Skin Problems: Hyperpigmentation

Throughout history, the popularity of a dark tan has come and go.  We have learned, although, that the damage done by tanning far outlasts the actual tan.  The results…hyperpigmentation.  As a result, both men and women seek ways to fade or even out the splotches of hyperpigmentation caused by sun exposure and the aging process.

What is Hyperpigmentation?  Hyperpigmentation is abnormally increased pigmentation of the skin.  To understand how to prevent or slow down the effects of hyperpigmentation, you need to understand what causes it.  The cells responsible for hyperpigmentation are located in the top layer of the skin and are called melanocytes.  Melanocytes are the cells that produce a chemical compound called melanin.  Melanin is a sort of protein made up of an amino acid called tyrosine.  It is what makes the skin tan on exposure to the sun.  Over time increased melanin may cause irregular dark spots on the face, back, arms, hands, and legs.  Those age spots, sunspots, liver spots and freckles are considered unsightly.

Another cause of hyperpigmentation, hormonal changes caused by pregnancy or oral contraception, can make the skin extremely photosensitive.  These hormonal changes can create a condition known as melasma.  Melasma is pigmentation that occurs on the face and is induced when the hormone estrogen stimulates the melanocytes.   When uneven melanin production occurs it creates patches of hyperpigmentation.  These patches of dark brown, sharply marginated, and roughly symmetric areas are also referred to as the mask of pregnancy.  Hormonally related hyperpigmentation may resolve after pregnancy, but sometimes it needs to be treated with treatment and skin lighteners.

Post inflammatory hyperpigmentation is the increase of pigmentation seen in the skin after an injury or inflammation to the skin such as a rash, acne breakouts, scratching, bruising, surgical and/or laser procedures.  Inflammation also can cause the melanocytes to produce more melanin.  Some drugs can also induce hyperpigmentation.  Some of the most common drugs that cause discoloration of the skin are amiodarone, minocycline, tetracycline, bleomycin, and cyclophosphamide and the antimalarial chloroquione. 

In most cases where the pigmentation only involves the superficial layers of the skin, it will eventually resolve, even when not treated.  However, if the condition affects deeper layers of the skin, treatment may be required and can be over a prolonged period of time.

Treatments for hyperpigmentation vary, depending on the individual need. Skin-bleaching agents or skin lighteners are one such treatment.  In actuality, these agents neither bleach the skin nor lighten.  What they actually do is block the production of the enzyme tyrosinase, therefore, inhibiting the overproduction of melanin. 

Topical treatment is usually with products that contain hydroquinone, kojic acid, glycolic acid, mandelic acid, azelaic acid, topical Vitamin A (Tretinoin), bearberry extract, licorice extract or combinations of the above.  

Hydroquinone lightens the color of the skin areas to which it is applies, and is the only FDA approved product for bleaching.  It is affective in about 60-to70% of its users.   It is available over the counter in concentrations up to 2%, with higher concentrations obtained by prescription.  It is safe to use in low percentages and short periods of time.  Too high a percentage of hydroquinone over prolonged use and direct sun can cause mutagenic damage to melanocytes.  It is imperative to stay out of the sun for the treatment to work

Kojic Acid is used as an alternative to hydroquinone. Research shows kojic acid to be an effective lightening agent, works in the same manner as hydroquinone and is less irritating.

Mandelic and glycolic acids are fruit acids.  They are not technically bleaching agents, but have shown to have lightening properties.

Arbutin is an extract of the bearberry plant.  It has been found to be a popular product used for de-pigmentation and is non-irritating to the skin.  Besides inhibiting the formation of melanin by inhibiting tyrosinase activity, arbutin is known as an anti-inflammatory and an anti-bacterial ingredient.  Licorice extract as well as arbutin are well tolerated and do not cause irritation.

When using any skin lightener, it is imperative that you use the best sunscreen possible.  This is because the melanocytes are particularly sensitive in the areas of hyperpigmentation and any UV sun exposure will just cause more pigmentation.

An even complexion is always desired.  Most don’t realize that effects of daily sun exposure.  Regular sunscreen usage can help to prevent unwanted discoloration from even occurring. Sunscreens, more than anything else, will help prevent Premature aging and wrinkles in the skin.  Just remember 90% of all wrinkles, age spots and skin discoloration is due to sun and tanning bed exposure.