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.

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.