Skin Pigmentation in Addison’s Disease

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Addison’s disease is a condition where the adrenal glands do not work properly and produce inadequate levels of  steroid hormones. In developing countries the main cause of Addison’s disease is tuberculosis infection of the adrenal gland. In developed countries the main cause is the adrenal gland being destroyed by the body- this is known as being autoimmune. It is thought that Addison’s disease affects around 60-110 people in every 1 million. It causes around 1.4 deaths per million cases each year.

Hyperpigmentation in Addison’s disease

Addison’s disease causes dark pigmentation, called hyperpigmentation, on the skin as well as inside the mouth. This hyperpigmentation in the mouth is a symptom which is specific to Addison’s disease. Changes in skin pigmentation caused by Addison’s disease occur in most people suffering from the disease.

When hyperpigmentation occurs it usually does so in areas which have more pressure placed on them, such as the knuckles. Whilst hyperpigmentation makes areas exposed to the sun darker, it also occurs in areas which are not exposed to the sun at all, such as the nipples. The hyperpigmentation caused by Addison’s disease will usually look like a sun tan.

It has also been seen that, in Addison’s disease, black freckles frequently appear on the upper body such as the face, neck and shoulders.

Discolouration in Addison’s disease

As well as hyperpigmentation there are other skin pigmentation changes that can take place in Addison’s disease. This includes areas such as the nipples, the mouth (including the lips), the vagina and the rectum turning a blue-black colour.

In patients with Addison’s disease skin can also appear normal or have vitiligo.

Why does Addison’s disease cause changes in skin pigmentation?

Hyperpigmentation happens in people with Addison’s disease because the adrenal insufficiency causes changes in hormone levels. These hormones changes means that more melanin is produced and the skin appears more tanned. This takes place all the time in Addison’s disease which means that the skin all over the body gets darker.

It is unknown what the cause of vitiligo in Addison’s disease is and it is thought that it could be caused by immune system changes which can damage the skin pigmentation cells.

What are the treatments for Addison’s disease?

The main treatment for Addison’s disease is to use medication in order to replace adrenal hormones. This treatment helps the hormones return to normal levels which means that gradually skin can return to its original colour.

Vitiligo is not as easily reversible and can be treated with cortisol creams or psoralen phototherapy. These treatments help to darken the skin.

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