Hyperpigmentation

What is hyperpigmentation?

When melanocytes, the cells responsible for melanin production, become hyperactive or proliferate, hyperpigmentation occurs. It can appear as isolated spots or patches or affect larger skin areas, often becoming a cosmetic concern for those affected.

What are the types of hyperpigmentation?

Hyperpigmentation can be grouped according to its depth within the skin, such as epidermal pigmentation, dermal pigmentation, and mixed pigmentation.

Epidermal pigmentation

Epidermal pigmentation occurs on the top layer of the skin, also known as the epidermis. Melanin in the top layer of the skin often looks brown, which usually responds well to topical treatment.

Examples of epidermal pigmentation include:

• Freckles: freckles are small, flat, light brown spots that typically appear on sun-touched areas such as the face and shoulders. They often run in families and are closely linked to sun exposure. They appear early in childhood and fade with sun avoidance.
• Sunspots: sunspots or lentigines are caused by cumulative sun exposure over time. These darker, larger spots reflect cumulative sun exposure over the years and do not fade even when avoiding the sun.

Freckles	Lentigines
Starts early in childhood	Later onset in life
Smaller 1-2 mm flat spots	Larger than freckles, but usually <6 mm
Tan, slightly red, or light brown	Often darker than freckles
Fades with avoidance of sun exposure	Does not fade with time

Dermal pigmentation

When melanin, our skin’s pigment, settles into the deeper dermis, it casts shadows of blue or grey. Examples of dermal pigmentation include:

• Hori’s Nevus: Hori’s Nevus is characterised by speckled brown to blue-grey pigmentation, often on the cheeks and nose, and may coexist with melasma. Predisposing factors include a genetic predisposition, sun exposure, and hormonal influences from pregnancy or oral contraceptive pills.
• Nevus of Ota: Nevus of Ota occurs around the forehead, face, and around the eyes. Not uncommonly, the pigmentation can extend up to the lid margin and conjunctiva.  
• Post-inflammatory hyperpigmentation (PIH): PIH may appear on the skin after an inflammatory event, such as the aftermath of acne, injury, or infection. The melanin falls into the dermis and is taken up by macrophages that work to clear the pigment over time.

Mixed epidermal and dermal pigmentation

Melasma is an example of mixed pigmentation, a blend of lighter and darker patches that form in response to hormones, genetics, and sun exposure. This form of pigmentation is usually more complex and requires a multimodal approach.

What causes hyperpigmentation?

Numerous factors can influence your body's melanin production; these are:

• Sun exposure: the sun plays a significant role in our skin’s pigmentation. Its ultraviolet (UV) rays prompt melanocytes to produce more melanin, leading to hyperpigmentation. Protecting your skin from the sun is often the first step in managing this pigmentation.
• Skin phototype: those with darker skin types have more melanin, which offers some protection against the sun. However, this also means they experience a more profound pigmented response to sun exposure, skin trauma, or inflammation.
• Medications: certain drugs, including anticoagulants, chemotherapy agents, and antiarrhythmics, can trigger hyperpigmentation. This is known as drug-induced hyperpigmentation, where the medication influences melanin production, leading to changes in your skin colour.
• Medical conditions: some health issues can cast a shadow on the skin. Addison’s disease, for instance, can paint the skin in darker hues, particularly in areas that are sun-exposed or experience frequent friction. It is a direct effect of hormone fluctuations influencing melanin synthesis.
• Pregnancy: the hormonal tidal waves of pregnancy can also affect skin pigmentation. Melasma, often dubbed the “mask of pregnancy,” is one such condition in which elevated hormone levels during pregnancy influence melanin production, leading to notable facial pigmentation.

Understanding these various causes is crucial for addressing and managing concerns related to skin pigmentation.

How is hyperpigmentation diagnosed?

At Lumine Dermatology & Laser Clinic, diagnosis for hyperpigmentation involves the following:

• Comprehensive skin evaluation: during your visit, we will conduct a thorough examination of your skin, noting the distribution, pattern, and unique characteristics of your pigmentation.
• Medical review: your dermatologist will examine your medical history, lifestyle, sun exposure habits, and skincare regime to uncover any contributing factors to your hyperpigmentation.
• Dermoscopic analysis: a dermatoscope is a noninvasive tool that helps to identify fine details like vessel patterns and depth of pigmentation, ensuring we chart the most effective treatment course for you.
• Wood’s lamp examination: this visualisation method allows us to determine if pigmentation is mainly epidermal or dermal.
• Selective diagnostic testing: while a visual assessment often suffices, we can perform a skin biopsy should the need arise.

What are the treatment options for hyperpigmentation?

At Lumine Dermatology & Laser Clinic, we understand that hyperpigmentation can affect more than just your skin –  it can affect how you feel in your skin. Depending on the intensity or severity of your hyperpigmentation, single or combined treatment methods may be recommended. Here’s a glimpse into the options we provide:

• Prescription-grade topical treatments: your journey might begin with specially selected topical agents proven to lighten hyperpigmentation. These may include hydroquinone, which inhibits melanin production, kojic acid, for its brightening properties; cysteamine, retinoids, and resorcinol, to accelerate cell turnover. We aim to match the most effective ingredients to your skin’s needs.
• Professional chemical peels: we might suggest a chemical peel to accelerate skin turnover of unwanted pigmented cells and reveal brighter skin beneath. Options like mandelic acid not only exfoliate but also work at a deeper level to improve skin barrier function.
• Advanced laser therapy: for stubborn pigmentation, laser treatments such as picosecond lasers, Q-switched lasers, and non-ablative fractional resurfacing lasers (MOXI) can precisely target melanin deposits without harming surrounding tissue.
• Microneedling radiofrequency: this treatment combines strategies to refine skin texture and lessen pigmentation, supporting your skin’s healing and renewal processes.

Your skincare routine is crucial, involving sun protection with SPF and brightening agents. Combining treatments tailored to your needs ensures an effective approach to managing hyperpigmentation, providing noticeable skin tone and texture improvements over time.

Frequently asked questions

What can I do to minimise hyperpigmentation?

The following measures will be helpful in minimising hyperpigmentation:

• Sunscreen is the first line of defence: choosing the right type, amount, and application method can help minimise hyperpigmentation.
• Time your outdoor activities wisely: UV index is the highest mid-day. Seek shade when the UV exposure is most intense.
• Dress smart: UV-protective clothing acts as a physical barrier. Look for garments with a high UV protection factor (UPF) rating, and don’t overlook the wide-brimmed hats and sunglasses for comprehensive coverage.
• Embrace a science-backed skincare regimen: incorporate products with active ingredients to lighten hyperpigmentation, such as vitamin C, retinoids, and niacinamide. These ingredients will complement treatments that you do to lighten pigmentation.

Are there home remedies for hyperpigmentation?

While many home remedies are available for treating hyperpigmentation, one should approach them with care, as certain natural ingredients may cause long-lasting damage or scars if one has sensitive skin. Always consult your dermatologist for an accurate diagnosis.

How can I tell if hyperpigmentation affects my specific skin type?

Hyperpigmentation can affect all skin types. However, individuals with darker skin types are more susceptible to it. Due to their lifestyle, individuals who tend to have higher UV exposure are also more likely to develop hyperpigmentation. 

Is hyperpigmentation harmful?

Generally, hyperpigmentation is harmless and does not pose a health risk. However, the uneven skin tone that results from hyperpigmented skin conditions can affect one’s self-esteem or how others perceive an individual.

Rarely, hyperpigmentation can result from underlying health issues such as endocrinological disorders, nutritional deficiencies, or medications. 

If you are unsure about the cause of your hyperpigmentation or experience any changes in skin appearance, consulting with a dermatologist is recommended for a proper evaluation and guidance on potential treatments.