How to treat and prevent it!
Hyperpigmentation is a very common problem. Research indicates that Melasma (a form of hyperpigmentation that appears as dark patches on the face) affects approximately 5 million people in the United States. According to a report, the pigmentation treatment market was valued at approximately $5.2 billion in 2017 and is expected to generate revenue of around $8.5 billion by 2024, growing at a compound annual growth rate (CAGR) of 7.02% between 2018 and 2024. Despite how common hyperpigmentation is; it can be very difficult to treat. Which is why it’s extremely important to diagnose and treat it early, and also prevent it from getting worse.
What is hyperpigmentation and why does it happen?
Hyperpigmentation is an umbrella term referring to a very common skin issue, discoloration. At the root of this problem is melanin, the pigment that gives skin its color. Melanin is produced by cells called melanocytes that reside in the base layer of the stratum corneum (outermost layer of skin). It’s the over production and uneven distribution of melanin that causes hyperpigmentation.
Sun exposure is the number one reason why the skin is triggered to produce more melanin. When our skin is exposed to the sun rays, melanocytes produce more melanin — an act done to protect the skin. This starts off as a nice tan on the skin, which with increasing sun exposure and over time results in irregular distribution of melanin. And you end up with age/sun spots, freckles and even melasma.
The sun is not the only culprit here, any kind of inflammation or trauma to the skin can result in over production of melanin. Think back to the stubborn acne marks that won’t fade, the eczema flare-up that takes forever to clear up or a small cut on the skin that won’t heal fast enough.
And some people are more prone to hyperpigmentation — because their skin has more melanin to begin with. That is, the darker your skin tone the more risk you have of developing hyperpigmentation in the first place.
What are the different types of hyperpigmentation?
- PIH (postinflammatory hyperpigmentation) — This is the discoloration that lingers after certain skin inflammation (pimples, cuts, or rashes). The reason — excess melanin gets deposited in the area due to our skin’s reaction to the trauma. PIH is typically light brown to almost black in color and affects people of color more since their skin has more melanin to begin with.
- Age spots — This is the most common sign of aging in people, this form of hyperpigmentation is caused by excessive exposure to the UV rays resulting in sun damage to the skin. You’ll see age spots spring up in areas that are exposed to the sun most frequently, like the face, arms, hands and neck. In women these age spots can get exacerbated during hormonal changes.
- Melasma — This will show up as patches of discoloration on the face, most commonly on the cheeks, the forehead, on the upper lip, and the chin area. It’s more common in women and is commonly triggered by hormonal changes, such as during pregnancy or menopause, or while on birth control. Some people may also be genetically predisposed to melasma.
- Freckles — The reason for freckles is linked to genetics. But they can get worse or darker with increased UV exposure.
How to prevent hyperpigmentation?
Hyperpigmentation is extremely difficult to treat, in most cases can only be reduced. So needless to say, prevention is better than cure.
- Avoid sun exposure — Sun is the biggest culprit when it comes to hyperpigmentation. Whether you are trying to prevent hyperpigmentation or applying products to treat it — you need to avoid direct sun exposure. No treatment in the world will work if the skin is not protected from the sun. Wear a broad spectrum sunscreen with an SPF of 50 every single day, rain or shine and don’t forget to reapply every 2 hours if staying outside. Try to stay away from the sun between 10–4 pm. If stepping outside, wear a wide brimmed hat to block out the sun rays.
2. Treat skin issues promptly and don’t scratch or pick at your skin — Whether it’s a cut, acne, or eczema flare up — address the issue as soon as it appears. If left unchecked the site is more prone to inflammation and infection, thus leading to hyperpigmentation. Also, don’t scratch your acne or wounds. Use gentle ingredients and avoid using harsh scrubs on the face — the more inflamed the skin gets the more likely you are to pigment.
How to treat hyperpigmentation?
A multi-pronged skincare approach is required to effectively treat hyperpigmentation and keep it in check. This involves using skin brightening agents to target the discoloration; use of retinoid and exfoliating acids to speed up cell turnover to reveal fresh skin; and using antioxidants to help counteract the sun damage.
- Skin brightening ingredients — Tyrosinase is the enzyme that facilitates the production of melanin in the skin. Ingredients in this category work by inhibiting tyrosinase so the skin can’t produce as much new melanin.
Hydroquinone is often considered the gold standard when it comes to treating hyperpigmentation. However, it’s use has been associated with adverse side effects such as skin irritation and exogenous ochronosis in dark-skinned people (a condition where the prolonged use of hydroquinone causes rebound pigmentation, worse than before and typically blue-black in color). This is the reason I don’t recommend using it unless prescribed by a dermatologist.
Side-effects of hydroquinone have led to the identification of newer ingredients. Research (review 1 and review 2) indicates these alternatives are safer and more potent inhibitors of melanin formation.
- Alpha arbutin — Sometimes referred to as “natural hydroquinone”, alpha arbutin is a plant derived antioxidant and skin brightener. It provides all the benefits of hydroquinone but without the side effects. This is my favorite ingredient for tackling hyperpigmentation. Stick with low percentages between 1–2%.
Products: The Ordinary Alpha Arbutin 2% + HA
- Azelaic acid — Another great tyrosinase inhibitor, azelaic acid has not only skin brightening properties but is also anti-microbial — i.e. it can help treat acne. This makes it a perfect choice to prevent breakouts and the associated hyperpigmentation.
Products: The Ordinary Azelaic Acid Suspension 10%
- Licorice extracts — This ingredient is a multi-tasker — it inhibits the production of tyrosinase, removes excess melanin from the skin, and also acts as an antioxidant to mop up the damage caused by UV rays.
- Kojic acid — It not only inhibits the production of melanin but also acts as an antioxidant undoing the damage wreaked by the sun. Kojic acid works best when paired with tranexamic acid (another skin brightener) and Niacinamide. According to a 12-week clinical study done in 2019, a combination of 3% TXA, 1% kojic acid, and 5% niacinamide reduced PIH and melasma by almost 60%.
Products: SkinCeuticals Discoloration Defense
- Tranexamic acid — This is a new ingredient on the scene, known for its melanin inhibiting properties. Works synergistically with other ingredients, but can also be used by itself (best between 0.5–2.5%).
- Niacinamide — It works by blocking the transfer of melanin from the melanocytes to skin cells on the outermost layer, thus reducing brown spots and evening out the skin tone.
2. Retinoid and exfoliating acids — Gosh is there anything retinoid can’t do? It increases cell turnover so is extremely effective in getting rid of those abnormal melanocytes. It is also anti-inflammatory so can help reduce PIH. Exfoliating acids work by shedding the outermost layer of skin, with regular use the skin tone becomes even and radiant.
3. Antioxidants — This class of ingredients work by neutralizing free radicals that damage our skin on a daily basis (think UV rays, pollution — car exhaust, cigarette smoke, chemicals). Vitamin C makes the cut not only because it is the most potent antioxidant, but because of its effectiveness in treating hyperpigmentation. It works by blocking excess melanin production in the skin, making it a must have ingredient in your treatment regimen.
The bottom line….
Nobody is immune to hyperpigmentation; most likely it will happen to you at some point in your life. So don’t take your skin for granted — start protecting it today with a broad spectrum sunscreen and treat it promptly at the first signs of hyperpigmentation.