Hyperpigmentation: Types and Treatments

Hyperpigmentation: Types and Treatments

Hyperpigmentation is a skin condition where some areas of the skin become darker (pigmented) than the normal color of the surrounding skin. Although it is harmless for the most part, it is a skin condition that causes many people to experience stress, anxiety, and loss of confidence.

People of all skin colors experience hyperpigmentation though it is more common in darker skin types.

What is Hyperpigmentation?

What is hyperpigmentation

To understand hyperpigmentation, we need to understand what melanin is. Melanin is a natural pigment that determines the color of our skin, hair, and eyes. Pigment-producing cells known as melanocytes produce melanin in the skin’s epidermis.

Everyone has the same number of melanocytes but produce more or less melanin depending on their genetics. If someone has less melanin production, their skin color will be lighter; if someone has more melanin production, their skin color will be darker.

Melanin is a natural protector from ultraviolent radiation (UV) which is why individuals with darker skin (i.e. more melanin) burns less in the sun, are less likely to develop skin cancer, and ages less quickly than those with lighter skin. However, melanin alone is not sufficient protection against sun damage which is why everyone must always wear sunscreen and take other skin protective measures.

Hyperpigmentation occurs when melanocytes become damaged or become unhealthy, and overproduce melanin. Although there are genetic causes for hyperpigmentation, most hyperpigmentation results from unprotected sun exposure.

Types and Causes of Hyperpigmentation

Types of hyperpigmentation

Although our melanocytes are naturally programmed to produce a certain amount of melanin, the melanin content is largely affected by the sun’s UV rays. Here, we explore the common types of hyperpigmentation.

Sun Spots are flat brown spots that are a result of over-stimulation of melanin caused by excessive sun exposure. Sun spots are not very visible in earlier years but become more visible in later years due to cumulative damage from the sun.

Age Spots are yellowish/brownish spots that are caused by an imbalance in the cellular disposal mechanisms in your body. They’re similar to sun spots since they darken with unprotected sun exposure.

Freckles are clusters of circular spots caused by the overproduction of melanin. Freckles are a genetic predisposition and lightens in the winter whereas other types of hyperpigmentation do not.

Post-Inflammatory Hyperpigmentation (PIH) is not a result of the sun, age, or genetics directly, but inflammation or trauma to the area. Inflammation or trauma causes an increased production of melanin to occur in the affected area, resulting in hyperpigmentation. PIH can result from acne (acne scars), eczema, burns, scars, skin products, and dermatological treatments. Those with darker skin types are generally more susceptible to PIH.

Melsama is a form of hyperpigmentation but is categorized separately because it occurs from hormonal influences. It mostly affects women at a rate of 90% compared to men. It is commonly known as the “mask of pregnancy” since it frequently occurs in pregnant women who are undergoing dramatic hormonal changes.

Treatment Options for Hyperpigmentation

Hyperpigmentation treatment options

There are a number of treatment options for hyperpigmentation. Depending on the severity, one or a combination of these options will provide optimal results.

Prevent with Sunscreen

Preventing hyperpigmentation from occurring in the first place, or at least minimizing it, is the best approach. This avoids the need for extensive and expensive treatments later on. UV light triggers an over-production of melanin, and a single session of unprotected sun exposure can mean months or years of hyperpigmentation treatment. Since we can’t prevent or control factors like natural aging and genetics, the least we can do is protect ourselves from sun damage.

And what better way is there to protect us from sun damage other than sunscreen? Sunscreen is readily available and affordable, making it the best option to prevent hyperpigmentation or prevent existing pigmentation from getting worse. Your sunscreen should have broad spectrum UVA/UVB protection and applied liberally and re-applied frequently. We recommend that you use physical sunscreens as chemical sunscreens are not environmentally-friendly and can cause irritation which can lead to more PIH.

Skin Care Products

Topical skin care products are great options to consider before undergoing harsher treatments. In some cases, these skin care products are so effective that the patient does not need additional expensive treatments. However, these products should be used with caution as triggering irritation can cause PIH or worsen pigmentation. Listed here are some key ingredients to lookout for when trying to reverse skin discoloration:

Antioxidants (ex. Vitamin C, Niacinamide) block the pathway of melanin production and helps to brighten skin tone. Antioxidants also protects against other environmental factors that might lead to hyperpigmentation as well as having anti-aging benefits.

Retinoids/Retinols (Vitamin A) help against hyperpigmentation by increasing cellular turnover. This means that the over-pigmented cells get removed and get replaced with normal-pigmented cells instead.

Hydroquinone is considered a gold standard for fighting hyperpigmentation. Hydroquinone blocks melanin from being formed. However, any product containing this ingredient must be used with caution, and you should consult a skin care professional before use. Prolonged or misuse of hydroquinone can lead to worsened symptoms. Generally, hydroquinone should not be used for more than 3 months continuously at which time you would cycle off for a few months to allow your skin to normalize.  Before resuming hydroquinone you must check with your clinician.

If hydroquinone isn’t an option, try gentler brightening options such as arbutin, kojic acid, azelaic acid, glycolic acid, or lactic acid. Some of these ingredients work by preventing melanin production whereas others remove the outer layer of your skin to reveal healthier, unpigmented skin.

Chemical Peels

Chemical peels should be done in combination with topical skin care products to enhance results. Chemical peels come with a lot of benefits such as correcting uneven pigmentation, treating acne, diminishing the appearance of wrinkles and fine lines, and brightening skin tone.

Chemical peels are more affordable than lasers or microneedling but require several treatments before optimal results are seen. However, chemical peels can cause further pigmentation if done incorrectly. Chemical peels should be done by a fully-trained professional to ensure suitability and to avoid complications. Performing chemical peels incorrectly may cause irritation, worsen your pigmentation, or create new PIH.

It is recommended to get professionally done chemical peels on a regular basis (for example, once per month) to enhance your home skin care routine.

Lasers and Microneedling

For patients with moderate to severe hyperpigmentation, stronger treatment options might be more ideal.

Some options available to treat hyperpigmentation are Fractional Lasers or Intense Pulse Light (IPL). Depending on the machine used, it can induce collagen formation (which will reveal healthier, unpigmented skin) or kill off pigmented cells. In some cases, lasers or IPL can show results after one session but optimal results will take several sessions of treatment.

Another treatment option is microneedling. Microneedling creates micro-punctures on the skin which induces the skin to “repair” itself. This causes the old and pigmented cells to be replaced with healthier and unpigmented skin cells, revealing a more even skin tone.

While there are many treatment options to consider, you shouldn’t try to resolve hyperpigmentation on your own because it can make the symptoms worse.

And in Closing...

Dealing with hyperpigmentation can be a confusing and stressful journey. Thankfully, most hyperpigmentation is triggered by sun damage which is preventable or treatable with a good skin care routine at home. Remember to always consult a professional before treating hyperpigmentation to prevent worsening symptoms or creating new PIH.

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