Small patches of skin discolouration can be mistaken as fungal infections, scars, or even as pre-cancerous lesions. While these lesions require further evaluation to be definitively diagnosed, there is at least one condition that may be considered. Idiopathic guttate hypomelanosis (IGH) manifests as multiple porcelain white macules in skin areas with sun exposure, affecting people mostly in their 40’s and above. This disease is mostly benign, but causes problems in the aesthetic aspects and potentially may cause psychological implications to the patient.
Epidemiology
While more women complain of this hypopigmentation, compared to men, studies have shown that the incidence of IGH occurs equally on both men and women, but maybe more reported in women due to its effect on aesthetics. Another feature is that this skin discolouration happens more in the skin of the elderly, specifically at around 80% in ages 70 years old and above. It begins as one hypopigmented macule in 87% of people aged 40 years old and above, but may still present in 20 to 30 year old individuals.
Pathophysiology
As the name implies, IGH is idiopathic, with unverified etiologies at present. Several hypotheses imply that developing IGH is a normal part of the skin ageing process, with uneven loss of melanocytes, or pigment-containing skin cells. Another thought is the effect of continuous sun exposure that causes UV radiation exposure to vulnerable skin cells, causing IGH. Another hypothesis says that the IGH is cause by repeated microtrauma, which brings about regeneration of the skin, but not with the original skin cells, thus resulting in macules with unmatching skin colour.
Pharmacologic treatment
Medically, IGH requires no drug intake, as it is a benign condition, but for patients with darker skin, this hypopigmentation may be noticeable and affect their aesthetics and self-esteem. While administering pharmacological treatment may not be indicated, IGH patients may opt to seek consult and try topical steroids, retinoid creams, and topical calcineurin inhibitors, but these have conflicting evidence as to their efficacy. As hypomelanosis does not respond completely to these medications, other options for management are invasive procedures such as cryotherapy, fractional carbon dioxide laser, and non-ablative fractional photothermolysis.
For a more predictive standpoint, sun exposure seems to be a significant risk factor so we must instruct our elderly to a limited sun exposure, and must apply a broad-spectrum sunscreen application. What bothers people most in this condition is the aesthetic aspect, which is the primary reason for seeking consultation. To help with this, mycotherapy has been known to have benefits to the skin, such as anti-oxidative and anti-inflammatory properties.
Mycotherapy for Hypomelanosis
Hypomelanosis is not without a solution as mycotherapy has been studied to manage hypopigmentation disorders. Some mushrooms have enzymes that help in the production of melanin, which is the component of the skin pigment, that may fill in any hypopigmented macules. Other substances have antioxidative effects that protect the skin from the harmful effects of the sun.
Ganoderma lucidum
One mushroom that has great potential in reducing the harmful effects of the sun, especially in the elderly is the Reishi. This is known to have high amounts of antioxidants that are known to remove reactive oxygen species, that are potentially contributory to the hypopigmentation. These are also part of the reason why Reishi is a mushroom with anti-aging properties, and is currently being studied for more benefits.
Agaricus bisporus
Agaricus contains significant enzymes that produce bioactive proteins for the skin and the rest of the body. One significant enzyme that is responsible for this is the mushroom tyrosinase which metabolizes tyrosine, thus supporting the formation of the protein, melanin. This increases the arborization of melanin-producing cells and expands the production of melanin granules. With this, uneven-coloured macules can gradually resolve and can help reduce the difference in skin colour.
Sparassis crispa
The Sparassis was discovered to have phenolic compounds that have an antioxidative effect, in addition to antimicrobial and antitumor effects. One remarkable bioactive compound noted in this mushroom is the phenolic veratric acid, which is photoprotective, meaning it helps protect the skin from ultraviolet rays, thus reducing damages done by sun exposure, all of which are published in the Archives of Dermatological Research. Also known as the Wood Cauliflower mushroom, this is a part of the Korean medicinal mushroom collection that is still being studied for more dermatologic benefits.
Cordyceps sinensis
The Cordyceps has been studied for its bioactive compounds that protects the skin from the harmful ultraviolet B rays, that is the possible triggering factor for hypomelanosis, in addition to other diseases caused by UV-B radiation exposure such as skin cancer. In preclinical studies, it has also been known to slow down aging brought about by frequent sun exposure.
Conclusion
Mushrooms, in addition to herbs, are known to have a cocktail of bioactive substances that help with skin nourishment that helps the skin recover in the cellular level, from regulating the development of cells responsible for skin pigmentation to reducing the impact of sun exposure to the skin. These could help with the reduction of macules in areas affected by IGH. In addition to these therapeutic mushrooms, some other mushrooms, like the cremini, portobello and oyster, are well-known for their high nutritive content, containing B vitamins, proteins, and phytochemicals to maintain healthy skin.