Hyperpigmentation is a condition affecting both men and women of all skin types. I want to break it down for you and offer a few viable solutions.
Let’s start with how pigmentation is formed. Our melanocytes deep in our skin are the source of melanin. Melanin is what shows up as pigment in our skin. There is a whole cascade of events leading to the appearance of that melanin on the surface of the skin. Essentially (and slightly simplified) a trigger stimulates tyrosinase (an enzyme) within the melanosome and converts the amino acid tyrosine into melanin. Then melanogenisis occurs where the melanin migrates to other cells and shows up towards the surface as a brown spot or hyperpigmentation. There are different types of hyperpigmentation, including;
- Solar Lentigines (age or liver spots)
- Ephelides (good old fashion freckles)
- Melasma (mask like, mostly affecting women and the most difficult to treat)
- Chloasma (the mask of pregnancy, can also occur on abdomen, similar to Melasma)
- PIH (post inflammatory hyperpigmentation)
The key to treating hyperpigmentation is a combination of prevention and correction.
There are multiple triggers for hyperpigmentation and pinning down the triggers is key. The biggest culprit is UVA/UVB exposure. (sun exposure) But there are other culprits as well, including;
- Medications (such as BCP, HRT, antibiotics and certain seizure medications)
- Skin injury leading to PIH (post inflammatory hyperpigmentation)
- Thyroid dysfunction
- Excessive picking at skin
- Hormone imbalances
Identifying if any of the above are contributing to your hyperpigmentation is helpful.
So now let’s talk about how to treat it once it is there. There are numerous approaches and combination therapy works best. Treatments and key ingredients can work synergistically together.
- SUNSCREEN, SUNSCREEN, SUNSCREEN (a must)
- Topical antioxidants
- Wearing a hat when prolonged exposure is unavoidable
- IPL (or photofacial)
- Laser resurfacing (for example Fraxel Dual)
- Topicals that are tyrosinase inhibitors or interrupt the formation of melanin
Let’s talk about that last one a bit. There are numerous ingredients which inhibit tyrosinase (remember that enzyme converts the amino acid tyrosine into melanin)or interrupt somewhere else on the pathway leading to pigmentation. There are both over the counter and prescription options.
- Hydroquinone (this is a tyrosinase inhibitor) is available both OTC in a 2% solution or as a Rx, 4% or higher. It is a proven ingredient that has been successfully used for years.
- Tretinoins- These Vit A derivatives help to turn over the skin cells and hyperpigmentation fades as the skin exfoliates. (Retinoids/Retinols)
- Kojic Acid- also helps inhibit tyrosinase and helps other products penetrate deeper.
- Niacinamide- Stops melanosomes from transferring melanin to surrounding cells. (melanogenisis)
- Arbutin- An alternative to hydroquinone. It is derived from bearberry plants.
- Antioxidants- Vit C (ascorbic acid), Vit E (tocopherol), Green Tea, Resveratrol
- Glycolic Acid- also helps with cellular turnover.
- Licorice Root- A chemical called galbridin inhibits tyrosinase.
- Kligman’s Solution- This is a very effective prescription combining hydroquinone, Tretinoin and a steroid. Your provider can determine what % of each active ingredient would be appropriate for you.
A popular line carried in doctor offices for pigmentation is the Obagi line. In most states the line includes several products with 4% Hydroquinone and a Tretinoin cream. This is a very effective and popular line for fading pigment and renewing the skin. Here in Texas, however, we are unable to sell prescription strength Hydroquinone or Tretinoin OTC so we carry the Fx version of the Obagi line which utilizes a high percentage of arbutin in place of Hydroquinone.
OTC products include Neocutis Perle and Nouvelle which have their Melaplex non-hydroquinone skin brighteners Melaplex is a proprietary blend of four ingredients which help fade pigmentation (Phenylethy Resorcinol, Leucine, Undecylenoyl Phenylalanine and Sodium Glycerophosphate). The Skinceuticals line has Phyto + which utilizes arbutin and kojic acid to help with pigmentation. Additionally, they have the Metacell Renewal B3 with a high percentage of niacinamide (one of my current faves!) which also assists with the fading of pigment. These are just a few of the OTC products available for pigment. Always look for the key ingredients to help choose products to fade pigment.
When a patient comes in wanting to address their hyperpigmentation we often prescribe a combination of therapies. A common combination is a series of IPL’s, peels or microdermabrasions with topical therapy to maintain the results. It really depends on the individual and how much downtime they can afford and how much they want to invest in their treatment.
I hope this helps give you an idea of how hyperpigmentation can be addressed.
Please feel free to ask any questions:-)