Hyperpigmentation is a very common and harmless skin condition that gives rise to darker patches of colour on the skin.
Hyperpigmentation is caused by an increase in melanin in the skin. Melanin is the naturally occuring pigment that gives our skin, hair and eyes their colour. There are several triggers that can increase the amount of melanin produced in the skin. The most common is sun exposure followed by hormones, age and inflammation.
There are different types of hyperpigmentation that give rise to different appearances on the skin. The three main types are:
Age or sun spots are small dark patches of pigment on the face caused by sun exposure. They’re most commonly found on sun-exposed areas like the face, neck, chest, hands and arms.
Melasma is the most common type of hyperpigmentation and it appears as larger patches of pigment that develop mainly on the forehead, cheeks, lips and nose. It is thought to be caused by a combination of sun damage, hormonal changes and heat. It can also occur in pregnant women when it is triggered by pregnancy hormones. When it arises in pregnancy, it’s called Chloasma.
Post-inflammatory hyperpigmentation is caused by injury or trauma to the skin which when it heals leaves flat dark spots behind. It is very common in acne sufferers but can also be caused by skin damage from dermabrasion, laser treatment and chemical peels.
As with most things in life, prevention is better than cure. Hyperpigmentation is no exception and even if you require treatment, it’s important to follow a few precautions to prevent it from coming back again. Sun damage is a major cause and so sun protection is essential. Protecting your skin with sunscreen and avoiding direct sun exposure will prevent sun or age spots as well as reduce the risk of melasma. Even in cases where it is caused by trauma such as in post-inflammatory hyperpigmentation, sun exposure can darken the hyperpigmented patches.
Where hyperpigmentation is caused by hormonal imbalance caused for example by the oral contraceptive pill, it may be possible to change medication and prevent this from developing. Good control of acne can help prevent post-inflammatory hyperpigmentation. Avoiding harsh skin agents and not squeezing or popping spots will also help reduce the risk of this. It’s also important to consider that post-inflammatory hyperpigmentation can be caused by the inappropriate use of chemical peels or lasers on the skin. This is especially important to consider in skin of color where brown and black skin is particularly sensitive to post-inflammatory hyperpigmentation. As such it is essential to only have these treatments performed by qualified medical practitioners.
There are a number of ways to treat hyperpigmentation and which one depends on the severity and your treatment goals. Professional in-clinic treatments for hyperpigmentation typically involve chemical peels or laser therapy. These procedures are effective but patient selection is important and they require a course of treatments. It is especially important for patients with skin of colour to seek an experienced medical professional as these treatments can sometimes trigger post-inflammatory hyperpigmentation.
Prescription skincare remains the mainstay of treating hyperpigmentation. These treatments when prescribed correctly are as effective as in-clinic treatments but with less downtime. Hydroquinone remains regarded as the most effective topical agent for reducing hyperpigmentation. This product reduces excess pigment and stabilizes the pigment reducing cells. Often results can be seen as early as 4 weeks into treatment. It is however only available under strict medical supervision and can only be used for a limited period. At-home professional skin treatments such as Obagi Nu derm and Obagi-C contain hydroquinone and are the most popular skin systems for treating moderate-severe hyperpigmentation and skin ageing. Tretinoin is a prescription retinoid that is also effective in treating mild hyperpigmentation, acne, and skin ageing. Glutathione is another treatment available in clinical settings but also without prescription which is also hyped up as a potent hyperpigmentation treatment. Whilst in some cases it may work over a period of time, there is no robust clinical evidence that shows this consistently and there is some doubt as to the longevity of the results.
For very early or mild signs of hyperpigmentation, there are a number of over the counter treatments that can help. Look for products containing Arbutin, Azelaic Acid, Kojic Acid, Retinol and Vitamin C. These products can help even out skin tone over time and may improve the quality of your skin overall.
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