Skip to main content
Log in

Pigmentation Disorders in the Elderly

Drugs & Aging Aims and scope Submit manuscript

Cite this article

Abstract

Aging skin is subject to morphological change due to both intrinsic (skin tone, genetics, endogenous hormones) and extrinsic (chronic sun exposure, medications, exogenous pigments) factors. The broad spectrum of transformation includes both hypo- and hyperpigmentation. Although cutaneous pigmentary disorders are common in younger individuals, certain disorders are more prevalent in the geriatric population. This article reviews the epidemiology, pathophysiology, clinical appearance, treatment, and prognosis of pigmentary lesions that are predominant in the elderly.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

References

  1. Ortonne JP. Changes in skin pigmentation in the elderly. J Eur Acad Dermatol Venereol. 1998;11:S33.

    Article  Google Scholar 

  2. Marcos-Garcés V, Molina Aguilar P, Bea Serrano C, García Bustos V, Benavent Seguí J, Ferrández Izquierdo A, Ruiz-Saurí A. Age-related dermal collagen changes during development, maturation and ageing—a morphometric and comparative study. J Anat. 2014;225(1):98–108.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Uitto J. The role of elastin and collagen in cutaneous aging: intrinsic aging versus photoexposure. J Drugs Dermatol JDD. 2008;7(2 Suppl):s12–6.

    PubMed  Google Scholar 

  4. Gunin AG, Petrov VV, Vasil’eva OV, Golubtsova NN. Blood vessels in human dermis during aging. Adv Gerontol. 2014;27(1):54–61.

    CAS  PubMed  Google Scholar 

  5. Taylor A, Pawaskar M, Taylor SL, Balkrishnan R, Feldman SR. Prevalence of pigmentary disorders and their impact on quality of life: a prospective cohort study. J Cosmet Dermatol. 2008;7(3):164–8.

    Article  PubMed  Google Scholar 

  6. Wang KY, Wang KH, Zhang ZP. Health-related quality of life and marital quality of vitiligo patients in China. J Eur Acad Dermatol Venereol. 2011;25(4):429–35.

    Article  PubMed  Google Scholar 

  7. Ortonne JP. Pigmentary changes of the ageing skin. Br J Dermatol. 1990;122:21–8.

    Article  PubMed  Google Scholar 

  8. Haddad MM, Xu W, Medrano EE. Aging in epidermal melanocytes: cell cycle genes and melanins. J Investig Dermatol Symp Proc. 1998;3(1):36–40.

    CAS  PubMed  Google Scholar 

  9. Hodgson C. Senile lentigo. Arch Dermatol. 1963;87:197–207.

    Article  CAS  PubMed  Google Scholar 

  10. Montagna W, Hu F, Carlisle K. A reinvestigation of solar lentigines. Arch Dermatol. 1980;116(10):1151–4.

    Article  CAS  PubMed  Google Scholar 

  11. Cohen LM. Lentigo maligna and lentigo maligna melanoma. J Am Acad Dermatol. 1997;36(6 Pt 1):913.

    CAS  PubMed  Google Scholar 

  12. Farshad A, Burg G, Panizzon R, Dummer R. A retrospective study of 150 patients with lentigo maligna and lentigo maligna melanoma and the efficacy of radiotherapy using Grenz or soft X-rays. Br J Dermatol. 2002;146(6):1042–6.

    Article  CAS  PubMed  Google Scholar 

  13. Kasprzak JM, Xu YG. Diagnosis and management of lentigo maligna: a review. Drugs Context. 2015;4:212281.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Marsden JR, Newton-Bishop JA, Burrows L, Cook M, Corrie PG, Cox NH, Gore ME, Lorigan P, MacKie R, Nathan P, Peach H. Revised UK guidelines for the management of cutaneous melanoma 2010. Br J Dermatol. 2010;163(2):238–56.

    Article  CAS  PubMed  Google Scholar 

  15. Rajpar SF, Marsden JR. Imiquimod in the treatment of lentigo maligna. Br J Dermatol. 2006;155(4):653–6.

    Article  CAS  PubMed  Google Scholar 

  16. Buettiker UV, Yawalkar NY, Braathen LR, Hunger RE. Imiquimod treatment of lentigo maligna: an open-label study of 34 primary lesions in 32 patients. Arch Dermatol. 2008;144(7):943–5.

    Article  PubMed  Google Scholar 

  17. Powell AM, Robson AM, Russell-Jones R, Barlow RJ. Imiquimod and lentigo maligna: a search for prognostic features in a clinicopathological study with long-term follow-up. Br J Dermatol. 2009;160(5):994–8.

    Article  CAS  PubMed  Google Scholar 

  18. Ortonne JP, Pandya AG, Lui H, Hexsel D. Treatment of solar lentigines. J Am Acad Dermatol. 2006;54(5 Suppl 2):S262–71.

    Article  PubMed  Google Scholar 

  19. Alexander A. Maturational hyperpigmentation. Dermatol Skin Color. 2009;1:344.

    Google Scholar 

  20. Vashi NA, Kundu RV. Facial hyperpigmentation: causes and treatment. Br J Dermatol. 2013;169:41–56.

    Article  PubMed  Google Scholar 

  21. Larocca CA, Kundu RV, Vashi NA. Physiologic pigmentation: molecular mechanisms and clinical diversity. Pigment Int. 2014;1(2):44.

    Article  Google Scholar 

  22. Baumann L, Rodriguez D, Taylor SC, Wu J. Natural considerations for skin of color. Cutis. 2006;78(6 Suppl):2–19.

    PubMed  Google Scholar 

  23. Roh MR, Chung KY. Infraorbital dark circles: definition, causes, and treatment options. Dermatol Surg. 2009;35(8):1163–71.

    Article  CAS  PubMed  Google Scholar 

  24. Sarkar R. Idiopathic cutaneous hyperchromia at the orbital region or periorbital hyperpigmentation. J Cutan Aesthet Surg. 2012;5(3):183.

    PubMed  PubMed Central  Google Scholar 

  25. Lowe NJ, Wieder JM, Shorr N, Boxrud C, Saucer D, Chalet M. Infmorbital pigmented skin: preliminary observations of laser therapy. Dermatol Surg. 1995;21(9):767–70.

    Article  CAS  PubMed  Google Scholar 

  26. Ranu H, Thng S, Goh BK, Burger A, Goh CL. Periorbital hyperpigmentation in Asians: an epidemiologic study and a proposed classification. Dermatol Surg. 2011;37(9):1297–303.

    Article  CAS  PubMed  Google Scholar 

  27. Bernardini FP, Cetinkaya A, Devoto MH, Zambelli A. Calcium hydroxyl-apatite (Radiesse) for the correction of periorbital hollows, dark circles, and lower eyelid bags. Ophthalmic Plast Reconstr Surg. 2014;30(1):34–9.

    Article  PubMed  Google Scholar 

  28. Katoulis AC, Stavrianeas NG, Georgala S, Katsarou-Katsari A, Koumantaki-Mathioudaki E, Antoniou C, Stratigos JD. Familial cases of poikiloderma of Civatte: genetic implications in its pathogenesis? Clin Exp Dermatol. 1999;24(5):385–7.

    Article  CAS  PubMed  Google Scholar 

  29. Cestari TF, Dantas LP, Boza JC. Acquired hyperpigmentations. Anais Brasileiros de Dermatologia. 2014;89(1):11–25.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Katoulis AC, Stavrianeas NG, Georgala S, Bozi E, Kalogeromitros D, Koumantaki E, Katsambas AD. Poikiloderma of Civatte: a clinical and epidemiological study. J Eur Acad Dermatol Venereol. 2005;19(4):444–8.

    Article  CAS  PubMed  Google Scholar 

  31. Katoulis AC, Stavrianeas NG, Katsarou A, Antoniou C, Georgala S, Rigopoulos D, Koumantaki E, Avgerinou G, Katsambas AD. Evaluation of the role of contact sensitization and photosensitivity in the pathogenesis of poikiloderma of Civatte. Br J Dermatol. 2002;147(3):493–7.

    Article  CAS  PubMed  Google Scholar 

  32. Katoulis AC, Stavrianeas NG, Panayiotides JG, Bozi E, Vamvasakis E, Kalogeromitros D, Georgala S. Poikiloderma of Civatte: a histopathological and ultrastructural study. Dermatology. 2007;214(2):177–82.

    Article  CAS  PubMed  Google Scholar 

  33. Rusciani A, Motta A, Fino P, Menichini G. Treatment of poikiloderma of Civatte using intense pulsed light source: 7 years of experience. Dermatol Surg. 2008;34(3):314–9.

    CAS  PubMed  Google Scholar 

  34. Nicolaidou E, Katsambas AD. Pigmentation disorders: hyperpigmentation and hypopigmentation. Clin Dermatol. 2014;32(1):66–72.

    Article  PubMed  Google Scholar 

  35. Krause W. Drug-induced hyperpigmentation: a systematic review. JDDG Journal der Deutschen Dermatologischen Gesellschaft. 2013;11(7):644–51.

    PubMed  Google Scholar 

  36. Dereure O. Drug-induced skin pigmentation. Am J Clin Dermatol. 2001;2(4):253–62.

    Article  CAS  PubMed  Google Scholar 

  37. Qato DM, Wilder J, Schumm LP, Gillet V, Alexander GC. Changes in prescription and over-the-counter medication and dietary supplement use among older adults in the United States, 2005 vs 2011. JAMA Intern Med. 2016;176(4):473–82.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Robins AH. Phenothiazine melanosis in schizophrenic patients. Psychopharmacologia. 1972;27(4):327–42.

    Article  CAS  PubMed  Google Scholar 

  39. Hommer A. A review of preserved and preservative-free prostaglandin analogues for the treatment of open-angle glaucoma and ocular hypertension. Drugs Today. 2010;46(6):409–16.

    Article  CAS  PubMed  Google Scholar 

  40. Cho EB, Kim BC, Park EJ, et al. Hydroxychloroquine-induced hyperpigmentation. J Dermatol. 2012;39:859–60.

    Article  PubMed  Google Scholar 

  41. Levin CY, Maibach H. Exogenous ochronosis. Am J Clin Dermatol. 2001;2(4):213–7.

    Article  CAS  PubMed  Google Scholar 

  42. Kim A, Finch J. Q-switched alexandrite laser for the treatment of drug-induced hyperpigmentation. J Am Acad Dermatol. 2016;74:AB22.

    Article  Google Scholar 

  43. Riemenschneider K, Powers JG. Successful treatment of minocycline-induced pigmentation with combined use of Q-switched and pulsed dye lasers. Photodermatol Photoimmunol Photomed. 2017;33(2):117–9.

    Article  PubMed  Google Scholar 

  44. Bergan JJ, Schmid-Schonbein GW, Smith PD, Nicolaides AN, Boisseau MR, Eklof B. Chronic venous disease. N Engl J Med. 2006;355(5):488–98.

    Article  CAS  PubMed  Google Scholar 

  45. Sippel K, Mayer D, Ballmer B, Dragieva G, Läuchli S, French LE, Hafner J. Evidence that venous hypertension causes stasis dermatitis. Phlebology. 2011;26:361–5.

    Article  CAS  PubMed  Google Scholar 

  46. Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005;15(3):175–84.

    Article  PubMed  Google Scholar 

  47. Yalçın B, Tamer E, Toy GG, Öztaş P, Hayran M, Allı N. The prevalence of skin diseases in the elderly: analysis of 4099 geriatric patients. Int J Dermatol. 2006;45(6):672–6.

    Article  PubMed  Google Scholar 

  48. Fiebig A, Krusche P, Wolf A, Krawczak M, et al. Heritability of chronic venous disease. Hum Genet. 2010;127(6):669–74.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Sundaresan S, Migden MR, Silapunt S. Stasis dermatitis: pathophysiology, evaluation, and management. Am J Clin Dermatol. 2017;18(3):383–90.

    Article  PubMed  Google Scholar 

  50. Myers MB, Cherry G, Heimburger S, Hay M, Haydel H, Cooley L. The effect of edema and external pressure on wound healing. Arch Surg. 1967;94(2):218–22.

    Article  CAS  PubMed  Google Scholar 

  51. Padberg FT Jr, Johnston MV, Sisto SA. Structured exercise improves calf muscle pump function in chronic venous insufficiency: a randomized trial. J Vasc Surg. 2004;39(1):79–87.

    Article  PubMed  Google Scholar 

  52. Weiss SC, Nguyen J, Chon S, Kimball AB. A randomized controlled clinical trial assessing the effect of betamethasone valerate 0.12% foam on the short-term treatment of stasis dermatitis. J Drugs Dermatol. 2005;4(3):339–45.

    PubMed  Google Scholar 

  53. Mirande LM, Landolfi JM, Pedemonte LH. Multiple applications of closed permanent wet dressings Their mode of action. Medicina Cutanea Ibero-latino-americana. 1981;9(1):67–71.

    CAS  PubMed  Google Scholar 

  54. McCafferty L. Schamberg’s “Peculiar progressive pigmentary disease of the skin. Arch JAMA Dermatol. 1926;14(1):53–8.

    Article  Google Scholar 

  55. Roehm HR. Progressive pigmentary dermatosis (Schamberg). Clin Pediatr. 1968;7(5):307–8.

    Article  CAS  Google Scholar 

  56. Ratnam KV, Su WD, Peters MS. Purpura simplex (inflammatory purpura without vasculitis): a clinicopathologic study of 174 cases. J Am Acad Dermatol. 1991;25(4):642–7.

    Article  CAS  PubMed  Google Scholar 

  57. Sardana K, Sarkar R, Sehgal VN. Pigmented purpuric dermatoses: an overview. Int J Dermatol. 2004;43(7):482–8.

    Article  PubMed  Google Scholar 

  58. Kim DH, Seo SH, Ahn HH, Kye YC, Choi JE. Characteristics and clinical manifestations of pigmented purpuric dermatosis. Ann Dermatol. 2015;27(4):404–10.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Fathy H, Abdelgaber S. Treatment of pigmented purpuric dermatoses with narrow-band UVB: a report of six cases. J Eur Acad Dermatol Venereol. 2011;25(5):603–6.

    Article  CAS  PubMed  Google Scholar 

  60. Shin MK, Jeong KH, Oh IH, Choe BK, Lee MH. Clinical features of idiopathic guttate hypomelanosis in 646 subjects and association with other aspects of photoaging. Int J Dermatol. 2011;50(7):798–805.

    Article  PubMed  Google Scholar 

  61. Juntongjin P, Laosakul K. Idiopathic guttate hypomelanosis: a review of its etiology, pathogenesis, findings, and treatments. Am J Clin Dermatol. 2016;17(4):403–11.

    Article  PubMed  Google Scholar 

  62. Kim SK, Kim EH, Kang HY, Lee ES, Sohn S, Kim YC. Comprehensive understanding of idiopathic guttate hypomelanosis: clinical and histopathological correlation. Int J Dermatol. 2010;49(2):162–6.

    Article  PubMed  Google Scholar 

  63. Falabella R, Escobar C, Giraldo N, Rovetto P, Gil J, Barona MI, Acosta F, Alzate A. On the pathogenesis of idiopathic guttate hypomelanosis. J Am Acad Dermatol. 1987;16(1):35–44.

    Article  CAS  PubMed  Google Scholar 

  64. Gordon JR, Reed KE, Sebastian KR, Ahmed AM. Excimer light treatment for idiopathic guttate hypomelanosis: a pilot study. Dermatol Surg. 2017;43(4):553–7.

    Article  CAS  PubMed  Google Scholar 

  65. Zak FG, Pai SH, Kanshepolsky J. Stellate spontaneous pseudoscars (Colomb). Arch Dermatol. 1968;98(5):499–501.

    Article  CAS  PubMed  Google Scholar 

  66. Colomb D. Stellate spontaneous pseudoscars: senile and presenile forms: especially those forms caused by prolonged corticoid therapy. Arch Dermatol. 1972;105(4):551–4.

    Article  CAS  PubMed  Google Scholar 

  67. Kaya G, Saurat JH. Dermatoporosis: a new concept in skin aging. Eur Geriatr Med. 2010;1(4):216–9.

    Article  Google Scholar 

  68. Randhawa M, Rossetti D, Leyden JJ, Fantasia J, Zeichner J, Cula GO, Southall M, Tucker-Samaras S. One-year topical stabilized retinol treatment improves photodamaged skin in a double-blind, vehicle-controlled trial. J Drugs Dermatol. 2015;14(3):271–80.

    PubMed  Google Scholar 

  69. Pimpinelli N, Olsen EA, Santucci M, Vonderheid E, Haeffner AC, Stevens S, Burg G, Cerroni L, Dreno B, Glusac E, Guitart J. Defining early mycosis fungoides. J Am Acad Dermatol. 2005;53(6):1053–63.

    Article  PubMed  Google Scholar 

  70. Boulos S, Vaid R, Aladily TN, Ivan DS, Talpur R, Duvic M. Clinical presentation, immunopathology, and treatment of juvenile-onset mycosis fungoides: a case series of 34 patients. J Am Acad Dermatol. 2014;71(6):1117–26.

    Article  PubMed  Google Scholar 

  71. Sant M, Allemani C, Tereanu C, De Angelis R, Capocaccia R, Visser O, Marcos-Gragera R, Maynadié M, Simonetti A, Lutz JM, Berrino F. Incidence of hematologic malignancies in Europe by morphologic subtype: results of the HAEMACARE project. Blood. 2010;116(19):3724–34.

    Article  CAS  PubMed  Google Scholar 

  72. Fung MA, Murphy MJ, Hoss DM, Grant-Kels JM. Practical evaluation and management of cutaneous lymphoma. J Am Acad Dermatol. 2002;46(3):325–60.

    Article  PubMed  Google Scholar 

  73. Zackheim HS, Kashani-Sabet M, Amin S. Topical corticosteroids for mycosis fungoides: experience in 79 patients. Arch Dermatol. 1998;134(8):949–54.

    Article  CAS  PubMed  Google Scholar 

  74. Kaye FJ, Bunn PA Jr, Steinberg SM, Stocker JL, Ihde DC, Fischmann AB, Glatstein EJ, Schechter GP, Phelps RM, Foss FM, Parlette HL III. A randomized trial comparing combination electron-beam radiation and chemotherapy with topical therapy in the initial treatment of mycosis fungoides. N Engl J Med. 1989;321(26):1784–90.

    Article  CAS  PubMed  Google Scholar 

  75. Schwartz C, Javvaji S, Feinberg JS. Linear rays of hypopigmentation following intra-articular corticosteroid injection for post-traumatic degenerative joint disease. Dermatol Online J. 2012;18(5):11.

    PubMed  Google Scholar 

  76. Llamas-Velasco M, Fraga J, Kutzner H, Steegmann JL, García-Diez A, Requena L. Hypopigmented macules secondary to imatinib for the treatment of chronic myeloid leukemia: a histopathologic and immunohistochemical study. J Cutan Pathol. 2014;41(5):417–26.

    Article  PubMed  Google Scholar 

  77. Dai J, Belum VR, Wu S, Sibaud V, Lacouture ME. Pigmentary changes in patients treated with targeted anticancer agents: a systematic review and meta-analysis. J Am Acad Dermatol. 2017;77(5):902–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Naveh HP, Rao UN, Butterfield LH. Melanoma-associated leukoderma—immunology in black and white? Pigment Cell Melanoma Res. 2013;26(6):796–804.

    Article  CAS  PubMed  Google Scholar 

  79. Nordlund JJ, Kirkwood JM, Forget BM, Milton G, Albert DM, Lerner AB. Vitiligo in patients with metastatic melanoma: a good prognostic sign. J Am Acad Dermatol. 1983;9(5):689–96.

    Article  CAS  PubMed  Google Scholar 

  80. Edmondson LA, Smith LV, Mallik A. Nivolumab-induced vitiligo in a metastatic melanoma patient: a case report. J Oncol Pharm Pract. 2017;23(8):629–34.

    Article  PubMed  Google Scholar 

  81. Mooney E, Rademaker M, Dailey R, Daniel BS, Drummond C, Fischer G, Foster R, Grills C, Halbert A, Hill S, King E. Adverse effects of topical corticosteroids in paediatric eczema: Australasian consensus statement. Australas J Dermatol. 2015;56(4):241–51.

    Article  PubMed  Google Scholar 

  82. Vachiramon V, Thadanipon K. Postinflammatory hypopigmentation. Clin Exp Dermatol Clin Dermatol. 2011;36(7):708–14.

    Article  CAS  Google Scholar 

  83. Salasche SJ. Epidemiology of actinic keratoses and squamous cell carcinoma. J Am Acad Dermatol. 2000;42(1):S4–7.

    Article  Google Scholar 

  84. Uhlenhake EE. Optimal treatment of actinic keratoses. Clin Interv Aging. 2013;8:29.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Linos E, Chren MM, Covinsky K. Geriatric dermatology—a framework for caring for older patients with skin disease. JAMA Dermatol. 2018;154:757–8.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

Drafting and editing of manuscript: AMA, EDH, AMA. Concept, guidance and review of manuscript: AMA.

Corresponding author

Correspondence to Ammar M. Ahmed.

Ethics declarations

Funding

No sources of funding were used to conduct this study or prepare this manuscript.

Conflict of interest

A. M. Armenta, E. D. Henkel, and A. M. Ahmed have no conflicts of interest that are directly relevant to the content of this article.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Armenta, A.M., Henkel, E.D. & Ahmed, A.M. Pigmentation Disorders in the Elderly. Drugs Aging 36, 235–245 (2019). https://doi.org/10.1007/s40266-018-00633-w

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-018-00633-w

Navigation