Treating Hyperpigmentation

Hyperpigmentation is a medical term used to describe patches of skin that have more pigmentation than other areas, making them darker than the surrounding skin. Pigmentation is a genetic cell mutation caused by hormonal changes or some sort of injury (e.g., sun damage, acne, lasers, etc). Hyperpigmentation can affect individuals with any skin type and while increased pigmentation usually isn’t harmful, its patchy appearance is typically regarded as aesthetically undesirable.

There are many different approaches to treating hyperpigmentation, but these depend of a variety of factors, including the individual with hyperpigmentation, the cause of the hyperpigmentation, and how severe the hyperpigmentation is.

Skin Pigmentation

To understand hyperpigmentation, one must first understand what skin pigmentation is and how the body controls it. Skin pigmentation is caused by a molecule called melanin. The amount of melanin in the skin influences the color of the skin, with more melanin causing darker skin coloration.

Melanin is created by cells in the skin called melanocytes through a process called melanogenesis. There are two forms of melanogenesis, these include basal melanogenesis and activated melanogenesis. Basal melanogenesis refers to the process of creating melanin that is always active in an individual’s skin. Basal melanogenesis is responsible for an individual’s overall skin tone.

Activated melanogenesis is the production of melanin due to external factors, such as inflammation, skin damage, or even exposure to ultraviolet light. Activated melanogenesis can be beneficial in some circumstances. Exposure to sunlight, for example, will stimulate melanin production, creating a tan. This helps the skin to absorb more sunlight, offering protection to the skin. Activated melanogenesis can have potentially negative effects on skin quality, however, when it occurs unevenly.

Types of Hyperpigmentation

There are several types of hyperpigmentation, the common ones being melasma, sunspots, and post-inflammatory hyperpigmentation. Understanding the root cause of hyperpigmentation is important for recognizing what treatment options are likely to help.

Sunspots

Sunspots, also called age spots, liver spots, or solar lentigines are a common type of hyperpigmentation that occurs with sun exposure, especially over a prolonged period of time. Sunspots are flat and typically round or oval shaped. They may range in shade from tan to dark brown and can group together, making them more noticeable. These spots can be as big as half an inch across and typically occur in areas exposed to the sun, like the hands and feet.

Although medical scientists do not fully understand how and why sunspots are formed, they are thought to be caused by overactive melanocytes that lead to excessive melanin production only in the areas of specific melanocytes. Sunspots are more common in people over 50, however, younger people who are frequently exposed to the ultraviolet light in sunlight or in tanning beds may also develop age spots.

Melasma

Melasma is a form of hyperpigmentation that is believed to be caused by hormonal changes. Melasma is characterized as blotchy patches of darker color skin that may be brown or gray-brown, and tends to affect individuals with darker skin pigmentation more than fair-skinned individuals.

Melasma is most common during pregnancy and may also be triggered by birth control measures that affect hormone levels. Melasma is much more common in women than it is in men, and typically occurs in areas that are exposed to the sun. While melasma can appear on any part of the body, it  most commonly occurs on the stomach and face.

Post-Inflammatory Hyperpigmentation

Post-inflammatory hyperpigmentation is a form of hyperpigmentation that occurs after damage or irritation to the skin that causes inflammation. Post-inflammatory hyperpigmentation can cause tan, purple, or brown discoloration after any skin-related damage. As with other types of hyperpigmentation, exposure to sunlight can cause the hyperpigmentation to worsen.

Injuries that may cause post-inflammatory hyperpigmentation can have several causes, including:

• Acne
• Psoriasis
• Eczema
• Allergic reactions
• Infections
• Insect bites
• Burns

While anyone can experience post-inflammatory hyperpigmentation, this condition is predominate in individuals with darker skin tones. According to the Skin of Color Society, over 65% of individuals who develop post-inflammatory hyperpigmentation are of African descent.

Preventing Hyperpigmentation

There are several methods that can be used for the prevention of hyperpigmentation, but the key method is to protect your skin from the sun. Sunlight contains wavelengths of light that activate melanocytes within the skin contributing to the development of sunspots and melasma. In addition to playing a role in the development of hyperpigmentation, melanocyte-stimulation by sunlight also worsens almost every form of hyperpigmentation.

While avoiding overexposure to sunlight is important to preventing, and reducing the effects of hyperpigmentation, there are other ways to reduce your risk of developing hyperpigmentation. For post-inflammatory hyperpigmentation, especially, avoiding skin irritation and damage is important. This includes not picking at skin injuries when they occur, treating skin conditions like acne that could cause further skin injuries, using insect repellent while outside, and avoiding potential skin injuries.

How is Hyperpigmentation Treated?

There are several different methods for treating hyperpigmentation, but these methods typically fall into one of two categories: skin-altering chemicals or light therapies. Chemical skin treatments are designed to either breakdown the pigmentation in skin chemically or to cause the skin to peel off, allowing the new layer underneath with less pigmentation to be exposed. Light therapies use specific wavelengths and intensities of light to break down the melanin and return the skin to its normal color.

Hydroquinone

Hydroquinone is a type of skin-bleaching agent that is used in most cosmetic treatments that reduce hyperpigmentation. Hydroquinone can be purchased over the counter in low concentrations, but requires a prescription when in concentrations in excess of 2%. Hydroquinone works by interfering with melanocytes and their ability to produce melanin, causing the area that it is applied to create less melanin.

Hydroquinone can cause several side effects. The American Osteopathic College of Dermatology warns that some people may have redness and itching when using hydroquinone. This could actually cause hyperpigmentation in the form of post-inflammatory hyperpigmentation. Other side effects could include dryness, irritation, pruritus, erythema, and contact dermatitis. Prolonged use of hydroquinone is also connected with ochronosis, a blueish-black discoloration of the skin.

Chemical Peels

A chemical peel, or corrective peel or cosmetic peel is performed by applying a chemical to the skin that causes the top layer of skin to peel off. Chemical peels can take off varying depths of skin layers, with deep chemical peels producing more noticeable results, but requiring longer downtimes and taking longer to recover from.

Chemical peels are typically performed by a doctor, or medical esthetician in most cases, and multiple chemical peels may be needed to fully treat hyperpigmentation. Deep chemical peels may take several weeks to recover from.

Red Light Therapy

Red light therapy, also known as photobiomodulation, uses healing natural light to help your body produce more energy and regenerate your skin. It is rapidly becoming a popular method of maintaining skin health, and a very effective natural treatment option for acne, inflammation, burns & scars, and yes, hyperpigmentation.

Red light therapy uses low energy wavelengths of light that penetrate deep into the skin. While ultraviolet wavelengths of light stimulate melanocytes and produce melanin, red and near infrared wavelengths do not, and instead stimulate mitochondria, the energy-producing organ of cells.

Red light therapy has many known skin benefits. The scientific journal Seminars in Cutaneous Medicine and Surgery reports that red light therapy can:

• Improve circulation in the skin
• Increase plumping of the dermis
• Protect skin cells from damage
• Enhance wound healing
• Increase collagen production, increasing the skin’s elasticity
• Reduce fine lines and wrinkles
• Improve skin clarity, tone and texture
• Control hyperpigmentation, balance skin tone, and diminish sunspots

Healthy wavelengths of light help your skin cells heal and rejuvenate, as we’ve seen with numerous clients. Researchers have also conducted numerous trials showing this. Red light therapy is also well-known as a powerful natural inflammation relief tool, and that makes a huge difference for the inflammatory kind of hyperpigmentation!

When used consistently, and part of a holistic treatment protocol, red light therapy is effective at reducing the appearance of hyperpigmentation patches and, for many of my clients, helping them heal and return to their normal pigment levels.

Additional Treatment Considerations

The tone of your skin matters in terms of which treatments will work best. Generally speaking, fair skin responds well to most hyperpigmentation procedures. Medium skin tones may find chemical peels and microdermabrasion therapy very helpful, but the use of pigment inhibitors both before the treatments begin (at least 2 weeks), and throughout the course of the treatment protocol is very important. Darker skin might benefit from Glycolic acid, Kojic acid, microdermabrasion (low setting), lower-strength chemical peels, and laser treatments, but only at lower intensities and over several sessions.

When treating hyperpigmentation, it’s very important to remember that it can lead to hypopigmentation (white spots), which cannot be fixed. So this is why treating darker, pigmented skin should be a much slower and cautious process.

Treating hyperpigmentation should be done on an individual basis, but typically, you want to keep 3 basic principles in mind:

• Keep melanocytes (melanin-forming cells) from producing more pigment by suppressing/inhibiting them (ie. “putting them to sleep”). Vitamin C (at 20% concentration) is an antioxidant, which helps to inhibit the enzyme tyrosinase and prevent melanin production. It significantly lightens pigmentation, but simply brightens normal skin. So vitamin C is a MUST-HAVE before any pigmentation treatments should be started.
• Although it sounds counterintuitive, you need to re-injure the affected area of the skin in order to flush the pigment to the surface so it can be effectively treated.
• Use red light therapy for its healing properties (e.g., improve circulation, stimulate fibroblasts, etc). Some people also use topical creams for the same purpose, while others use home remedies like aloe vera, green tea, and licorice however, we experience the most success treating hyperpigmentation with red light therapy, through our Joovv Full Body Light Therapy, or our Opera Mask Red Light Therapy.

Preventing Hyperpigmentation

Red light therapy may also offer a degree of protection from ultraviolet light that could reduce the effects of sunlight on hyperpigmentation. A 2016 study published in the Journal of Photochemistry and Photobiology B showed that exposing skin to certain wavelengths of red light lessened skin damage caused by ultraviolet light.

PLEIJ Salon + Spa offers a variety of services to address hyperpigmentation and other skin-related problems. We invite you to schedule a skin analysis and consultation appointment. During this service we will assess your skin’s precise condition, taking note of lifestyle factors to help us create a customized treatment program for your personal skin care needs.