The causes behind pigmentation can be excessive sun exposure, hereditary factors, pollution, stress, and hormone fluctuations.


Types of Pigmentation


Freckles or Ephelides Freckles is one of the most commonly seen types of skin pigmentation. They scatter throughout the face and concentrate on areas with the most sun exposure, such as the cheeks, nose bridge, neck, shoulders, back of hands. Freckles are caused by excessive sun exposure, causing the pigment-producing cells in the epidermis of the skin to become more active and produce more pigment. Freckles typically darken during the summer and lighten during winter time.


Solar Lentigo

Solar lentigo is a harmless patch of darkened skin. It results from exposure to UV radiation, which causes local proliferation of melanocytes and accumulation of melanin within the skin cells (keratinocytes). Solar lentigos or lentigines are very common, especially in people over the age of 40 years. Sometimes they are also known as an “old age spot” or “senile freckle”.


Seborrhoeic Keratosis (Seborrhoeic Wart)

A seborrhoeic keratosis is a harmless warty spot that appears during adult life as a common sign of skin aging. Some people have hundreds of them. Seborrhoeic keratosis is also called SK, or senile wart.


Café-au-lait macules or CALMS

A café-aut-lait macule is a common form of birthmark; it has the appearance of a hyper-pigmented skin patch with a sharp border and diameter of > 0.5 cm. It is also known as circumscribed café-aut-lait hypomelanosis or Recklinghausen spot. It is often abbreviated as CALM. It maybe associated with hereditary disorders like Neurofibromatosis,  McCune-Albright’s Syndrome.



Melasma is a chronic skin disorder that results in symmetrical, blotchy, brownish facial pigmentation. The pigmentation is due to overproduction of melanin by the pigment cells, melanocytes, which is taken up by the keratinocytes (epidermal melanosis) and deposited in the dermis (dermal melanosis). There is a genetic predisposition to melasma, with at least one-third of patients reporting other family members to be affected. In most people, melasma is a chronic disorder.


The cause of melasma is complex. Known triggers for melasma include: Sun exposure, pregnancy, hormone treatments—oral contraceptive pills containing oestrogen and progesterone, hormone replacement. Anything containing scent can be a trigger too. For examples: deodorant soaps, cosmetics, and fragrances. All of the above may cause a phototoxic reaction that triggers melasma, which may then persist long term.


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