Hyperpigmentation is a common skin condition with an array of causes. Depending on the severity and location, it can be distressing but there are a number of good over the counter and prescription treatments for it. Unfortunately, the path to clearer and more radiant skin is not always straightforward. Sometimes even great results can reverse or worse still the very treatments used can lead to this. This rebound hyperpigmentation can be distressing especially if good results had been achieved. In this article we’ll review what causes rebound hyperpigmentation and its association with popular treatments like hydroquinone and alpha arbutin. We’ll also explore how to prevent and reverse rebound hyperpigmentation.
What Causes Rebound Hyperpigmentation?
Rebound hyperpigmentation is a post-treatment phenomenon where the skin undergoes a sudden increase in pigmentation. Basically, previously treated areas darken again. This rebounding or retaliation of the skin happens due to a surge on melanin production or redistribution. When it occurs, it is usually at the end of hyperpigmentation treatment and several factors can contribute to it starting.
Interrupted Melanin Inhibitors
Products like hydroquinone and alpha arbutin work by suppressing melanin production. They are invaluable in treating hyperpigmentation. However, prolonged or inappropriate usage or sudden discontinuation can sometimes cause the skin to overcompensate. This produces even more melanin than before and hence cause rebound hyperpigmentation.
Sun Exposure
One of the most significant exacerbating factors of rebound hyperpigmentation is sun exposure. This is because treatments for hyperpigmentation often leave the skin more sensitive to UV rays. Without adequate sun protection, melanin production can ramp up to protect your skin. This leads to darker patches forming.
Hormonal Fluctuations
In general, hormones play an important role in melanin production. Sudden changes in your hormonal profile can occur for a number of reasons such as medications, pregnancy or the menopause. This may lead to increased pigment production and rebound hyperpigmentation.
Inappropriate Skincare Protocols
Overusing or underusing skincare products, or not following the recommended application procedure, can lead to uneven results and potential rebound. Additionally, mixing multiple active skin-lightening agents without proper guidance can result in increased sensitivity. This increases the chances of rebound hyperpigmentation.
Oxidative Stress
When skin is treated to reduce pigmentation but then exposed to factors that cause oxidative stress like UV radiation or pollution, it can retaliate with an overproduction of melanin. This leads to rebound hyperpigmentation. That’s why its advisable to use antioxidants in your skincare routine and diligent sun protection.
Underlying Skin Conditions
Conditions like eczema or dermatitis can make the skin more susceptible to discolouration and rebound hyperpigmentation. This is especially if the skin barrier is compromised.
Hydroquinone and Rebound Hyperpigmentation
In general, hydroquinone stands as one of the most potent agents in the arsenal against hyperpigmentation. It works by inhibiting tyrosinase. This is an enzyme that is essential for melanin production. If used correctly and for a limited period, it can fade hyperpigmentation, scars and even out the skin tone. However, its relationship with the skin is complex which is why it is a prescription only medicine in many parts of the world.
High strengths and/or extended use can lead cause rebound hyperpigmentation. Even worse, inappropriate use can cause paradoxical darkening called ochronosis. Additionally, hydroquinone rebound hyperpigmentation can occur if treatment is stopped too early (its best to stay on it for at least 3 months) or when there is sudden cessation or reduction of hydroquinone use. This causes the skin to overcompensate and produce an excess of melanin. Another common cause of hydroquinone rebound hyperpigmentation is sun exposure. Skin can become more sensitive to UV radiation during hydroquinone treatment. Without rigorous sun protection, even minimal sun exposure can exacerbate melanin production. This can then cause darkening of the treated area.
As you can see, hydroquinone treatment is a double-edged sword. Although hydroquinone can significantly reduce hyperpigmentation, it also holds the potential to trigger the opposite effect if not used properly.This underpins the importance of careful use under the guidance of a medical professional.
Alpha Arbutin Rebound Hyperpigmentation
Alpha arbutin is often correctly hailed as a gentler alternative to hydroquinone. It works in a similar way to hydroquinone to suppress melanin production. Hence, it is less irritating to the skin and can generally be used for prolonged periods unlike hydroquinone. However, whilst the risk is deemed lower, instances of alpha arbutin rebound hyperpigmentation have been reported. These are rare and usually associated with high doses of synthetic forms of arbutin, alpha arbutin and deoxyarbutin. The risk of rebound hyperpigmentation also increases if alpha arbutin is stopped abruptly or skin is exposed excessively to sunlight without protection. Otherwise, alpha arbutin can be safe to use in the long term if the correct strength and protocols are followed.
How To Prevent Rebound Hyperpigmentation
The best way to prevent rebound hyperpigmentation is to understand the causes of it. A lot of the risks can be reduced by avoiding these and taking a careful and gentle approach to treating hyperpigmentation in the first place. Here are the best ways to prevent rebound hyperpigmentation:
- Guided Usage: always use treatments like hydroquinone, under the guidance of a medical professional. This ensures you’re using the right concentration and frequency for an appropriate duration. They will also make sure that the rest of your skincare routine supports your treatment and provide a protocol that will allow you to transition off the treatment without risking rebound hyperpigmentation.
- Strict Sun Protection: sunscreen isn’t just for sunny days. You should use a broad spectrum sunscreen with at least SPF 30 every day. Even if it is cloudy or you’re indoors. If you’re out in the sun, also use additional protection like hats and clothing. This will protect you fro UV damage and prevent rebound effects.
- Gradual Discontinuation: instead of stopping usage abruptly, it is better to taper off products like hydroquinone and alpha arbutin gradually. This can give the skin time to adjust without overreacting. Using a retinoid alongside hydroquinone and after finishing can also help maintain the results and reduce the chances of rebound. Often doctors will also start alpha arbutin when hydroquinone is stopped alongside a retinoid to stabilise the melanin cells and further reduce the risk of rebound hyperpigmentation.
- Antioxidant Support: incorporate antioxidant-rich products into your routine like Vitamin C serum. This can protect against oxidative stress which can contribute to rebound hyperpigmentation.
Preventing Hydroquinone Rebound Hyperpigmentation
There are a number of ways to reduce the risk of hydroquinone associated rebound hyperpigmentation. First of all you should only really use hydroquinone under the guidance of a medical professional who will take steps to minimise risks. In general you should avoid strengths of no more than 4% unless your doctor recommends it. Furthermore, hydroquinone should only be used for a maximum of 5-6 months continuously. If another course is needed then a gap of at least 2-3 months should be observed.
An exit plan is also crucial. Often hydroquinone is started alongside retinoids like Tretinoin to both augment its effects and because the retinoid can then be used after to help maintain the results. After gradually stopping hydroquinone, you might be transitioned to alpha arbutin and alongside retinol or prescription retinoid. This will stabilise the melanin producing cells and reduce the chances of rebound hyperpigmentation. Of course, whilst on hydroquinone, it is absolutely vital to use strict sun protection.
Reversing Rebound Hyperpigmentation
Addressing rebound hyperpigmentation needs a careful and methodical approach. It may also require time, effort and patience. If you are using hydroquinone or any other prescription skincare then your first step should be to speak to a dermatologist or doctor experienced in treating rebound hyperpigmentation. They will guide you on whether you need to stop certain skin products and on the routine you should follow. Some of the most common steps taken to reverse rebound hyperpigmentation include:
- Stop The Culprits: in general, if rebound hyperpigmentation is suspected to be due to excessive or prolonged use of alpha arbutin or hydroquinone use then these are normally stopped.
- Chemical Exfoliants: incorporating gentle exfoliants, like alpha hydroxy acids or azelaic acid to promote skin cell turnover and gradually lightening the affected areas.
- Antioxidants: products rich in antioxidants, such as vitamin C serums can help fade the darkened areas and prevent worsening.
- Niacinamide: this is another potent but gentle ingredient that might help. Niacinamide not only reduces inflammation but also regulates pigment production.
- Retinoids: retinol and prescription retinoids like Tretinoin can help treat rebound hyperpigmentation and prevent another relapse.
- Pigment suppressors: if the rebound hyperpigmentation was caused by abruptly stopping alpha arbutin or hydroquinone, then your doctor may recommend restarting these. Often this is alongside a retinoid and sometimes they may use a hydrocortisone containing formulation. Once the pigmentation is reversed, they will then gradually taper off the treatment.
- Sun Protection: there’s absolutely no way to treat rebound hyperpigmentation without this. Strict sun protection is paramount with a broad-spectrum sunscreen.
The journey to treating hyperpigmentation is one paved with patience, awareness and the right guidance. Rebound hyperpigmentation, is definitely an unwelcome and disappointing risk. However, you can usually avoid this with a careful protocol that uses the right products appropriately for the correct lengths of time. Understanding the causes and potential triggers of rebound hyperpigmentation is crucial for both prevention and treatment. A strategic and informed approach will allow you to reap the benefits of effective treatments like hydroquinone without the backlash. Basic measures like protecting your skin from the sun will also go long way towards safe-guarding against rebound hyperpigmentation. Always consulting with a dermatologist or other medical professional when considering or undergoing hyperpigmentation treatments to help you achieve your skin goals and mitigate risks.
We passionately believe that skincare should always be personalised. Our virtual skin clinic offers safe and effective prescription-strength treatments like Tretinoin and hydroquinone for conditions like melasma, hyperpigmentation and skin ageing. Book an online consultation with one of our doctors or fill in our online consultation form today and take your first step towards great skin.
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