WHAT IS HYPERPIGMENTATION?
Hyperpigmentation occurs when the skin produces more melanin, the pigment that gives skin its color. This can make spots or patches of skin appear darker than surrounding areas. Hyperpigmentation may be localized, as in the case of post- inflammatory hyperpigmentation or melasma, or more diffuse in its presentation. Diffuse hyperpigmentation tends to be associated with metabolic causes, certain medications, malignancy, or autoimmune or infectious etiologies¹.
WHAT CAUSES HYPERPIGMENTATION?
Post inflammatory hyperpigmentation (PIH) and reactions to systemic drugs are two major causes of both localized and diffuse hyperpigmentation. Melasma is another common cause of localized hyperpigmentation. Additional causes of diffuse hyperpigmentation include metabolic diseases, nutritional deficiencies and, occasionally, HIV infection. Age spots also are another common cause of hyperpigmentation.
Post inflammatory hyperpigmentation (PIH): represents an acquired excess of melanin pigment following cutaneous inflammation or injury. It can occur anywhere on the skin surface, including the mucous membranes and the nail unit. PIH is extremely common and can have significant cosmetic and psychosocial consequences. Acne vulgaris, atopic dermatitis and Lichen simplex chronicus are disorders associated with post inflammatory hyperpigmentation.
Melasma: is a common acquired disorder characterized by symmetric, hyperpigmented patches with an irregular outline, occurring most commonly on the face.
Age spots: also called liver spots — are small dark areas on the skin. They vary in size and usually appear on the face, hands, shoulders and arms — areas most exposed to the sun. Age spots are very common in adults older than 50. But younger people can get them too, especially if they spend a lot of time in the sun.2
Medical conditions: more serious causes of hyperpigmentation include Addison’s disease and hemochromatosis
WHAT ARE THE TREATMENT OPTIONS FOR HYPERPIGMENTATION?
Although hyperpigmentation is harmless, some people wish to get rid of it.
To prevent hyperpigmentation, or to stop it becoming more prominent:
- Avoid exposure to the sun
- Use a sunscreen with an SPF of 30 or higher , to protect the skin and stop hyperpigmentation from becoming darker.
To treat hyperpigmentation, two lines of therapies are available:
- First line therapy includes topicals with triple combination therapy (including hydroquinone, topical retinoids, topical steroids). Often due to the irritations and allergies caused by the triple combination, the patients look for other topical therapies like azelaic acid, kojic acid or dermocosmetics like Trimethoxybenzylidene Pentanedione (Synoxyl® HSS), with less or absent topical skin reactions.
- Second line of therapy include chemicals peels like salicylic acid peels and glycolic acid peels in combination with topicals and Laser therapy. Only a derma expert should perform these procedures.
New skin problems can occur when the person who gives the treatment does not tailor it to the patient’s skin type.
If you have hyperpigmentation, dermatologists recommend the following tips:
- Wear sunscreen daily: one of the most common treatments for hyperpigmentation is sun protection. Apply sunscreen 15 minutes before going outside and reapply at least every two hours.
- Choose gentle skin care products: choose skin care products that don’t sting or burn, as products that irritate the skin may worsen hyperpigmentation.
- Avoid picking at the skin: To prevent hyperpigmentation from forming after an injury, avoid picking at spots, scabs, and acne.
- Bolognia Dermatology – 3d edition