Causes of Confetti Hypopigmentation
The causes of confetti hypopigmentation include:
1. Tuberous Sclerosis
Tuberous sclerosis is a genetic disorder that affects the skin, brain, spinal cord, heart and kidneys.
30% of patients with tuberous sclerosis, which is also known as adenoma sebaceum, develop confetti hypopigmentation.
Most cases of tuberous sclerosis are caused by mutations or changes in the TSC1 and TSC2 genes.
These gene mutations are passed on from parents to their children in an autosomal dominant pattern. This means that children with of a person with this condition have a 50% chance of inheriting it.
2. PUVA Therapy
Confetti hypopigmentation has been reported to develop in patients who received local PUVA (psoralen + UVA treatment). This therapy is used to treat skin conditions like vitiligo and psoriasis. It involves the application of a psolaren to the part being treated to make it more sensitive to light before it is exposed to UVA.
Confetti hypopigmentation has also been reported to develop in patients who received systemic PUVA. In this therapy the psolaren is taken by mouth before the patient is exposed to UVA.
3. Hydroquinone Therapy
Confetti depigmentation has also been reported to develop in patients who used hydroquinone. This is a skin lightening medication used to treat conditions like melasma.
4. MBEH Therapy
Confetti depigmentation has also documented to have developed after using the monobenzyl ether of hydroquinone (MBEH). This is another skin lightening agent used by patients with extensive vitiligo.
Symptoms of Confetti Hypopigmentation
Symptoms of Confetti Hypopigmentation include many hypopigmented macules or flat white spots on the skin which are around 1-3 mm in diameter.
These hypopigmented areas are usually on the arms and legs.
Treatment for Confetti Hypopigmentation
The treatment of confetti hypopigmentation can be divided into:
1. Camouflage cosmetic application
2. Sun protection
3. Vitamin D supplementation
4. Psychological treatment
5. Treatment of underlying causes
Camouflage Cosmetic Application
The use of camouflage cosmetics can be divided into using cover-up makeup and using self-tanning lotions.
Cover-up makeup usually comes as sets which include concealing creams and setting powder. The Smart Cover-Up Starter Kit is a good example.
1. Clean the skin with soap and water.
2. Apply the concealing cream foundation to the white patches. This cream foundation should be 1 or 2 shades darker than the surrounding skin.
3. Lightly dust the area with loose powder.
Self-tanning lotions which contain Dihydroxyacetone (DHA) are used medically to darken skin which has lost its normal color. They can be applied to any part of the body and their color changes begin to become apparent around 1 hour after application.
DHA self-tanning lotions are available in concentrations which range from 2.5 to 10%. It is advisable to begin with the lower concentrations, which are lighter in color, since it is easier to darken a lighter shade than to lighten a darker shade.
1. Clean the skin with soap and water.
2. Exfoliate it with a body scrub to make it smoother for more even coloration.
3. Wipe it with hydroalcoholic to neutralize alkaline compounds from the soap.
4. Moisturize the skin.
5. Wear gloves to avoid developing tanned palms.
6. Apply a thin layer of the DHA self tanner to the white areas on the skin using long, uniform strokes.
7. Wipe off any excess color to prevent uneven darkening with a damp cloth.
8. Wait for 60 minutes before bathing.
9. Reapply the color once it begins fading which is usually after around 3-7 days.
Broad spectrum sunscreens that offer protection from UVA and UVB rays should be used by all persons with patches of depigmented or hypopigmented skin. This is due to the fact that the skin lacks the protection it gets from melanin when it is exposed to the sun and it is therefore at risk for developing sunburn and subsequently skin cancers.
Sunscreens also prevent the tanning of the normal skin which contributes to making the hypopigmented patches more obvious. Therefore application of sunscreen with a sun protection factor (SPF) of 30 or above is vital.
Protective clothing with long sleeves and slacks that cover the legs should be worn together with wide brimmed hats and shades.
Sun avoidance should also be encouraged to minimize sun exposure when it is brightest which is usually from around 10 am to 4 pm. This should be combined with staying away from sunbeds and other sources of UV rays.