Hyperpigmentation describes a common skin condition where patches of skin become darker in color than the surrounding skin. When the complexion is spotted or mottled, it can have a dull and worn out appearance. Hyperpigmentation occurs when excess melanin, the brown pigment that produces skin color, forms deposits in the skin. The epidermis is made up of mainly skin cells, but about every eighth cell is a melanocyte--a cell that makes melanin. A few factors can encourage an abnormal increase in melanin production, but exposure to UV rays is the most common. Melanin absorbs the sun's energy to protect the skin from overexposure. It's the reason we get a tan. Too long or too frequent UV exposure can cause melanocytes to go into overdrive. This results in uneven pigmentation. Spots or blotchy patches are a sign that your skin has been overexposed. Hyperpigmentation is an issue for people of all skin tones.
The different types
Lentigines are one form of hyperpigmentation. Commonly known as age or liver spots, these marks have a clearly defined edge. They form as a result of sun damage. Small darker patches of skin like this are often present on the hands, face, and other areas frequently exposed to the sun.
Melasma can resemble age spots but generally covers a larger area of skin. Melasma is a result of hormonal changes. Pregnancy can trigger overproduction of melanin, causing what is sometimes called the "mask of pregnancy." This darker skin can appear on the face and sometimes the stomach. Birth control pills can also lead to this type of hyperpigmentation because the body undergoes similar hormonal changes as it would during pregnancy. Thyroid dysfunction can also lead to melasma.
Post-inflammatory hyperpigmentation (PIH) describes pigmented marks left behind by skin conditions like acne, cuts, scrapes or even rashes. Friction or picking the skin will lead to spots that linger as well. PIH fades over time and is the easiest type of hyperpigmentation to treat.
Phytophotodermatitis (PPD) is an inflammatory response to UV exposure after contact with specific plants and vegetables. Limes, parsley, and celery, for example, contain photosensitizing chemicals. Skin exposed to these chemicals that is subsequently exposed to sunlight becomes red and inflamed, sometimes even blistered. The reaction results in marks that can look like this:
Freckles are small brownish spots that appear anywhere on the body but most commonly the face and arms. Freckles are a genetic trait.
What makes it worse
Regardless of the cause of your hyperpigmentation, it can become darker or more noticeable due to UV rays. A broad-spectrum sunscreen is a must to prevent it from worsening. Even incidental sun exposure can reverse months of treatment to lighten hyperpigmentation.
What makes it better
There are multiple treatments available for treating hyperpigmentation, but a combination of therapies will speed up and enhance your results.
Microneedling
Microneedling works well to eliminate dark spots on the complexion. It involves the use of a pen-like device equipped with several tiny needles. After applying a numbing cream, the practitioner uses the device to carefully create hundreds of minuscule "micro-channels" in the skin. The procedure is sometimes called "collagen induction therapy," because that's precisely what it does. The body's healing process is initiated by these tiny, precise injuries to the skin. More collagen is produced, improving the skin's elasticity and replacing the top layer of skin with fresh, spot-free skin. Platelet rich plasma (PRP) or lightening skin care products applied during the microneedling session penetrate below the surface of the skin, enhancing their effectiveness.
If the pigmentation is deep within the dermis (and it often is), it can take a number of treatments to resolve. But with each successive treatment, there is an improvement, brightening, and firming of the complexion. Four to six sessions are recommended for best results, with four to eight weeks between each appointment. It's safe for all skin types, and there is no real downtime. At most your skin will be pink afterward for a few hours. Microneedling sessions can be alternated with laser treatments or chemical peels to expedite results.
Chemical Peels
Chemical peels break up the top layer of skin, helping eliminate surface discoloration. A series of four to six peels is ideal (waiting four to six weeks between appointments) to eliminate hyperpigmentation that is deeper within the dermis gradually. Peels are not only good for hyperpigmentation: They increase collagen production, minimize fine lines, diminish the appearance of pore size, improve skin texture, and acne. There are different types of chemical peels, and your esthetician will choose one for you based on your specific skin type and concerns.
Depending on the depth of the peel, you may have a few days where your skin is red, peeling, or scaly looking. Find out what to expect from your treatment beforehand so that you can plan accordingly. Staying out of the sun and wearing a good sunscreen is essential after a peel. Your skin will be more sensitive to the sun, and your hyperpigmentation can return or worsen.
Lasers
Stubborn pigmentation often needs more than microneedling or chemical peels. Laser treatments like Clear + Brilliant or Aerolase can be alternated with peels and needling sessions to remove pigment that originates deeper within the dermis. Sunscreen is especially a must after laser treatments. The skin will be more susceptible to damage and hyperpigmentation. Wear a hat if you will be out during hours of the day when the sun is intense.
The Aerolase Lightpod is an Nd: YAG 1064 nanometer laser with a 650-microsecond pulse duration. The rapid pulse of energy keeps your skin from overheating, which makes it one of the most comfortable treatments on the market. It's useful for removing hyperpigmentation as well as unwanted hair, veins, wrinkles, enlarged pores, lax skin, red moles and more. The hands and chest can also be treated with Aerolase. (It's safe for use anywhere on the body.) There is no downtime after treatment. At the most, your skin will lightly flake over the next couple of days, but not to the point where it's evident to anyone but you. Up to 6 treatments are recommended; one a month for six months, ideally.
The ultimate choice for hyperpigmentation is the fractional laser. But fractional lasers require up to a week of downtime, due to a healing process that involves scaly, discolored, peeling skin. Clear + Brilliant is a gentler fractional laser. It breaks up the irregular color in the dermis via heat without leaving the skin irritated and inflamed for days. It not only breaks up hyperpigmentation, it diminishes pores and fine lines, encourages new collagen formation, and improves skin tone and texture. Your skin may feel a bit rough (think sandpaper) for a day or two, but no one will notice you’ve had anything done, and by day three or four, new, fresh, “clear and brilliant” skin will be revealed. Multiple treatments are recommended for best results.
Clear + Brilliant gives you the results of a fractional laser spread out over the course of a few appointments so that you never have to miss a day of work. You'll see brighter skin after a few days, and because the laser stimulates collagen, your complexion will continue to improve over the next few months.
Skincare
No matter what treatments you choose to eradicate hyperpigmentation, skincare is an essential part of keeping hyperpigmentation from returning. Some even have success lightening their hyperpigmentation at home with the right products. Look for skincare that features or combines the following ingredients to keep skin bright:
Sunscreen is the first and most important product in any skincare arsenal. It will prevent worsening of current hyperpigmentation and protect you from new hyperpigmentation. It will also protect you from premature wrinkles, sagging and skin cancer. Look for active ingredients zinc or avobenzone.
Hydroquinone is considered the gold standard for skin lightening, but it shouldn't be used long-term, and some people experience sensitivities to it. It works by inhibiting tyrosinase. Tyrosinase stimulates the production of melanin.
Glucosamine is known to stop the chemical signals that cause melanin production.
Hydrolyzed Pearl Powder inhibits tyrosinase and gives the skin a brighter appearance.
Licorice Root Extract is not only an antioxidant; it's known for preventing the synthesis of tyrosinase.
Niacinamide (Vitamin B3) is excellent for treating PIH. It's an anti-inflammatory and plays a role in preventing the production of excess melanin.
Phytic Acid is another effective tyrosinase inhibitor.
Vitamin C (ascorbic acid and its derivatives) has potent antioxidant properties that help protect from UV damage and inhibit tyrosinase.
Azelaic Acid is a naturally-occurring acid that not only has exfoliation properties but is on par with hydroquinone to treat hyperpigmentation. It's especially great for skin with acne and PIH.
Kojic Acid is another tyrosinase inhibitor. It can be a bit sensitizing but is still a gentler alternative to hydroquinone.
Oligopeptide-34 and Oligopeptide-51 are peptides that limit the formation and activity of tyrosinase.
Hydroxyphenoxy propionic acid inhibits melanin transfer throughout the epidermis. In addition to its brightening and lightening abilities, HPA has a protective effect against hyperpigmentation and inflammation.
AHA, BHA, or a retinoid: Add an exfoliating agent to your brightening regimen for best results. You must gradually slough off the layers of skin that have excess pigment in them, allowing brighter skin to take its place. Over-exfoliating can cause irritation that leads to hyperpigmentation, so start slowly to determine the strength and frequency that works best for your skin.
Biopelle skincare's Brighten line consists of three products that prevent and correct hyperpigmentation using multiple proven lightening agents. You can purchase Biopelle skincare products right here at One Aesthetics.
In conclusion
To effectively remove or improve hyperpigmentation we utilize consistent and alternating treatment modalities alongside daily sunscreen and medical grade skincare. Depending on the amount and depth of unwanted pigment in the skin, results may be gradual and require multiple and varying techniques.
It's always easier to prevent hyperpigmentation than it is to correct it, so always keep your skin protected from the sun, and treat it with care to avoid injury and irritation.