- What is hyperpigmentation and the causes?
- Acne Scarring vs Post Inflammatory Hyperpigmentation (PIH)
- Ethnic Skin & Hyperpigmentation
- How long does it take to get rid of hyperpigmentation?
- How do you treat hyperpigmentation?
The Story Behind Hyperpigmentation
Hyperpigmentation has numerous causes and triggers and can be particularly stubborn to treat.
This article covers several points:
- What is normal pigmentation?
- What is hyperpigmentation?
- Where does it come from?
- It also list the three different types of hyperpigmentation
- Methods to treat and control hyperpigmentation.
Normal Pigmentation Function
Pigmentation in the human skin 1 protects us against UV radiation, it acts as a own multi-SPF. Protecting your skin cells from radiation damage, by absorbing the UV rays.
Research has shown, Caucasian skin has an SPF of about 3.4, whereas Black skin is protected with a “natural” SPF of 13.4.
Unfortunately, they can only absorb so much, then the process breaks down, leading to hyperpigmentation and possibly skin cancer.
Let’s examine the three layers of skin to see where pigmentation starts.
The Epidermis - The epidermis, consisting of two layers.
- The top layer, the Stratum Corneum contain layers and layers of dead cells
- The bottom layer of the epidermis is alive.
There at the base of the bottom layer of the epidermis exist a wavy border.
Bingo,,,, This is where the color factory begins.
Where does pigmentation come from?
In this wavy layer between the dermis and live layer of the epidermis, the melanocytes cells exist and the epithelial cells are also born in this wavy border.
The melanocytes sprinkle melanin into the new epithelial cells as they come into existence. Melanin is the natural pigment in your skin, it what gives your skin, hair and nails their color. Each cell is given a dose according to your generic programing, in other words your “Fitzpatrick Skin Type” . More information below on Skin Fitzpatrick Scale .
The Role of Epithelial Cells Plays In Producing Even Skin Tones
As each epithelial cell is born it absorbs the melanin give it by the melanocytes and starts its migration to the surface carrying its bounty of nutrients and melanin. Each generation as it’s being born moves the previous generation upward. Bringing with its allotted amount of pigment.
If nature is undisturbed everything works according to plan. We have even skin tones, no dark spots or hyperpigmentation. But, that’s not the case, is it?
The most common cause of hyperpigmentation is sunlight. Exposure to the sun's UV rays triggers a protective mechanism; the production of melanocytes. Melanocytes are a group of special cells existing in the bottom layer of the epidermis, they are responsible for producing skin-darkening pigment melanin. Melanin is responsible for the color of your skin, eyes and hair
What is hyperpigmentation and the causes?
Hyperpigmentation is an excess quantity of skin pigment (melanin), triggered by an internal or external cause. Where the areas on the skin become darker than the surrounding skin. The excessive pigmentation everyone calls hyperpigmentation, presents itself in different ways. Listed below are the three types of pigmentation disorders.
1. Age Spots, Lentigines, Liver Spots
Lentigines usually come more widespread with age. 90% of light-skinned people over the age of 60, Lentigines are not caused by the aging process, but linked to ultra violet radiation exposure.
Protect your skin from UV radiation. We’re exposed to UV rays every day despite how bright the sun is shining. You should also use beauty products that contain SPF protection, including moisturizers, lip balm, lipstick and makeup.
2. Melasma or Pregnancy Mask
Melasma is the excess of pigment in areas, such as the cheeks,temples or forehead. Why does 5melasma happen? Melasma is in your genes it could be hormonal and UV induced or possibly triggered by phototoxic medications.
Hormonal in balance can trigger melasma. The rise and fall of hormones during pregnancy, thyroid dysfunction, hormone replacement therapy or with birth control pills are possible causes.
Melasma is a very difficult condition to treat. It affects about five to six million women in the United States. A patchy brown discoloration that occurs on sun-exposed areas on the face and is frequently referred to as the “mask of pregnancy” because it often happens during pregnancy. Melasma can materialize in anyone, although the disorder is more common in the Fitzpatrick IV skin.
Sun exposure also can worsen melasma. According to dermatologist’s recommendations, sunscreen should be applied every two hours and wearing a wide-brimmed hat for extra protection.,
Melasma pigmentation can be reduced certain lasers, chemical peels and melanin suppressants.
Tranexamic Acid for Melasma
Among the 12 trials examining oral, topical and injectable tranexamic acid for melasma treatment, several were high-quality studies supporting tranexamic acid’s use as a monotherapy or in combination with other melasma treatments. None of the trials reported any adverse events, suggesting the therapy is safe. The risk of relapse is high when tranexamic acid is discontinued, so providers might consider it as a long-term therapy option,
3. Post-inflammatory Hyperpigmentation (PIH)
The injury or trauma to the skin produces inflammation. This inflammation causes the melanocytes cells to produce extra melanin . Post-inflammatory hyperpigmentation is most common in people with darker skin tones.
This type of hyperpigmentation usually follows skin injuries, such as, acne injuries, psoriasis, burns, manual friction or the wrong chemical peel.
Acne Scarring vs Post Inflammatory Hyperpigmentation (PIH)
According to dermatologist Corey Hartman, there is a difference. Your dark spots could be the results of post inflammatory hyperpigmentation (PIH). The texture of PIH spots and acne scars are different.
Nodulocystic acne creates scar tissue that pulls down the skin. They are called icepick scars. When you touch the spots, you can feel an obvious texture difference.
In the case of post inflammatory hyperpigmentation (PIH), the discoloration on the skin usually feels smooth to the touch without raised texture.
Afro Americans should take extra care when treating acne scars. Treating the scarring incorrectly could cause undesirable results; additional pigmentation.
Ethnic Skin & Hyperpigmentation
Ethnic skin has an increase melanin in their skin and the 4melanocytes the cells that make the pigment are very sensitive to trauma. Consequently, any minor injury, such as picking a blemish or an insect bite could develop into a long-lasting or permanent dark spot.
The major of Post Inflammatory Hyperpigmentation is the results of the additional melanin produced in people of color, which includes African, Asian, Hispanic, Middle Eastern, Native American and Pacific Island heritage see (Skin Fitzpatrick Scale) below.
Inflammation produces extra pigment, The melanin produced during an inflammatory injury can enter the dermis. These cells can stay in the upper dermis for a long period. That includes wearing sunscreen. Darker-skinned people are not immune to sun damage. Even though high levels of melanin exist, it does not give 100% protection from the sun’s UV radiation.
In fact, it’s the same melanin levels, that causes darker-skinned people to develop dark spots easily. That’s why reducing hyperpigmentation should be a slow process. It’s important not stimulate the melanocytes into producing additional melanin. The skin needs time to regenerate itself, this process could take months depending on cell turnover. Steps should be taken as to not cause additional inflammation or injury.
Fitzpatrick Skin Scale
photograph courtesy of the Researchgate
How long does it take to get rid of hyperpigmentation?
"Epidermal hypermelanosis will appear tan, brown, or dark brown and may take months to years to resolve without treatment".
Other possible causes of hyperpigmentation
- Certain prescription medications make the skin photosensitive, resulting in hyperpigmentation.
- In addition, some illnesses could cause hyperpigmentation.
- Hyperpigmentation and driving - UV exposure is 5 times greater to the left arm and 20 times greater to the left side of the face. This left-side sun exposure triggers sun damage, wrinkles, skin leathering, sagging, hyperpigmentation and age spots. The more time you spend driving, the higher your risk of sun related skin damage.
To accelerate the brightening process, introduce melanin suppressants into your home care treatment as well as professional treatments.
Products must be used morning and evening for a minimum of 8 weeks before an improvement in the skin is noticed. Patches may actually look darker before they look lighter because of the speeding up of the desquamation (shedding) process.
If the injury is not repeated and the area is protected from direct sun light, the dark spot will begin to fade on its own as the skin renews itself - this process could take months or more.
First and above all else, you HAVE to protect the area from UV radiation. Wearing good sunscreen protection is a must. Use a hat and stay out of direct sunlight as much as possible. This will allow the melanocytes cells to calm down and work less aggressively.
How do you treat hyperpigmentation?
There are many combinations of treatments available to treat PIH safely and effectively. When treating epidermal PIH the best products for hyperpigmentation are topicals 6,7depigmenting agents, such as the following ingredients:
These depigmenting topicals can be effective by themselves or synergistically. Chemical peels, such as salicylic acid, glycolic acid, Jessner's and Trichloracetic acid (TCA) peels can be combined with topicals as part of a PIH treatment program for deeper pigmention problems.
Studies have shown laser therapy is beneficial, particularly the Q-switched ND:YAG.
In addition to depigmenting topicals, there are quite a few cosmeceutical ingredients that can be added to enhance your results. I’ve listed thirteen in my article 13 Skincare Ingredients To Reduce Hyperpigmentation, but there are many more available in today’s market.
Start with a good skin care routine
First of all a GOOD sun protection is a must. It’s very important to minimize the effects’ of the sun UV’s rays being absorbed by your skin’s cells.
Your skincare regime should include natural melanin inhibitors to lower the amount of melanin distributed into the skin.
Then, once the skin starts responding, it’s ready for a gentle exfoliation. The exfoliation should be very gentle, steady, but effective to rid the skin of pigmentation and restore even skin tones.
In order to keep the results you must remain on a good skincare regime.
One that should include retiniol (vitamin A) for normalizing celllular turnover, vitamin C & E for anti-oxidant support. Vitamin C is a natural skin brightener.
How you treat hyperpigmentation depends on it’s root source. In addition to the individual’s skin Fitzpatrick type. Each cell is given a dose melanin according to genetic heritage.
Melasma is an acquired pigmentary disorder characterized by brownish hyperpigmented macules usually on the face.
Laser and IPL treatments of melasma are for individuals with stubborn melasma who failed with topical treatments or a series of chemical peels.
The persistent and stubborn characteristics of melasma make it difficult for treatment. Choosing the right laser and the correct settings is vital in the treatment of melasma.
According to Asher Milgrom, PhD – AMA’s CEO and Chief Scientist, “The trick is knowing what kind of energy to use, or combination of energies to use that are emitted from different lasers.
As a matter of fact, there are 5 different frequencies of laser energy that are useful in targeting melanin. Furthermore, there are 3 different ways to modulate the “pulse duration” of the energies that also affect how the melanin will interact with the laser (Long-Pulse, Q Switched, PICO).”
Studies of laser– IPL treatments for individuals with melasma have shown that a maintenance routine after treatment is necessary to slow the recurrence of melasma.