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 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.