commonly used in the treatment of stretch marks. Pulsed laser therapy remodels the dermis (middle layer of skin) by stimulating the growth of elastin and collagen fibres. This type of therapy is effective on newly formed stretch marks. Excimer laser stimulates the production of melanin cells (pigment cells). This allows the hypopigmented stretch marks to blend into the surrounding skin marking it less visible. Excimer laser therapy is effective for both new and old stretch marks.

• Micro-dermabrasion resurfaces the skin by using minute sand-like crystals. These crystals erode the surface of the skin while a thin tube suctions the crystals and dead skin cells. Microdermabrasion is effective on old stretch marks as it removes the upper layer of skin (epidermis) resulting in the growth of new cells.

What is a hair dye allergy?

Initially, the allergy to a hair dye presents as skin sensitivity, with itching and burning in response to the application of a hair dye. A hair dye allergy is classified as an allergic contact dermatitis where a delayed hypersensitivity reaction occurs in response to the chemical constituents of the hair dye. While itching and burning may be noticed, at times there are no symptoms upon applying the dye and any signs of an allergy appears weeks after the hair dye application. Continued exposure to the hair dye can aggravate the allergy further.

Symptoms of a Hair Dye Allergy

• Inflammation of the affected area (mostly the head area).
• The skin has a red appearance with a presence of a rash.
• Itchy and burning sensations often accompany the allergy.
• Temporary thickening of the skin can occur.
• The skin may become dry and scaly.
• Eruption of blisters or ’scalp pimples’.
• In some cases severe swelling can occur.
• Systemic allergic reactions may occur in hypersensitive individuals.
• Secondary infection of the scalp rash or blisters will result in thick crusts, and oozing pus from the scalp.

Causes of a Hair Dye Allergy

The cause of most hair dye allergies is linked to a substance called paraphenyenediamine (PPD) which is commonly found in permanent hair dyes. PPD is banned in some European countries due to its tendency to cause hair dye allergies and severe skin irritation. Commercial hair dyes that are widely used in the retail market contain PPD along with hydrogen peroxide. PPD functions as a replacement for the color of the hair whilst hydrogen peroxide breaks down the melanin (natural pigment) of the hair. A reaction occurs with PPD and hydrogen peroxide which may result in a partial oxidation of the dye color. During this stage an allergic reaction can occur if the PPD is not completely oxidized.

Preventing a Hair Dye Allergy

• It is advisable to do an allergy sensitive test or a patch test to determine if the skin will react to the hair dye preparation.
• Apply hair dye on a small sensitive area of the skin for 5 to 10 minutes.
• Wash off the area completely with warm to cold water.
• After a waiting period of 48 to 72 hours, if a rash appears, this indicates an allergy to the hair dye. Do not use the dye if a reaction is evident.
• If no reaction occurs, the skin is unlikely to react to the hair dye preparation.
• Stop using the hair dye or reduce the frequency of application.
• Switch to a ‘non-permanent’ or a natural hair dye preparation like henna.
• Wait for the symptoms to disappear or resolve before considering another hair dye application.

Treatment of Hair Dye Allergies

• In cases where the allergy is present the use of a corticosteroid cream can be effective to reduce the itching, burning and skin rash.
• Anti-histamines may offer some short term relief for the itching.
• In acute reactions, immediately after applying the hair dye, a thorough rinsing with cold water may reduce the severity of the itching or burning. However this is unlikely to prevent the development of a rash.
• Secondary bacterial or fungal infections should be treated immediately to prevent further complications like hair loss.

Skin lighteners (bleaching or whitening creams) are a commonly used cosmetic product among men and women looking for a lighter skin complexion (‘fair skin’) for aesthetic purposes. Cultural misconceptions and personal beliefs about the appeal of a lighter skin complexion have made these creams, soaps and lotions a popular beauty product in Asia and Africa among darker skinned ethnic groups. A lack of appropriate regulation in many developing countries allows for these products to be sold over-the-counter although it contains pharmacologically active and toxic compounds like hydroquinones, corticosteroids and mercury.

Natural Skin Pigmentation

Melanin is a brown pigment produced by the melanocytes (melanin forming cells) in the deeper layers of the skin. The function of melanin is to absorb harmful ultraviolet (UV) rays from the sun and protects the skin from diseases such as cancer. The distribution of melanin differs among  individuals and is influenced by genetics (familial and racial). Hormonal disturbances such as pregnancy or menopause may cause conditions such as melasma, where the skin may appear hyperpigmented (dark patches) in certain areas. In these cases, the use of skin lighteners may assist to ‘even out’ pigmentation and blend these areas with the natural skin tone.

The effect of skin lighteners differs among individuals as it is dependent on:

1. The individual skin type (dry, dehydrated or oily).
2. The condition being treated (sun damage, pigmentation in pregnancy, damage from cosmetic products such as steroid creams).
3. The concentration or strength of the active ingredients.
4. The period of time during which the skin lightener was used.

Ingredients in Skin Lightening, Whitening & Bleaching Products

Hydroquinones (often misspelled as ‘hydroquinine’) is by far the most common ingredient in these skin lightening products. The bleaching effect of hydroquinones has been widely known for many decades and has been banned as a cosmetic product in many developed countries. Pharmaceutical applications include the treatment of certain hyperpigmentation disorders, like melasma, damage caused by skin sun sensitivity or photodermatosis, blemishes, freckles and age spots. Other common ingredients in cosmetic skin lightening products include hydrocortisone (’steroid cream’) and mercury, both of which have a host of side effects if used over long periods of time.

Hydroquinone

Although hydroquinone is widely used in skin bleaching cosmetic products in Africa and Asia, it is banned in Europe due to its side effects. Hydroquinone is a toxic chemical that is also used in the processing of photographs and the manufacture of rubber and hair dyes. The side effects of hydroquinone include:

• Thinning of the skin which affects the collagen fibers.
• Due to the damage of collagen fibres pre-mature wrinkling can develop.
• Hydroquinone can cause irritation to the skin as it is an unstable ingredient.
• Blistering or cracking of the skin can often result with long term use.
• Prolonged use of hydroquinone can cause grey or bluish black pigmentation.
• Impaired wound healing which can result in recurrent or chronic skin infections.
• Hydroquinone can cause cancer as it inhibits the production of melanin thereby ‘robbing’ the skin of its natural UV protection capabilities.

Mercury

Mercury which is the second common ingredient used in skin lighteners is derived from mercury chloride and is a carcinogen. The side effect of mercury includes:

• An increased risk of cancer as the skin has no protection from the sun.
• Damage of the skin connective tissue.
• A rough blotchy skin with a spotty appearance.
• Mercury poisoning as it accumulates in the skin cells and enters the blood stream.
• Dryness of the skin as moisture is depleted from the skin cells.
• Ulceration of the skin.

Corticosteroid or Hydrocortisone

Steroids which is another widely used ingredient used in skin lighteners and is an effective but dangerous compound. Fortunately, the use of corticosteroids in cosmetic products is being restricted in many countries due to its classification as a pharmaceutical. The side effects of long term topical corticosteroid use includes :

• Thinning of the skin
• Appearance of pale and dark ‘lines’ similar to stretch marks
• The skin may become prone to bacterial and fungal infections, dermatitis and systemic conditions like Cushing’s syndrome could occur.
• Pre-existing conditions like eczema and acne may ease with ’steroid’ use but will often return and aggravate over time or once the cream is discontinued.

Causes of Melasma

Hyperpigmentation is the increased melanin production causing a characteristic dark discoloration of the skin. The increased melanin (pigment) production is often an indication of hormone imbalances in the body and therefore melasma is commonly found in women who are pregnant or on hormone replacement therapy (HRT).

Pregnancy causes an over stimulation of melanocytes (pigment cells) resulting in pigmentation occurring on the nipples, lower abdomen and face areas. Exposure of light on the skin can further aggravate the condition. The pigmented patches usually disappear after the birth of the baby or the cessation of the hormone therapy but in some cases it may remain as a permanent blemish.

Treatment for Melasma

Treatment for melasma does not have a 100% success rate as the as pigmentation can fade into the normal skin tone giving the appearance of a ‘cure’. There are preventative measures and treatment that can aid in the management of melasma.

• Treatment with 2% to 4% hydroquinone in a cream base may decrease pigmentation but may aggravate or cause dermatitis of the skin.
• Topical 0.1% tretinoin sequentially used with hydroquinone will enhance the effect in the treatment of melasma.
• Hydroquinone is contra-indicated in individuals with liver or kidney conditions, open cuts and bruises and severely sun burn skin. Individuals who have allergies, sensitive skin or are on certain type of medication need to use hydroquinone with caution especially if the treatment is long term.
• Long term application of hydroquinone can cause local ochronosis and hydroquinone creams should only be prescribed by your dermatologist. A skin assessment will first be conducted before you dermatologist will decide upon the most appropriate course of treatment.
• For the maximum bleaching effect from the use of hydroquinone applications, avoid excessive sun exposure. Light and sun sensitivity of the skin may be noticed after starting a hydroquinone cream.
• A sunscreen with a sun protection factor (SPF) of 15 to 30 should be used to prevent the aggravation of melasma. Avoid daily use of sunscreen creams with an SPF greater than 30.
• Small patches of melasma can be camouflaged with cosmetic creams that do not wipe off (stay-fast formulation) although these should only be used when other treatment is not successful.
• The use of corticosteroid creams are another common approach to treating early stages of melasma. Hydrocortisone applications are never recommended as it causes thinning of the skin and the condition often returns worse that the original state once the hydrocortisone is discontinued.

The cosmetic industry is constantly marketing new and more effective treatments for melasma, often promoting products that have not undergone clinical trials. From whitening creams (skin bleaches) to ascorbic acid (vitamin C) applications and vitamin A creams, melasma should be treated by a professional rather than risking your skin with overpriced, over-the-counter products.