Stella Pavlides was admiring her new ruby ring under the black lights of a New York City bar when she noticed something else glowing: “I had white spots on my knuckles,” remembers Pavlides, a 70-year-old in Clearwater, Florida, who was 22 at the time.
But when she stepped outside, the spots were gone. “I didn’t think much of anything,” she says.
Within a few years, however, the bleached-looking patches became more prominent against her Greek skin, and spread to the tops of her hands, her elbows, back, knees, armpits and genitals, and around her eyes and mouth.
Dermatologists told her it was vitiligo, an autoimmune disease that causes the skin to lose the melanin that colors it – sometimes in small patches, other times across most of the body. While the condition – which affects about 1 percent of the world’s population and can be more noticeable in people with darker skin – is relatively physically harmless, it can be emotionally devastating and socially isolating.
No big deal, it’s only vitiligo, it won’t kill you,’” Pavlides recalls doctors telling her. But to people with the condition, it is a big deal. “I got inhibited,” says Pavlides, an otherwise confident, straight-shooting native New Yorker who remembers turning down trips to the beach with her friends, wearing long sleeves that she’d pull down to cover her knuckles no matter how high the temperature and feeling degraded when people dropped – rather than placed – change in her hands. Since founding the American Vitiligo Research Foundation more than 20 years ago, she’s heard from countless kids who’ve been bullied or beaten up due to the condition, and even from a parent whose son with vitiligo committed suicide.
“It’s a very, very difficult disease,” says Pavlides, who runs the foundation full time.
While there’s no cure for vitiligo, which typically first appears between ages 10 and 30, there are treatments – ranging from makeup and steroids to light therapies and skin grafts – that can help stop the disease progression, restore color or at least mask the lack of it. “Do we have an optimal treatment? The answer is no,” says Dr. Pearl Grimes, director of the Vitiligo and Pigmentation Institute of Southern California who also prescribes vitamin D and antioxidants to patients with vitiligo to support their immune function. “But there is hope.”
For Pavlides, who says she’s “tried everything” with not enough success to make the side effects or expense of treatment worth it (insurance companies don’t always cover therapies because they deem them cosmetic or experimental), she feels the best medicine is support. “Don’t give up,” she tells parents of kids with the condition. “Tell your kids they’re beautiful. Tell them everybody’s different.”
Still, it’s important to seek care for any skin pigmentation changes, dermatologists say, since some can signal more serious problems and many influence quality of life. Here are some reasons your skin might be losing, gaining or otherwise changing color – and what to do about it:
1. You Have Vitiligo
If Pavlides’ symptoms sound like yours – or if you have a loss of pigmentation elsewhere, such as in the hair on your body or head or inside your mouth – find a dermatologist who specializes in treating vitiligo, Grimes suggests, since many physicians wrongly believe there are no treatments and don’t understand the condition’s psychological impact. Vitiligo also shouldn’t be ignored, experts add, since the condition – which Michael Jackson had but treated by removing the pigment from the rest of his skin rather than trying to restore color to the vititigo patches – often coincides with other autoimmune problems like thyroid disorders and can make people’s skin more vulnerable to sun damage.
2. You’re Pregnant
While vitiligo causes a loss of pigmentation in the skin, melasma – sometimes called “the mask of pregnancy” – seems to cause some skin cells to produce more pigment, which usually appears as brown or gray-brown patches on the face, according to the American Academy of Dermatology “It’s just so prominent and concerning to people,” says Dr. Bruce Robinson, a dermatologist in New York City and spokesman for the American Academy of Dermatology, noting that the vast majority (some 90 percent) of patients with the condition are women, since it seems to have a hormonal component. “Pregnancy makes it worse, birth control makes it worse and sunlight makes it worse,” he says.
While having the baby, stopping the birth control or protecting yourself from the sun can clear up the condition, it often recurs, experts say. “For a lot of people, it’s a constant battle,” says Dr. Marie Jhin, a dermatologist in San Francisco. But, with expert supervision, chemical peels, bleaching creams and laser therapies can help mask flare-ups.
3. You Mixed Limes and Sunshine
When patients come to Jhin panicked about mysterious dark marks on their hands or around their mouth, she asks, “Did you just go on vacation?” If the answer is yes, everyone breathes a sigh of relief. Chances are, the diagnosis is phytophotodermatitis, a skin reaction to sunlight and a chemical in limes and other citrus fruits such as lemon and oranges. While the first reaction – blisters or burning – is often dismissed as sunburn or allergies, if noticed at all, the lingering pigment changes usually fade in a few months. It’s common in the spring and summer months, Robinson says, since people makemixed drinks with lime, get some juice on their skin and then go out in the sun. That’s why the condition is often nicknamed “Club Med Dermatitis” and “Mexican Beer Dermatitis.”
4. You Have a Form of Eczema
Another condition that tends to bring patients – typically children – to dermatologists during warm-weather months is pityriasis alba, which first causes red, scaly patches before leaving lighter patches on the skin, according to the American Osteopathic College of Dermatology. “It gets moms really nervous that their kid has vitiligo,” Robinson has found. But in fact, the condition seems to be a feature of eczema that’s simply more apparent on tanned skin, Jhin says. Treatment is usually simple sunscreen or, if more severe, a topical steroid, she says. As Robinson puts it: “You stop the eczema and the pigmentation comes back.”
5. It’s a Remnant of Past Skin Damage
The technical term is “post-inflammatory hyperpigmentation.” To the layperson, it simply means darker skin in places you once had acne, allergic reactions, an injury or any other type of skin inflammation, perhaps from another condition like psoriasis. Here, too, the first-line defense is treating the underlying inflammation.
6. It’s Fungus
Before you say “ew,” keep in mind this possibility is pretty much harmless – and sometimes not even noticeable. Tinea versicolor, a common fungal infection when the natural yeast on our skin overgrows, tends to pop up in the hot, humid summer months – or among people who’ve visited those climates. “Most of the time it’s brown or red or white and it’s … in the areas where people sweat,” Jhin explains. The solution? An anti-fungal treatment.
7. You Have Addison’s Disease
If you thought John F. Kennedy was just a tan guy, you are mistaken: He had Addison’s disease, which is actually an adrenal – not skin – problem in which the adrenal glands don’t produce enough of some hormones, Jhin says. “Someone who says, ‘I’m a lot darker but I didn’t get any sun,’” might have the condition, Jhin says, and should visit his or her primary care doctor, who might prescribe oral medicaitons to help replace the lacking hormones.
8. You Have Acanthosis Nigricans
Here’s another mouthful of a name; this one describing the darkening and thickening of skin folds, such as those in your neck or under your breasts. “It could just be because you’re a little overweight,” Jhin says, noting, however, that it could also be a sign of diabetes. If blood and other tests come up normal, though, the common condition can be treated with creams or other products that help soften the skin, she says.
9. You Have Cancer
Cancer is, of course, the worst-case scenario for oddly-colored skin. Fortunately, it’s also among the rarest of pigmentation issues, Robinson says. “People with melanoma – we talk about their skin turning ‘slate blue,’” he says. “That’s a really bad sign” because it signals that the melanoma is cancerous and has traveled throughout the body. If you have moles that change color, size or shape, too, see a dermatologist pronto.
Bottom line? If you notice any changes in your skin color, see a board-certified dermatologist, who can properly diagnose and treat you. Hopefully, it was the margarita.