Addison’s disease is a rare adrenal gland disease that causes various symptoms, including distinct skin effects like hyperpigmentation and vitiligo.

Addison’s disease is rare. It’s often due to autoimmune diseases, where the immune system attacks the adrenal glands. Depending on the underlying cause, it can lead to various symptoms, including skin changes like hyperpigmentation and vitiligo.

Without treatment, Addison’s disease can lead to a life threatening condition called Addisonian crisis. Symptoms may include severe pain, vomiting, diarrhea, and loss of consciousness.

Read on to learn more about the effects of Addison’s disease on the skin, its causes, other symptoms of Addison’s disease, and possible treatment options.

Your skin can take on visible skin tone and color changes with Addison’s disease.

Addison’s disease and skin hyperpigmentation

Hyperpigmentation is an early and usually distinct symptom of Addison’s disease. It happens when certain areas of the skin become darker than the surrounding areas in different body parts.

However, these skin changes can be less clear, especially in people with dark skin tones. This can sometimes delay diagnosis.

The most commonly affected areas are sun-exposed body parts, such as the elbows, knees, and knuckles, as well as creases and scars. You may also notice skin discoloration on the lips and gums.


Although it’s less common than hyperpigmentation, some people with Addison’s disease may develop vitiligo. This is a condition characterized by discolored skin patches that appear lighter than your natural skin tone.

These patches may appear almost white for people with light skin tones, while those with dark skin tones may notice more obvious lighter spots.

Vitiligo can appear on various body parts, but it most commonly develops on the scalp, face, neck, and other areas with frequent sun exposure.

Black freckles

Black freckles may appear on sun-exposed areas of the skin, such as the face, forehead, and shoulders. They’re due to the overproduction of melanocyte-stimulating hormones.

These freckles are darker and more obvious than ordinary freckles, and they’re more visible in people with light skin tones.

In people with dark skin tones, the freckles may be less pronounced, but they can still be noticeable as darker spots on the skin.

Addison’s disease skin effects are linked to the hypothalamic-pituitary-adrenal (HPA) axis. It’s a complex system comprising the adrenal glands, hypothalamus, and pituitary glands that regulate hormone production in your body.

The hypothalamus, a part of the brain, releases a compound called proopiomelanocortin. That’s then converted into adrenocorticotropic hormone (ACTH) and melanocyte-stimulating hormone (MSH) in the pituitary gland.

However, when the adrenal glands don’t produce enough hormones, the HPA axis compensates by increasing the production of proopiomelanocortin, increasing ACHT levels. High levels of ACTH stimulate the release of MSH, which causes an overproduction of melanin in the skin. That leads to hyperpigmentation and other changes in skin color.

The symptoms of Addison’s disease often result from a deficiency in cortisol and aldosterone. They can develop slowly over time or rapidly if acute adrenal failure occurs.

The most common and earliest symptom of Addison’s disease is fatigue, but there are other symptoms associated with this condition, including:

Consider getting medical help if you have persistent fatigue that rest doesn’t help with.

Medical emergency

The following symptoms could indicate Addisonian crisis, a serious condition that can be fatal without prompt treatment. Go to the nearest emergency room if you experience:

  • extreme weakness
  • severe pain in your lower back or legs
  • severe vomiting and diarrhea
  • sudden weight loss
  • dizziness, fainting, or lightheadedness, especially upon standing

Treating Addison’s disease skin effects involves managing the underlying hormonal deficiencies. Hormone replacement therapy, which is the primary treatment for Addison’s disease, involves replacing the deficient hormones, particularly cortisol.

Addison’s disease skin effects often improve with the appropriate hormone replacement treatments, typically corticosteroids like hydrocortisone (Cortef). By stabilizing cortisol levels, these medications help manage the overproduction of ACTH and MSH, reducing hyperpigmentation.

A healthcare professional can also prescribe fludrocortisone to help replace aldosterone, which may help restore fluid and salt balance. In periods of stress, illness, or surgery, your healthcare professional may adjust your medication to mimic the body’s natural increase in cortisol production. This can help stabilize symptoms.

Although the treatment of skin symptoms is important, it’s also important to manage Addison’s disease itself.

Learn more about treating Addison’s disease.

Skin effects from Addison’s disease result from hormonal imbalances, particularly increased levels of ACTH and MSH, leading to higher melanin production.

Treatment primarily involves hormone replacement therapy to manage cortisol deficiency, which can also help alleviate some of the skin symptoms.