What is hyperpigmentation?
Hyperpigmentation describes an increase in pigment, also known as melanin, in the skin.
First, there are brown spots, also known as sun spots, which are caused by sun exposure and pollution. Hyperpigmentation can result from UV exposure and environmental stressors that lead to free radical damage, which can manifest as brown spots.
Then there’s post-inflammatory hyperpigmentation, which is the spot or stain on the skin that may show up after a pimple disappears. Post-inflammatory hyperpigmentation is the most common form of hyperpigmentation and it occurs in darker skin tones after almost any type of rash, with acne and eczema being the most common causes. Depending on your propensity for dark spots, you may even get post-inflammatory hyperpigmentation after a mosquito bite or once a wound heals. Any type of inflammation may lead to post inflammatory hyper pigmentation.
Finally, there’s melasma which typically occurs on sun-exposed areas. It causes brown to gray-brown patches, usually on the face. Most people get it on their cheeks, bridge of their nose, forehead, chin, and above their upper lip. It also can appear on other parts of the body that get lots of sun, such as the forearms and neck. It looks more like an ill defined patch than a singular, discrete spot. It’s chronic, whereas post-inflammatory hyperpigmentation and sun spots may fade on their own. Women are far more likely than men to get melasma. It is so common during pregnancy that melasma is sometimes called “the mask of pregnancy.” Hormones seem to trigger melasma.
Sunscreen is a nonnegotiable part of hyperpigmentation treatment. Since sun exposure intensifies hyperpigmentation, skipping it nullifies any benefits you would have gotten from using any other product. This means wearing sunscreen every day and reapplying the sunscreen every two hours. Dermatologists also recommend wearing a wide-brimmed hat when you are outside. Sunscreen alone does not give you all the protection you need. Because sunscreen does not completely protect you from visible light which also causes hyperpigmentation, applying an antioxidant which neutralizes oxygen radicals generated by visible light, UV and infrared, in combination with the application of sunscreen, is a must. Vitamin C serum is the best form of antioxidant but it is not stable in the presence of light. To enhance its stability and function, vitamin C is often coupled with vitamin E and ferulic acid. Besides its ability to help protect against photodamage, in conjunction with sunscreen, Vitamin C has pigment-regulating properties. Vitamin C is helpful to reduce melasma, post-inflammatory hyper pigmentation and sun spots.
Besides vitamin C, key ingredients used for lightening include hydroquinone, retinoids, azelaic acid, glycolic acid, kojic acid, cysteamine and licorice root extract. Before applying skin-brightening ingredients on your face, it is good to be aware of the risk of developing irritation. Post-inflammatory hyperpigmentation may develop as a result if too high of a concentration or too many ingredients are started. This isn’t a worsening of the underlying condition but instead, the creation of a new issue which is from the treatment itself. Investing in a multi-step skin care regimen, using higher grade ingredients, in a more balanced vehicle, and gradually increasing the frequency of application, may help to prevent skin irritation. Treating dark spots, especially if you have a darker skin tone, requires patience and time — as well as consistent, ample sun protection.
Hydroquinone is an ingredient used for hyperpigmentation, as it is a tyrosinase inhibitor that blocks the production of melanin. Hydroquinone is banned in the EU, Japan and Australia, but the FDA still permits it in the US at low concentrations. In general, I recommend the use of hydroquinone up to 4 months at a time, to avoid ochronosis (which leads to worsening discoloration as a result of staining of collagen). Ochronosis has been described in the setting of prolonged use of hydroquinone at high concentrations.
Retinol, a form of vitamin A, helps to improve hyperpigmentation, acne and skin texture by increasing collagen production to minimize fine lines and wrinkles. I recommend starting all retinoid applications slowly to avoid irritation.
Azelaic acid, which is a natural ingredient, is helpful to treat both melasma and post-inflammatory hyperpigmentation, by selectively targeting overactive pigment production, which allows lightening of darker areas without lightening the normal skin tone. It is safe to use during pregnancy and while breastfeeding.
Tranexamic acid, which traditionally has been used for those with increased uterine bleeding to help with clotting, has been shown to be helpful in the treatment of melasma, as recent studies have shown that there is a vascular component in the etiology of melasma, where dermatologists see an increase in blood vessels and increased vascular endothelial growth factor (VEGF) in the affected versus nonaffected skin, suggesting a form of photo damage.
Exfoliating products, such as chemical exfoliants and peels, utilize ingredients such as glycolic acid or lactic acid to help improve skin discoloration and brighten the skin. While exfoliating is helpful for hyperpigmentation, as it helps to break up the pigment cells and dead skin cells, it is important to avoid harsh scrubs or over-exfoliation, as it can lead to worsening pigmentation. For this reason, it helps to use exfoliating products in gentle and balanced formulations which brighten the skin without leading to irritation.