Uneven skin tones, dark spots, blemishes – regardless of what you call it, hyperpigmentation is a major complexion killer.  Even clear skin without discoloration gives an impression of healthy skin.  Hyperpigmentation is a general term to refer to an increase or excess of natural pigment of the skin.  This can encompass a vast variety of skin phenomena, which range from acne and post inflammatory hyperpigmentation, to sun damage and photoaging.  Hyperpigmentation can affect everyone, and even in the best of skin care routine, we may be dealing with it ourselves.  In this blog, we’ll talk about common types and causes of hyperpigmentation and a doctor’s approach to MANAGE hyperpigmentation.

What is hyperpigmentation?

Hyperpigmentation is caused by pigment-producing cells called ‘melanocytes’ that start to make too much melanin.  Melanin’s main function is to protect from UV damage. That is why it is produced when there is an external danger like UV rays, free radicles, Inflammation, or injury.  The extra melanin makes our skin look darker. However, when the melanin is spread unevenly, this melanin appears as dark patches or spots, that differs from the surrounding skin.

The causes of excessive melanin production.

Many factors can cause hyperpigmentation. Individuals with darker skin tone are more susceptible to hyperpigmentation due to their baseline higher melanin in the skin.  These factors include . o    pregnancy o    medications o    hormones o    birth control o    excessive UV light o    environmental pollutants o    trauma to the skin, including picking and acne scarring

The many faces of hyperpigmentation Hyperpigmentation comes in different forms.

• Solar Lentigines, aka age spots: These are often referred to as sun spots or solar keratoses. They are pigmented blemishes that are common in Caucasians and the white population, become more numerous with repeated sun exposure and with advancing age.  You’ll find it commonly on hands, forearms, face, upper chest and upper back – where the sun most often strikes.
• Ephelides, aka freckles: These are small (1-3mm) pigmented spots containing more melanin than the surrounding skin.  It is a classic cause of the sun’s UV spurring on the production of melanin, AND are believed to be an inherited skin characteristic due to overactive melanocytes. They can pop up all of a sudden, grow darker, and cluster together.  Freckles are similar to solar lentigines but freckles have the potential to naturally fade over time or colder months, and responds well to various topical and professional treatment.
• Melasma: Also known as ‘mask of pregnancy ‘ – is not just for the pregnant.  Indeed, 90% of those affected are women, and predisposition to certain populations, especially Asians.  A whopping 40% of women in Southeast Asia has it.  It is characterized by light to dark brown spots varying in size on the face, and usually in specific patterns – centered on the face, across the cheeks, and/or on the forehead.  It is generally believed that there is a genetic predisposition, which is then activated by chronic sun exposure or female hormonal changes like pregnancy and oral contraceptives.  Sometimes these marks disappear as the trigger resolute, but in some cases, they remain permanently.
• Post-inflammatory hyperpigmentation: PIH appears due to trauma to the skin, such as a burn, acne, or squeezing a pimple. It is an overproduction of melanin following inflammation.  A frustrating part of PIH is that the inflammation can also be caused by cosmetic treatment meant to improve the skin, including chemical peels, lasers, dermabrasion et al.  With these challenges in mind, it is crucial to focus on the prevention if you are predisposed to PIH, and also work with a board certified plastic surgeon or dermatologist who can guide you towards minimizing potential irritant and working to find treatment and solutions.

Doctor’s approach

1. Keep skin hydrated and use medical grade ingredients to boost cell turnover.

While your primary goal is to lighten the hyperpigmentation, an effective skin care routine should contain three basic skin beneficial ingredients:

• (1) Retinoids: Retinoids are Vitamin A products that can penetrate deep into the skin and restrict melanin production. They also boost cell turnover to reveal fresh, more even-toned skin.
• (2) Vitamin C serum: another ingredient you will want to add to your skincare routine for battling hyperpigmentation is Vitamin C. This antioxidant is effective for hyperpigmentation and a whole range of solutions. Vitamin C serum reduces wrinkle formation by improving collagen production and provides extensive protection against harmful UVA/UVB rays. Vitamin C also defuses free radicals and reduces oxidative stress produced due to harmful pollutants. So, we should never forget to add Vitamin C to our skincare regimen to get soft, younger, and healthy skin.
• (3) Broad spectrum sun protection: An ounce of prevention really is worth a pound of cure. The most effective way to prevent sun-induced discoloration is to diligently apply a broad-spectrum sunscreen with a SPF 30 or greater, every day, even on cloudy or cool days.  UV rays just send the pigment into overdrive, turning dark spots darker.  So wear sunblock daily on exposed areas.

2.  Hands off pimples, blackheads, and other injuries.   As tempting as it might be to squeeze a pimple, trauma to the skin causes inflammation that is responsible for skin discoloration.  So follow the warning ‘don’t pick’, and treat early.  Pigmentation can move deeper into skin overtime, so the sooner you treat it, the easier it will be to erase.  Other injuries includes over exfoliation.  When done properly and gently,   can help lift dead skin cells from the surface of the skin. Exfoliation increases cell turnover causing pigmented cells to slough off to the skin surface and heals acne scars. Over exfoliation damage, the skin triggers Inflammation and weakens the skin moisture barrier function. The skin barrier is the first line of defense against UV harmful rays. When our skin becomes damaged, it cannot protect us; as a result, sun exposure worsens hyperpigmentation.

3.  Consider an Rx for stubborn skin discoloration Prescription-strength hydroquinone, alone or combined with other lighteners, are the gold standard for fading dark spots because it slows the production of pigment.  However, these treatment need to be closely monitored by your treatment physician because of potential risk of sun sensitivity, too much bleaching, or worsening of pigmentation.

4.  Ask your doctor about high-tech options If topical solutions aren’t fixing the problem, you may want to seek more aggressive ways to banish discoloration such as chemical peels, or a laser and light-based procedures such as the Lutronic Spectra Hollywood Laser which targets deeper discoloration. Before booking a treatment, consult your plastic surgeon or dermatologist to help identify what treatment best suits your condition and complexion.