hyperpigmentation full image

Quick Summary: Hyperpigmentation (skin color irregularities) is caused through sun spots, post-inflammatory hyperpigmentation, or melasma. Fortunately there are many great treatment options for hyperpigmentation including topical skin care products, chemical peels, laser or light therapy and Cosmelan Skin Lightening System. Continue reading to learn how to get rid of hyperpigmentation for good!

What is Hyperpigmentation?

Skin coloration irregularities are relatively common. Pigmentation disorders like hyperpigmentation can make the skin appear lighter or darker, or blotchy in places and can occur affect people of all races. Hyperpigmentation is a skin condition in which some areas of the skin produce more melatonin than others, causing dark spots.

Skin pigmentation is determined by melanin, a substance produced by melanocyte cells in the skin. Melanin absorbs UV light, thus protecting the body from its harmful effects. However, it is quite common for melanin to be excessively produced by the body leading to Skin pigmentation irregularities. These fall into one of three categories:

  • Actinic lentigines, also known as sun spots
  • Post-inflammatory hyperpigmentation
  • Melasma

Actinic Lentigines

Actinic lentigines (AKA age spots or sun spots) are brown spots that develop as a result of the cumulative effects of sun damage inflicted on our skin, throughout the years. The spots are pale brown or gray in color and have a clearly defined edge. They typically develop on the areas of the skin most frequently exposed to the sun, such as the face and back of the hands. The number of sunspots become more visible as we age.

Actinic lentigines are particularly common in places like Austin, where the weather is hot and sunny and the residents like to spend lots of time outdoors.

lentigines 2

Actinic lentigines on the upper back (Photo Credit: http://www.aocd.org)

Post-inflammatory Hyperpigmentation

Post-inflammatory hyperpigmentation is the result of inflammation in the skin caused by acne, burn, rash or traumatic injury.

It appears as irregular shaped patches of brown skin. They are caused when an injury, illness, or infection triggers an inflammatory response within the skin. This causes the melanocyte cells to increase their rate of melanin production, and the melanin leaks out and upwards towards the surface of the skin.

post inflammatory hyperpigmentation case

Post-inflammatory hyperpigmentation before and after (Photo Credit: HealthFox.com)

Melasma

Melasma shows up as larger patches on the cheeks, forehead, upper lip and jaw line. It is caused when the female hormones estrogen and progesterone stimulate the melanocyte cells to produce excessive amounts of melanin when exposed to sunlight. Due to this involvement of the female hormones, melasma is much more common in women, particularly pregnant women, and those taking birth control pills. The occurrence of melasma will increase the more the skin is exposed to sunlight.

It is typically the most difficult to treat because the pigment can be deep in the skin and the discoloration tends to recur easily with the slightest sun exposure.

melasma forehead

Meslama on the forehead (Photo Credit: WebMD)

Hyperpigmentation can result from sun exposure, inflammation, scarring, hormonal changes, or age. This relatively harmless condition can be treated multiple ways, each with their own pros and cons.

Hyperpigmentation Treatment Options

There are a range of cosmeceuticals and other hyperpigmentation treatment options available to combat any of the above pigmentation issues. The following is a basic road map for effectively treating hyperpigmentation:

Step 1: Sun Protection

The first course of action for any form of hyperpigmentation is to use sun protection to prevent it worsening. UV rays, from sunlight, are the primary cause of hyperpigmentation. You can protect your skin with a high sun protection factor (SPF) sunscreen, SPF clothing, wide brimmed SPF hats and sunglasses.

Our offices carry a variety of excellent broad spectrum sunscreens such as EltaMD, Skin Medica, IS Clinical and Revision Intellishade.

We can help you select one that best suits your skin type and lifestyle.

Step 2: Over The Counter Topical Products

The next step is the use of several over the counter topical products including the following:

Topical Lightening Creams

Lightening creams are available over the counter, or in stronger prescription-only formulas. They’re sometimes labeled as skin bleaching creams, fading creams or whiteners. These topical treatments are typically applied to the skin twice per day and lighten hyperpigmented spots over time.

Hydroquinone is the most popular active ingredient in lightening creams. Others include retinoic acid and other Vitamin A derivatives, kojic acid, arbutin or steroids. Although banned in the United States, some lightening creams still use mercury as the active ingredient, so be sure to read the label carefully. Mercurio, mercuric and calomel are alternative names for mercury.

Pros:

  • Work best for flat, superficial age spots and melasma
  • Work well on a variety of skin types
  • Available over the counter
  • Easy to apply at home

Cons:

  • Can take longer to work than professional treatments
  • Prolonged use of steroids may lead to unwanted health conditions
  • Prolonged use of skin lighteners can lead to premature skin aging
  • Prolonged use can increase risk of sun damage and skin cancer

Topical Facial Acids

Skin acids chemically exfoliate the top layer of skin to shed discolored skin cells and encourage new skin cell growth. They are available over the counter, or by prescription only for more concentrated strengths.

The most common of these acids are in the hydroxy acid family. The most used beta hydroxy acid is salicylic acid. Common alpha hydroxy acids include citric acid, lactic acid and glycolic acid. Vitamin-C, in the form of l-ascorbic acid, is an increasingly popular facial acid.

Pros:

  • May decrease other signs of aging, including wrinkles
  • Available over the counter
  • Easy to use at home

Cons:

  • Work best on light skin tones
  • Increases risk of sunburn and sun damage
  • Can cause dryness and irritation

Retinoids

Retinoids are a derivative of Vitamin-A and available over the counter, or in their most common prescription formula, as Retin-A. OTC varieties are gentler on the skin than Retin-A, although they will take longer to work.

Retinoids penetrate into the deeper layers of the skin to increase skin cell turnover. They also specifically block the formation of melanin.

Pros:

  • May decrease other signs of aging, including wrinkles
  • Suitable for all skin tones
  • Available over the counter
  • Easy to use at home

Cons:

  • In some people, retinoids trigger hyperpigmentation
  • Can take a long time to see results
  • Increases risk of sunburn and sun damage
  • Can cause dryness and irritation

Step 3: Cosmelan Skin Lightening Mask

For moderate to severe hyperpigmentation or melasma that is unresponsive to the treatments outlined above, there’s the option of using Cosmelan Mask by Mesoestetic. Cosmelan works by peeling surface pigment away to lighten any hyperpigmentation. It also blocks the enzyme involved in the melanin formation process to prevent any further pigmentation in the skin. This non-invasive skin lightening treatment rejuvenates the skin and brightens the complexion. It’s safe to use on all skin types and is highly effective on all types of hyperpigmentation, including melasma, sun spots, or hyperpigmentation caused by acne scarring.

Step 4: In Office (Professional) Treatments

If the hyperpigmenation is resistant to the Cosmelan Mask, we offer a variety of powerful in office treatments including:

Microdermabrasion

Microdermabrasion is a method of manual exfoliation that removes the top layer of skin. A hand-held tool sprays the skin with tiny crystals that sand off the top layer of skin cells which are then vacuumed up into the device.

Because it treats the epidermis only, microdermabrasion is only effective for superficial hyperpigmentation that doesn’t penetrate the deeper layers of skin.

Pros:

  • A quick, in-office procedure
  • Requires no downtime
  • Unlike dermabrasion, microdermabrasion works well on all skin tones

Cons:

  • Only targets surface hyperpigmentation
  • Skin may be red and swollen for 24 hours after treatment
  • Requires multiple sessions for best results

Chemical Peels

Chemical peels are facial acids applied at stronger concentrations by a dermatologist or trained esthetician. They reduce hyperpigmentation by removing the top layer of skin, encouraging skin cell turnover.

More stringent (concentrated) peels are able to penetrate deeper layers of the skin, but require more downtime to allow exposed skin to heal.

Pros:

  • Works more quickly than OTC topical treatments
  • Can penetrate into deeper layers of the skin, for more dramatic results
  • Work well on age spots, sun spots and melasma

Cons:

  • Works best on light skin tones
  • May require downtime to heal
  • Increases risk of sunburn and sun damage
  • Can cause redness, blistering or general irritation

Laser Skin Resurfacing

Laser resurfacing treatments use the light from a laser to target hyperpigmented areas of the skin. Ablative lasers remove the top layer of the skin, while non-ablative lasers target the deeper layers of the skin to promote collagen growth and skin cell turnover while leaving the outer layer of the skin untouched. Popular resurfacing lasers include Fraxel and Clear + Brilliant.

Pros:

  • Ablative lasers are strong and offer dramatic results
  • Non-ablative lasers require no downtime
  • Non-ablative lasers will also firm skin and may reduce wrinkles

Cons:

  • Ablative lasers require several weeks of downtime
  • Ablative treatments leave skin raw and exposed
  • Ablative lasers work best on light skin tones
  • Non-ablative lasers may also cause redness and swelling
  • Non-ablative lasers cause some people’s skin to darken

Intense Pulse Light Therapy

Intense Pulse Light Therapy, or IPL, is a type of non-ablative resurfacing. This technique is sometimes known as a photo facial. IPL targets the skin with light at varying wavelengths, which is gentler than the intensely-focused single-wavelength laser.

The technique improves hyperpigmentation and will also boost collagen production for tighter skin and fewer wrinkles. IPL is also used for permanent hair removal.

Pros:

  • Can also remove freckles, birthmarks and varicose veins
  • Is gentler than laser resurfacing
  • In-office sessions are quick and easy
  • Requires no downtime

Cons:

  • Works best for those with light skin tone
  • Not recommended for those who scar easily
  • Can cause mild redness and swelling
  • Requires several treatments for best results

Recurrence

None of these treatments can completely prevent pigmentation problems from returning. You can minimize the possibility of pigmentation problems by limiting your skin’s exposure to the Sun’s UV rays.

Which Hyperpigmentation Treatment is Best for Me?

Choosing the hyperpigmentation treatment option that’s best for you depends on the severity of your skin spots, your tolerance for recovery time, and your skin tone.

Simple, at-home methods include lightening creams, facial acids and retinoids. Each of which is available in prescription strength for faster results.

More dramatic results are available with chemical peels or laser skin resurfacing, but these treatments may require a recovery period for skin to cycle through regrowth, peeling, and healing.

If you’re someone who tans easily, or has darker skin IPL therapy and more intense lasers may be off-limits. Lower-strength chemical peels and microdermabrasion work well on those with medium to dark skin tones.

An experienced dermatologist can help you decide which method is best for your unique skin type and skin condition.


Lela Lankerani, MD

Lela Lankerani D.O. received her undergraduate degree in Biology at Washington University where she graduated cum laude. Dr. Lankerani has published articles in several scientific journals and has presented at national scholarly meetings including the American Academy of Dermatology and American Osteopathic Academy of Dermatology.


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Source: WESTLAKEDERMATOLOGY.COM

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