- Hyperpigmentation refers to dark spots and patches on the skin.
- Hydroquinone, tretinoin, and corticosteroids are used to treat hyperpigmentation topically.
- For more severe hyperpigmentation, dermatologists may recommend laser treatments, chemical peels, or microdermabrasion.
- Home treatments need more research at this time.
Hyperpigmentation occurs when patches of skin appear darker than the skin surrounding them. Common forms of hyperpigmentation include melasma, sunspots, and post-inflammatory hyperpigmentation. Both topical creams and professional dermatology treatments are used to reduce hyperpigmentation. Home treatments are available as well, but more research is needed to prove their efficacy.
What is hyperpigmentation?
Hyperpigmentation occurs when a patch of skin produces more melanin than usual. Hyperpigmentation is a relatively common condition and affects people of all skin types and colors. Hyperpigmentation can manifest in several different forms.
Melasma causes patches that are brown or gray-brown in colors. The patches usually appear on the face, most often on the cheeks, the bridge of the nose, the forehead, the chin, and the upper lip. However, melasma can also appear on other body parts, such as the neck and arms.
Sometimes also called liver spots, sunspots are flat brown spots that develop on skin exposed to the sun, such as the face, neck, arms, and backs of the hands. Sunspots often look like large freckles and are more likely to appear after the age of 40, though some people develop them earlier.
Injury or inflammation can also result in hyperpigmentation. The cause of inflammation can take many forms, most commonly acne but also other cuts and burns. Individuals with darker skin are more likely to develop post-inflammatory hyperpigmentation.
There are a few other types of hyperpigmentation that can result in discoloration of the skin, such as Acanthosis nigricans, Schamberg’s disease, and Lichenoid dermatitis of Gourgerot-Blum. However, these hyperpigmentation disorders are very rare compared to the other conditions listed here.
What causes hyperpigmentation?
Different causes and conditions can trigger the skin to produce more melanin, resulting in hyperpigmentation. While these causes are all different, the mechanism (overproduction of melanin) is ultimately the same.
These conditions trigger the melanin-producing cells (a.k.a. melanocytes) to release excessive pigment granules, which are called melanosomes. The greater the trigger, the more melanin released and the darker the hyperpigmentation.
Sun exposure is one of the most common causes of hyperpigmentation, as exposure to UV rays triggers the skin’s production of melanin. Sun exposure can cause hyperpigmentation on its own, or worsen hyperpigmentation caused by other conditions, such as acne.
Acne blemishes make the site inflamed, which triggers the release of melanin. A larger blemish results in more melanin being released. Picking at the blemishes or otherwise aggravating them can increase inflammation and therefore hyperpigmentation.
Pregnancy is a common cause of hyperpigmentation due to hormonal changes. Melasma is sometimes called the “mask of pregnancy” given how common the condition is among pregnant women.
Pregnancy may also cause hyperpigmentation in other areas of the body, such as the linea nigra, a darker line about a centimeter in width that stretches down the front of the stomach.
Hyperpigmentation is a common symptom of Addison’s Disease, an endocrinal (i.e. hormonal) disorder. Lupus, a systemic autoimmune disease, also causes inflammation that can result in skin conditions and hyperpigmentation. Cuts, burns, and other injuries to the skin may cause hyperpigmentation.
Topical Hyperpigmentation Treatments
Unless the hyperpigmentation has already progressed very far, topical cream are usually the first choice of treatment for hyperpigmentation disorders. These treatments seek to lighten the affected patches and may also provide protection against hyperpigmentation triggers, such as sun exposure.
Hydroquinone is often considered the gold standard in hyperpigmentation treatment. Hydroquinone inhibits the activity of the enzyme needed to make melanin, called tyrosinase. This decreases the production of melanin and increases the breakdown of melanosomes.
If used for too long, hydroquinone can result in over-lightening of the skin. Like all topical treatments, it can also result in skin sensitivities or allergic reactions in a small number of individuals.
Tretinoin interacts with receptors in the nucleus of dermal cells to block the release of inflammatory mediators. It also increases the production of procollagen, which improves the skin’s rejuvenation and elasticity and helps it heal from sun damage.
Tretinoin is especially helpful for individuals with acne because of the way it calms inflammation and clears pores. However, it can cause several side effects — such as redness, dryness, and itching — which can aggravate hyperpigmentation in some.
Corticosteroids mimic hormones that your body produces naturally in the adrenal glands. When taken in doses larger than the amount your body usually produces, corticosteroids help suppress inflammation that can trigger hyperpigmentation. Corticosteroids can’t address hyperpigmentation that isn’t caused by inflammation.
Corticosteroids can also be taken by pill, inhalation, or injection. This is very helpful for sufferers of Addison’s Disease, which is caused by corticosteroid deficiencies and often results in hyperpigmentation.
Professional Hyperpigmentation Treatments
If topical treatment don’t work, or your hyperpigmentation is already very severe, you’ll need to see a dermatologist for professional hyperpigmentation treatments. They may also prescribe topical creams as a followup to one of these treatments.
Lasers work to reduce and remove hyperpigmentation by breaking up the pigment deposit. (This is also why lasers are used to remove tattoos.) Laser removal is very effective and not very painful compared to other treatments.
However, it may take several lasering sessions to achieve your desired results, especially if the affected area is very large or very dark. The lasers can result in burning or inflammation is used improperly, so be sure to go to a reputable clinic.
Proper after-care is required, as the skin will likely be red and swollen after the treatment. Patients should stay out of the sun, keep the area protected, and avoid picking or irritating the affected area.
The ingredients in chemical peels dissolve the bonds between dermal cells, removing the top layer of skin and stimulating the product of healthy collagen. Chemical peels may be superficial or deep, and can be formulated with different ingredients to treat the patients particular skin concerns.
Chemical peels are noninvasive and usually only require one session. The downtime is usually minimal or nonexistent, depending on the peel. The right formulation can also be used on patients with darken skin.
However, chemical peels can actually cause hyperpigmentation if the wrong ingredients are used, or ingredients with too high a concentration. Chemical peels also increase your skin’s sensitivity in the short term, which makes you more vulnerable to sunburn and inflammation
Microdermabrasion uses exfoliating crystals to “sand’ away the top layer of skin. This lightens the appearance of dark spots and also stimulate your skin to produce new cells that don’t contain excess melanin.
This treatment is easy and safe, and doesn’t typically require downtime or have any harsh side effects. Sessions are also short, though you may need several of them to achieve your desired results.
Since microdermabrasion only treats the surface of the skin, it’s only effective for smaller, shallow deposits of pigmented skin. For more severe hyperpigmentation, a stronger treatment such as lasers or chemical peels would be more appropriate.
Home Remedies for Hyperpigmentation
Many home treatments are alleged to lighten hyperpigmentation. Some of these treatments — including apple cider vinegar, aloe vera, and green tea extract — do have some initial research behind them that indicates these claims may be right.
However, more studies on human subjects are needed to fully prove these claims. For now, clinically-proven topical creams and professional dermatology procedures are a more reliable treatment for hyperpigmentation.
While not all causes of hyperpigmentation are within your control, many of them are. Following the guidelines below can also avoid exacerbating hyperpigmentation caused by other conditions, such as pregnancy.
Choose a sunscreen with SPF 30 or higher whenever you’re going to be outside, even if it’s a cloudy day. In addition, wear a daily moisturizer with SPF included so you’ll have a layer of protection in case of an impromptu walk.
Don’t Pick at Your Face
Picking at acne blemishes will only increase inflammation and hyperpigmentation. This is also true for scabs, cuts, and other injuries. Don’t aggravate them, and make sure to thoroughly wash your hands before applying a topical cream to them.
When to See a Dermatologist
If over-the-counter topical creams aren’t working, that’s a sign you need to see a dermatologist to try a stronger treatment. If you notice any sudden large changes in your hyperpigmentation, you should also see a dermatologist in case the changes are a symptom of a larger underlying problem.
Hyperpigmentation is a very common and very treatable skin condition. If topical treatments such as hydroquinone don’t work, see a dermatologist for a more advanced treatment such as a chemical peel or microdermabrasion. If you don’t have hyperpigmentation yet, wearing strong sunscreen and avoiding picking at your face will decrease your risk of developing it.
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