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INTRODUCTION

The pigmentary component of the skin is of supreme importance. First and foremost, it provides protection from the damaging UV rays of the sun. Over many thousands of years, populations closest to the equator have evolved toward darker skin and those further away from the sun toward lighter skin. Yet with easy worldwide travel in this modern age, light-skinned patients are living in very sunny climates and vice versa. Thus the healthcare provider must be familiar with a wide range of skin conditions related to skin pigmentation, including photoaging changes (Ch.17) and sunlight-induced neoplasia (Ch. 32).

This chapter will concentrate on:

As a general rule, most patients see uniform pigmentation as normal. Any condition that results in patchy pigmentation or, even worse, complete loss of pigmentation, is greatly distressing. For example, vitiligo, which causes loss of pigmentation, which can range from small, scattered patches to near-complete loss, is not deleterious to the health but can be psychologically devastating. Darker-skinned patients with acne usually complain more of the postinflammatory dark spots than of the acne itself. In fact, any rash in the darker-skinned patient can cause darker or lighter patches that can last for months to years.

White/Cox: Diseases of the Skin, 2ed.(c) 2006, Elsevier Inc. All rights reserved.