In this blog article, I hope to answer common questions about hyperpigmentation – a very common condition

What is Hyperpigmentation?

If you are aware of dark patches or spots on your skin you probably have hyperpigmentation. Pigmentation is the result of cell mutations or changes caused by either hormonal fluctuations or some sort of injury (e.g., sun damage, acne, over-aggressive chemical peels, lasers, and/or microdermabrasion treatments)

In response, an inflammatory response is triggered in the skin which ultimately leads to the pigment-producing cells melanocytes producing excess pigmentation, and the consequent visible darker spots.

Before we go any further, a little note on how pigment is produced in the skin:

Melanin is produced when an enzyme called tyrosinase makes the amino acid tyrosine, and then the tyrosine gets passed off to cells called melanocytes that convert the tyrosine into melanin.

Whilst most hyperpigmentation lesions may be harmless, they can affect self-esteem driving people to seek cosmetic treatments to address the concern.

Whilst hyperpigmentation may look different depending on the tone of the skin, it is a condition that affects people of all ethnicities.

What Causes Hyperpigmentation and Who Commonly Experiences it?

There are 3 main types of hyperpigmentation, and whilst they all have different causes, they are all the result of the pigment-producing cell, the melanocyte whose job it is to protect the skin cells’ DNA when it encounters an inflammatory response.

The 3 causes of pigmentation are:

Age Spots (also called senile or solar lentigines, liver spots)

These are the common spots of brown, black, or tan skin that older people often develop over time on their hands, face, and head, especially. Age spots are typically the result of long-term excess sun exposure and lighter-skinned people tend to be more affected.

Melasma (also called chloasma, or the mask of pregnancy):

These larger patches of darkened skin often appear on women’s faces and stomachs due to hormonal changes experienced during pregnancy (hence the name, mask of pregnancy) in addition to hormonal supplements

That said, it’s not only pregnant women who will experience melasma as it can affect anyone, but is more common in women, and people with darker skin.

Post-inflammatory hyperpigmentation (PIH): Inflammatory hyperpigmentation is caused by the autoimmune reactions people have due to either certain skin conditions like acne and eczema or following a skin injury. These hyperpigmentation markings most often appear on the face and neck.

How is Hyperpigmentation Treated?

The tone of the skin matters in terms of which treatments are suitable and which will work best. As a rule of thumb, lighter skin responds well to most hyperpigmentation procedures (including light-based therapies), whilst medium skin tones may find chemical peels and microdermabrasion therapy more helpful. However, in the case of darker skin, the use of pigment inhibitors both before the treatments begin (2 -4 weeks), and throughout the course of the treatment, the protocol is very important. Also, darker skins are not suitable for light-based therapies.

Paradoxically, when treating hyperpigmentation, there is a risk of hypopigmentation (white spots), which cannot be reversed, thus the treatment of darker, pigmented skin needs to be a much slower and more cautious process.

Therefore, treating hyperpigmentation requires a bespoke approach and a customised treatment programme.

That said, all treatment plans must aim to:

Keep melanocytes (melanin-forming cells) from producing more pigment by suppressing/inhibiting them (ie. “Putting them to sleep or into a state of dormancy”). This can be achieved by using antioxidants and or skin-lightening agents

Vitamin C in the form of L-ascorbic acid (10- 20% concentrations) is a potent antioxidant, which fights against and suppresses dark spots by inhibiting the enzyme responsible for melanin production tyrosinase. Even on a skin free from pigmentation, vitamin C brightens the skin making it appear radiant and glowing. Furthermore, it helps to neutralise free radical damage, supports cellular immunity, improves barrier function and stimulates collagen production. So you can see that vitamin C is a MUST-HAVE before any pigmentation treatments should be started.

Try OBAGI professional serum and C clarifying serum

Arbutin is derived from the leaves of fruits such as bearberry (uva-ursi), pear and cranberry, and it is sometimes made synthetically.

Arbutin stops any extra production of melanin by disrupting the normal chain of events by telling tyrosinase to pause on the tyrosine production – without tyrosine, melanocytes have nothing to work with which limits the melanin production in the skin. So, less tyrosine and less melanin means less pigment, less dark spots, and a more even complexion. That’s the ultimate goal!!Arbutin evens and brightens skin tone resulting in a healthier and vibrant complexion; instead of blending out with a tinted foundation, arbutin works to naturally blend out the skin tone.

Arbutin is a natural derivative of hydroquinone

Hydroquinone (HQ)-Hydroquinone lightens the skin by decreasing the number of melanocytes present.

It takes about four weeks on average for the ingredient to take effect. It may take several months of consistent use before you see full results.

Both arbutin and HQ can make skin more susceptible to sunburn and more sensitive to UV rays. This is because Melanin helps protect the skin from sunburn, and since they both limit melanin production, they can make skin more vulnerable to sunburn. Therefore, sunscreen is a must

Consistency is key to treating hyperpigmentation. You’ll want to use this ingredient every day for maximum results. Follow all product instructions carefully.

It is important to do a patch test before your first full application. This will allow you to determine how your skin will react and whether it results in unwelcome side effects.

Try OBAGI clear and blender, C clarifying serum and therapeutic night lotion

Although it sounds counterintuitive, re-injuring the affected area of the skin in order can help to flush the pigment to the surface so it can be effectively treated.

This can be done via chemical peels, light-based devices such as laser and IPL (intense pulsed light), micro-needling and exfolaition

They use red light therapy for its healing properties (e.g., improve circulation, stimulate fibroblasts, etc).

Red light therapy, also known as photo-biomodulation, uses healing natural light to help the body produce more energy and regenerate the skin.

Healthy wavelengths of light help skin cells heal and rejuvenate, and is a powerful anti-inflammatory treatment, and that makes a huge difference for the inflammatory kind of hyperpigmentation!

Try Dermalux LED light therapy

To summarise

Pigmentation is a common condition that can affect all skins of all ethnicities and it comes in many forms and has many causes.

The process of pigmentation is complex as is the treatment of it.

Treatment plans must therefore be customised and take skin types and types of pigmentation into account.

There is a range of treatments but they must be multifaceted and work to:

  • Inhibit and lift pigment
  • Provide enhanced protection in the form of anti-oxidants and anti-inflammatories
  • Protect the skin from solar radiation and free radical damage

Please speak to a member of the KAST Medical Aesthetics clinical team for more information.