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All about Hyper-pigmentation

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EXPERTS SPEAK

Hyper-pigmentation is characterized by a darkening of an area of skin caused by the overproduction of a pigment in the skin known as melanin. Melanin is a pigment that gives skin its color. It is produced by skin cells called melanocytes.

Proper evaluation of the patient which can help to diagnose the right reason why one has developed pigmentation is the key. Since the pigmentation can also be caused by systemic illnesses, treating the cause can also help in reducing the pigmentation.

Hyper-pigmentation is usually used as a common term for any skin darkening but it is important to know the different types:

  • Lentigo/Lentigenes- lentigo simply means one freckle; lentigenes are multiple freckles. (Freckles are little light brown flat spots which are clusters of concentrated melanin.  Those with fair skin and hair and light eyes are more predisposed to getting them.)
  • Solar Lentigenes- widely known as ‘sun spots,’ ‘age spots’ and ‘liver spots,’. These are caused by sun exposure.
  • Melasma- often known as the ‘pregnancy mask,’ melasma is caused by hormonal changes due to pregnancy and is characterized by pigmented areas usually on the face (except the eye area). Remember melasma patches are usually symmetrical, with matching marks on both sides of the face. CLICK TO READ ALL ABOUT MELASMA
  • Post-inflammatory hyper-pigmentation- occurs when a skin injury or trauma heals and leaves a flat area of discoloration behind. This is the most common type. It’s found among acne sufferers, and can also be caused by scratching, injuring or if any aesthetic procedure goes wrong.

Note: It is always advisable to consult a dermatologist as soon as you see the first signs of pigmentation because it is imperative to find out the underlying cause of hyper-pigmentation so that you can prevent it from getting worse. Also it is much easier to resolve hyperpigmentation in early stage. 


MUST KNOW FACTS ABOUT HYPER-PIGMENTATION

  1. There is no overnight treatment or results for hyper-pigmentation. It may take several weeks before any noticeable difference is visible. Hence three things are very important consistency, patience and persistence.
  2. All skin types are prone to the formation of dark spots. People with darker skin tend to have darker areas of pigmentation than people with lighter skin, but pigmentation spots tend to be more obvious on fair-skinned people due to the contrast in colors.
  3. It is paramount to protect your skin from UV rays if you have hyper-pigmentation. And note even if you are indoors most of the time you must not skip using a sunscreen because the tubelights, computers also emit UV rays. Also UV rays can penetrate through the windows.
  4. The key to fade the dark spots or patches is stringent sun protection and use of right kind of skin lightening products. Also preferably apply hyper-pigmentation treatment creams at night because most (not all) of the potent skin- lightening ingredients degrade or photosensitize skin on exposure to sunlight.
  5. Few factors that trigger hyper-pigmentation-
    • Excessive sun exposure
    • Skipping a sunscreen
    • Heat: environmental heat can trigger your hyper-pigmentation because thermal heat encourages melanocytes to produce melanin. 
    • Picking, squeezing, scratching or injuring your skin
    • Hormonal imbalance or hormonal changes during pregnancy
    • Smoking
    • Stress and also lack of sound sleep because it triggers stress
    • Formation of free radicals
    • Facial hair removal: Avoid bleaching as it has chemicals that can irritate your skin. If you wax, be sure to use non-flavored hard wax rather than flavored and avoid pulling the skin too hard. Best option though could be threading but from an experienced beautician.
    • Choosing incorrect skincare products and regime: make sure you use only those skincare products that are skin pH friendly, formulated specifically for your skin type/ concerns/ needs, are safe (do not contain toxic/ harmful ingredients in them) for application on human skin. Avoid products containing fragrances, colorant dyes, cooling ingredients like menthol, surfactants, sulphates, excessive preservatives, alcohols (SD alcohol, isopropyl alcohol, alcohol denatured, ethanol) and  certain plant oils eg eucalyptus, peppermint. All these are skin irritants and the skin reacts to any form of irritation or injury by inflammation which in turn causes post-inflammatory hyper-pigmentation.
  6. If a hyper-pigmentation spot or area is changing in size, shape, colour, or is itching or bleeding; a dermatologist should be consulted in order to check that it is not due to something more serious like skin cancer.

CAUSES

The most common causes of hyper-pigmentation are:

  1. Sun exposure: sun exposure is the number one cause of hyper-pigmentation. Ultraviolet radiations of the sun are a powerful simulator for pigment-forming cells called as melanocytes. Melanin (produced from melanocytes) absorbs the UV-radiation of the sun’s rays in order to protect the skin but if skin is exposed to too much sun, over a long period of time, the activity of melanocytes will increase, resulting in excess melanin production leading to hyper-pigmentation. Also once the dark spots have developed, further sun exposure exacerbates these marks making them even darker. 
  2. Hormonal changes: dark patches in females can be caused by hormonal changes in cases of-
    • pregnancy
    • intake of oral contraceptive pills 
    • polycystic ovarian disease
    • ovarian cancers
    • hypo/hyperthyroidism
  3. Inflammation and skin injuries: after any trauma, injury, rash, spot, acne pimple or any other kind of influence causes skin to become inflamed; this inflammation triggers the production of melanin and develops into post-inflammatory hyper-pigmentation. Excess melanin darkens and discolors the wounded area. Therefore people suffering from acne should be extremely careful not to pick or rupture their pimples. If a pimple is squeezed or picked it will increase the chance of developing post-inflammatory hyper-pigmentation.
  4. Nutritional causes: deficiency of vitamin B12 or anemia due to deficiency of iron might cause hyper-pigmentation in many undernourished females. See a physician if your hemoglobin is low. Also, ensure that you take at least two fruits a day, two servings of vegetables, omega-3 fatty acid rich foods, antioxidants.
  5. Stress: adrenocorticotropic hormone is released in response to stress. This hormone activates tyrosinase activity in melanocytes leading to enhanced production of melanin and resulting in the augmentation of hyper-pigmentation process. Note even depression is a form of stress.
  6. Certain medical conditions or diseases: addison’s disease, hyperthyroidism, acanthosis nigricans, insulin resistance/metabolic syndrome, cushing’s disease and vitamin deficiencies. Hyper-pigmentation is also a side effect of certain hormone treatments, chemotherapy drugs, antibiotics, anti-malarials or anti-seizure drugs. Also taking contraceptive pills for a number of years can trigger pigmentation as a side effect.

TREATMENT OPTIONS

The most commonly employed treatments for hyper-pigmentation are as follows:

Well the first line of therapy for hyper-pigmentation is a broad-spectrum sunscreen to protect the skin from sun exposure. The second line of therapy involves usage of hydroquinone, tretinoin, azelaic acid, or kojic acid.

  1. Topical De-pigmenting agents: these creams can be further categorized under different heads depending upon their active ingredients. Most of these either inhibit the enzymes or block the receptors that are involved in melanin secretion pathway. 
    • Hydroquinone
    • Azelaic acid
    • Kojic acid
    • Arbutin
    • Licorice extract
    • Soy
    • Niacinimide
    • Adapalene
    • Retinoic acid derivatives
    • Vitamin C derivatives and Alpha-hydroxy acids. 

Plz Note: though some of these creams may be available over-the-counter; it should be used only under medical supervision or as prescribed by your dermatologist/ cosmetologist.

  1. Aesthetic procedures:
    • Chemical Peels: these involve applying an acidic solution to the skin. Peels help by exfoliating the pigment-containing cells in the epidermis and also helps in rejuvenating your skin. The chemicals present in peels cause the skin to eventually peel off, revealing new and evenly pigmented skin beneath. There are variety of peels and their combinations available these days hence it is important to get it done under supervision from a cosmetologist.
    • Lasers: laser-therapies and impulse light treatments tend to be more precise than chemical peels, as they use targeted high-energy lights to reach affected areas. The mildest treatments work just on the skin’s epidermis (surface layer), while more intense treatments can penetrate the deepest layers of the skin depending on how severe the hyper-pigmentation is. They can be used for resistant dark patches.

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IF YOU want to resolve and get rid of your skin concern (Hyperpigmentation); then instead of a Basic Skincare Regime; you would require a CUSTOMIZED SKINCARE REGIME (containing specific skincare products that can target to resolve your concerns) along with correct skincare guidance. 

CLICK TO GET A COMPLETE SKINCARE REGIME CUSTOMIZED (Specifically for your Skin Type, Skin Concerns & Needs); BY OUR DERMATOLOGISTS/SKIN EXPERTS


COMMON QUERIES- RESOLVED

Q1) Scrubbing the skin using wash cloths, sponges or gritty exfoliants helps to remove dark spots and pigmentation?

ANS: Inflammation actually triggers your skin to produce pigment. Scrubbing and irritating your skin will typically make skin discoloration worse, not better.

Q2) Do men need separate de-pigmentation creams for treatment?

ANS: No. Hyper-pigmentation  in both men and women occurs in the same manner (with the exception of hormonal changes as seen in women) and thus the treatment is common.

Q3) I have always used expensive cosmetics and never had acne, then why did I develop pigmentation?

ANS: Although some cosmetics are known to cause hyper-pigmentation, cosmetics may not be the sole cause for everyone with the problem. Other factors such as sun exposure, hormonal changes, abrasive treatments that cause inflammation, etc can also cause hyper-pigmentation.

Q4) How long does it take for hyper-pigmentation to go away?

ANS: It depends on the cause and the type of treatment approach your physician chooses. Realistically, it could take from weeks to months before hyper-pigmentation disappears completely. It is important that you closely follow the treatment regimen your doctor prescribes and learn how to lower your risk for developing hyper-pigmentation in the future.

Q5) I heard fragrance containing products trigger post-inflammatory hyper-pigmentation, so what about the perfumes?

ANS: Perfumes are usually applied on the body, behind earlobes or inner part of our wrists and not on our face. Our concern in all the above sections have been fragrance containing skincare products which remain in direct contact with the skin. Also all skin types are not equally prone to irritation from fragrances. Still its always a good idea to spray the perfume on the clothes instead of spraying directly onto the skin.

*Disclaimer : Result may vary from person to person.