Hyperpigmentation is a common skin condition that affects many people worldwide. Many of our clients at City Skin Clinic often ask us how to reduce and prevent it. The important thing to remember is that you are not alone. Hyperpigmentation is common, and regardless of the cause, there are plenty of treatments available to help you get rid of it. This blog will discuss hyperpigmentation in its entirety, covering topics such as causes, treatment and prevention.
What Is Hyperpigmentation?
Hyperpigmentation is a condition that causes areas of your skin to darken more than others. This occurs due to increased pigmentation in the skin and is usually a response to sun damage or skin trauma. Most people find hyperpigmentation develops in small patches and localised to specific areas such as on sun-exposed areas of the face such as the forehead and cheeks or around the eyes in hereditary cases.
However, it can affect larger areas and anywhere on the body. The good news is that hyperpigmentation is not usually harmful and in most cases treatable. In some cases, however, hyperpigmentation can signify an underlying medical condition. In these cases treatment of the medical condition needs to happen first and this is why seeking advice from a medical professional is always necessary.
Causes Of Hyperpigmentation
In general, hyperpigmentation is caused by a high production of melanin by the skin’s pigment-producing cells; the melanocytes. This is the pigment that gives the skin its colour. The most common cause of hyperpigmentation is repeated sun exposure which causes skin damage. The melanocytes respond by producing more melanin in an attempt to protect the skin from harmful sun exposure.
This is why sun damage results in patches of hyperpigmentation in the high points of the face such as the nose, forehead and cheeks which get the most sun exposure. Trauma to the skin also causes a special form of hyperpigmentation called post-inflammatory hyperpigmentation. Of course, there are times when there is no obvious cause and it is just hereditary hyperpigmentation where there is usually a family history of this. There are also several other causes of hyperpigmentation which are secondary to a medical condition these include:
- Medical conditions, such as Addison’s disease, Diabetes and hemochromatosis
- Certain medications, including antimalarial drugs, topical treatments and tricyclic antidepressants
- Pregnancy and changes in hormone levels
- Melanoma skin cancer (at an early stage it may look like just a patch of darker skin)
Types Of Hyperpigmentation
Hyperpigmentation is a condition that is categorised into multiple types. The main types we treat in aesthetics are:
- Post-inflammatory hyperpigmentation
Treatment options and effectiveness can vary based on the type. Below – we have explored each type in more detail:
This skin disorder is the most common type of hyperpigmentation and is due to sun damage. Patches or freckle-like spots develop on the skin. These patches or spots are often brown, blue, or grey in colour and are often seen on the face. However, they can occur anywhere on the body. A condition called Chloasma, similar to Melasma in appearance, also frequently affects pregnant women. Here hyperpigmentation is caused by hormonal changes and is often called the “mask of pregnancy” due to its appearance. Both Melasma and Chloasma can be treated using similar products and protocols although Chloasma may improve after pregnancy is complete.
These flat, brown spots develop on areas of skin exposed to the sun. Although they are generally harmless, they can cause cosmetic issues for many. You may recognise sunspots by their other names: liver spots and age spots. These names stem from the fact that the spots are most common in older people. Luckily, sunspots are treatable with similar protocols to Melasma. You can also prevent them with small lifestyle changes like avoiding sunbeds and sun exposure as well as protecting your skin with sunscreen.
Post-Inflammatory Hyperpigmentation (PIH)
PIH causes patches and spots to develop on the skin. These patches/spots can be brown, blue, or grey. It occurs when your skin increases melanin production after irritation or injury. This most commonly affects acne sufferers whereby breakouts can be followed by PIH. It may also be caused by certain chemical peels or lasers where the skin may not have been [prepared adequately before treatment. PIH treatment needs to prevent ongoing trauma as well as treat the areas where hyperpigmentation developed.
Best Treatments For Hyperpigmentation
Most cases of hyperpigmentation are treatable, and an array of treatment options are available both over the counter and professional. If you have tried over-the-counter products but had little success or if your hyperpigmentation is severe then you may need clinical skincare to treat it. Doctors – like our skilled team at City Skin Clinic – can recommend the best treatment for your unique case and if relevant provide you with clinical-grade products as well as a personalised protocol.
In our experience, we have had the most success with the following hyperpigmentation treatments:
- Exfoliating Acids
- Vitamin C
- Kojic acid
- Chemical Peels
- Obagi Tretinoin Cream
- Obagi Nu-Derm
- Obagi C-System
- Laser treatment
Retinoids For Hyperpigmentation
Over-the-counter Vitamin A and its derivatives have clinically proven value in treating hyperpigmentation. Retinoids are compounds derived from Vitamin A and in some cases provide more active forms such as retinaldehyde, adapalene or Tretinoin. They treat hyperpigmentation by causing skin cells to turn over more, which begins the process of removing pigmented cells. This treatment is also commonly used to treat conditions such as acne and to reduce the appearance of wrinkles and other signs of skin ageing. The most powerful and active retinoid is Tretinoin which is a prescription-only product that we will discuss below.
Exfoliating Acids For Hyperpigmentation
There are a number of exfoliating acids that can help treat hyperpigmentation. As a general rule, alpha hydroxy acids (AHAs) such as glycolic acid or milder forms like mandelic or lactic acid can help exfoliate the skin and reduce the appearance of hyperpigmentation. AHAs are generally effective in most people though people with skin of colour will need to use milder forms such as lactic acid to reduce the risk of PIH. For those with acne, beta hydroxy acids (BHAs) such as salicylic acid can help manage both acne and PIH but are not safe for use by pregnant women.
Vitamin C For Hyperpigmentation
Ascorbic acid (also known as Vitamin C) and its derivatives are an effective treatment for hyperpigmentation. It works by inhibiting an enzyme called tyrosinase which is needed in melanin production. On its own, Vitamin C is a good treatment for very mild hyperpigmentation but its most effective when combined with other hyperpigmentation treatments such as exfoliating acids, retinoids and/or other pigment suppressors.
Arbutin For Hyperpigmentation
The reason Arbutin is widely used in treating hyperpigmentation is that its a naturally occurring derivative of hydroquinone which is the active product in prescription hyperpigmentation treatments such as Obagi Nu-Derm and Obagi-C system. Arbutin works by impairing tyrosinase activity and hence reducing melanin production. Whereas hydroquinone is more active and is particularly effective in the skin of colour, Arbutin is better suited for mild hyperpigmentation in lighter skin tones.
Kojic Acid For Hyperpigmentation
Another natural occurring form of hydroquinone is Kojic acid which is a by-product of fermentation. Like Arbutin, it also suppresses melanin production by interfering with tyrosinase activity. It is effective in mild to moderate hyperpigmentation but is less suited for those with sensitive skin as it can cause irritation.
Chemical Peels For Hyperpigmentation
A chemical peel uses acid to remove the surface layer of your skin. This helps reduce the appearance of hyperpigmentation. Although there are good over-the-counter options which have a very mild acid, for moderate or severe hyperpigmentation you will need a course of clinical peels performed by a medical practitioner. These peels are higher in strength and can be tailored to your skin’s specific needs but carry a risk of irritation or scarring if not performed by a medical practitioner or team of aesthetic doctors offer bespoke chemical peels which we tailor to your skin type, tone and needs at City Skin Clinic.
Obagi Tretinoin Cream
This powerful topical cream is a retinoid that is highly effective for dry skin, acne, ageing skin and hyperpigmentation. It is a prescription-only retinoid that stimulates cell division and increases cell turnover. This removes old and damaged cells, allowing new skin cells to grow. Obagi tretinoin cream comes in a number of different strengths and treatment needs to be under a dedicated doctor to ensure that a personalised treatment plan is set up for you. If you’re in the UK, we offer this service through our virtual skin clinic.
This complete skin care system is specially formulated to treat moderate to severe hyperpigmentation as well as skin ageing. The Nu derm system can be Arbutin or 4% Hydroquinone and your doctor will select the best one based on your skin colour and hyperpigmentation. As a general rule, the hydroquinone system is better suited to medium and darker skin tones. It requires a prescription as it contains high-frequency/strength ingredients.
The system is a complete skincare routine with active ingredients designed to treat hyperpigmentation and/or skin ageing. It is often best combined with Retinol or Tretinoin for an even greater effect. You can access the Obagi Nu-Derm system through our virtual clinic where one of theCity Skin Clinic doctors will design a treatment plan to fit your needs. This skin care system has successfully treated many cases of melasma and sunspots, giving countless clients the refreshed and healthy-looking skin they desire.
This is another prescription-only skin care system that either contains arbutin or 4% hydroquinone combined with Vitamin C. The Obagi-C system is designed for those with mild-moderate hyperpigmentation who are looking for an easy-to-use system with fewer steps. The kit significantly helps reduce the appearance of melasma, skin ageing, and dark spots. Like Nu Derm, Obagi-C system is usually combined with Retinol or Tretinoin to boost its effect. You can access Obagi C-System through City Skin Clinic using our virtual skin clinic service. It starts with a consultation with one of our doctors who will assess you and create a custom treatment plan that includes follow-up.
Laser Treatment For Hyperpigmentation
This treatment uses beams of light to reduce the appearance of hyperpigmentation. Two types of lasers can be used: ablative and non-ablative. Ablative lasers are very intense and remove layers of the skin, while non-ablative lasers heat up the cells and promote collagen growth so they are much gentler on your skin.
The type of laser needed and strength will depend on the extent of your hyperpigmentation and skin colour. Laser treatment can be a very effective way to manage hyperpigmentation but it requires multiple treatments and has some downtime hence it is not always the right choice for everyone.
Please ensure that you see an aesthetic doctor or dermatologist who specialises in laser treatment and if you have skin of colour, someone who is experienced in treating similar patients. They should be able to advise you whether laser is the best treatment for you, the type of laser and protocol that would work best and any alternatives.
How To Prevent Hyperpigmentation
Whilst hyperpigmentation is very common, there are a number of professional and over-the-counter treatments that may help. As with anything in life, prevention is always the best cure. This is even more important if you have already gone to a lot of effort to treat hyperpigmentation. Although not all causes of hyperpigmentation can be avoided (e.g. hereditary), hyperpigmentation due to skin injury or sun damage can be prevented. There are some tips you can follow that will help prevent most instances of acquired hyperpigmentation:
- Avoid direct sun
- Daily use of SPF cream at least SPF 30
- Avoid irritating your skin by picking spots or squeezing blackheads
- Avoid prolonged pressure on places like elbows and knees which are also prone to traumatic hyperpigmentation
- Be careful with trying new active skincare products especially if you have sensitive skin or skin of colour as you may be more prone to PIH
- Only ever have professional skin treatments such as laser and chemical peels at a reputable medical clinic by a medical practitioner as these can cause PIH and scarring if not performed correctly
Book An Appointment For An Initial Consultation
If you would like to treat your hyperpigmentation, City Skin Clinic can help. Our team of medical doctors are highly trained and experienced to assist you with your unique beauty goals. We empower clients to enhance their natural beauty, helping them tailor their treatments to achieve their desired look. If you would like to know more about the treatments we provide, you can book a consultation via our website. We are huge advocates for taking care of patients – and would be delighted to join you on your aesthetic journey.