Hyperpigmentation usually refers to any darkening of the skin. Regardless of the cause – be it a breakout or eczema – hyperpigmentation is an umbrella term for visible patches of darkened, discolored skin caused by an overproduction of melanin. While hyperpigmentation is a normal function of the skin, it is a common concern for women of color and can be an anxiety-inducing skin condition. Ahead is a breakdown of it’s causes and prevention measures and treatments used to manage it.
TYPES OF HYPERPIGMENTATION
Discoloration is not one in the same and the specific type will determine how the skin will be treated. If an appropriate treatment is not used discoloration can worsen. As always, when considering what treatments to incorporate into your routine remember that what works for one person may not work for you. There are four main types of hyperpigmentation - Post-Inflammatory Hyperpigmentation (PHI), freckles, age and sunspots, and melasma.
Post-Inflammatory Hyperpigmentation, or PIH, is the medical term used to describe discoloration of the skin that follows an inflammatory wound. It can develop in all skin types, but it tends to be more severe and longer lasting for people with medium to deep complexions. It is the skin's natural response to inflammation. PIH usually looks like a flat area of discoloration on the skin. It can range in color from pink to red, purple, brown, or black, depending on your skin tone and the depth of the discoloration. As the skin heals, it produces too much melanin. It's the excess melanin that darkens and discolors the skin. This discoloration remains even after the wound has completely healed. (American Academy of Dermatology)
Freckles are small brown spots on the skin, often in areas constantly exposed to the sun. In most cases, freckles are harmless. They form as a result of melanin overproduction. Light and dark freckles normally appear in childhood and are most visible on lighter skin tones but all skin tones can develop them. New “adulthood” freckles can appear and existing freckles darken after extensive sun exposure. (American Academy of Dermatology)
Age and sunspots are small dark areas on the skin that vary in size and usually appear on the face, hands, shoulders and arms — areas most exposed to the sun. They are very common in adults over 50, but anyone can get them. Especially if significant time is spent in the sun. Similar to freckles, age spots are most visible on lighter skin tones. (American Academy of Dermatology)
Melasma is a common skin concern. It causes brown to gray-brown patches, usually on the face. Most people will see this on their cheeks, bridge of the nose, forehead, chin, and above the upper lip. Women are far more likely than men to experience melasma. It is so common during pregnancy that it is commonly referred to as "the mask of pregnancy." Because hormones seem to trigger melasma it is especially difficult to treat. (American Academy of Dermatology)
1. SUN DAMAGE - A major cause of hyperpigmentation and large factor in worsening existing pigment issues. People of color aren’t exempt from sun damage. Damaging sun rays penetrate all skins, regardless of ethnicity and tone. More importantly, the damage isn’t limited to hyperpigmentation. Skin cancer isn’t as common in people of color, but it is often associated with increased morbidity and mortality in people of color*. It’s also important to note that people of color can experience sunburn, which is sun damage. Sunburn in darker skin tones will present darker and feel painful, hot and dry. More severe cases can experience swelling, peeling, cracking and blisters
*Ip et al, Skin cancer awareness in communities of color, JAAD January 2011.
2. HEAT - Raising the body’s temperature can trigger an inflammatory response, triggering increased melanin activity.
3. GENETICS - Some are genetically prone to pigmentation like dark circles around the eyes.
4. AGING - Very common cause of increased pigmentation due to hormonal changes (especially during the onset of menopause).
5. TRAUMA - Acne, breakouts, cuts, burns, bruises, bug bites result in trauma to the skin and post-inflammatory hyperpigmentation (discoloration left after the lesions resolve). Picking makes it worse.
6. SKIN CONDITIONS AND DISEASES - Acne, eczema and psoriasis often leave skin scarred, patchy and discolored.
7. HARSH PRODUCTS AND PROFESSIONAL TREATMENTS - Inappropriate treatments and products (harsh facial scrubs are common culprits) can inflame skin resulting in post-inflammatory hyperpigmentation. Now that we have greater access to different modalities and treatments (ie products, lasers and chemical peels) it’s essential that you do your research and speak with a skin expert. All lasers and peels are not created for all skins and can cause very serious damage. Research and consult with a skin expert prior to undergoing a treatment and never perform professional treatments at home (“professional strength” peels from Amazon are a not your friends regardless of what Youtubers say). Skin experts are familiar with products and ingredients and how they react to the skin. They’re also trained to act if an emergency occurs in the treatment room.
8. PREGNANCY - Common cause of melasma (patches of discoloration often referred to as “pregnancy mask”) due to changes in hormone levels. This type of hyperpigmentation can sometimes fade on its own post pregnancy but often reoccurs with sun exposure and heat and can be difficult to manage.
9. HORMONES - Contraceptives can cause unwanted pigment due to the increase of hormone levels.
10. PRESCRIPTION MEDICATION - Discoloration can be a side effect of some prescribed medications. While you can take steps to treat this type of hyperpigmentation topically, it’s important to keep your physician in the loop.
While bouts of hyperpigmentation cannot be avoided, there are ways to reduce its impact on the skin. A skincare regimen that includes products specific to your skin type and concerns is important to keep your skin protected and prevent breakouts that cause and leave dark spots once resolved. Regardless of skin type, a proper routine will include the following:
SUNSCREEN - Prevention nor reduction of existing pigment is possible without sunscreen. Because UV rays are one of the largest contributors to hyperpigmentation, the first step is to protect the skin from sunlight. There’s a consensus among skin experts worldwide that the use of SPF 30 is suitable for all skins. It is a common misconception that people of color don’t need sunscreen. While melanin does provide some protection from UV rays, the protection is minimal – about SPF 15. This misconception has led to miseducation about sun protection and undiagnosed skin cancers. Foundation, mineral makeup and powders can offer additional protection when applied over sunscreen.
ANTIOXIDANTS - Daily use of an antioxidant (vitamin C is the standard) serum can provide additional protection and skin brightening.
NOT PICKING - Refrain from picking at breakouts.
Regardless of how it occurred, there are several products and treatments available to treat hyperpigmentation.
EXFOLIATION - Exfoliating a couple times a week will help break down and remove pigmented cells. This is gentle exfoliation. Trying to “scrub away” unwanted pigment will only cause more trauma to the skin and make it worse. Look for well-formulated acid exfoliants and gentle scrubs used with a light hand.
RETINOL – The gold standard of skin care ingredients is a great topical treatment to increase cell turnover and reduce the visibility of pigmented skin.
SKIN LIGHTENERS/BRIGHTENERS – Targeted serums and spot treatments should be used to fade and suppress melanin production. For the purposes of this article, skin lighteners are not used bleach the skin. They are specific to the hyperpigmented areas only to fade unwanted pigment to the skin’s normal color. Look for products that include vitamin C, licorice root extract, kojic acid, and hydroquinone to name a few. Note: There is much controversy surrounding the OTC use of hydroquinone. While the percentage used in OTC products is minimal (1%-2%), hydroquinone should be used with caution and knowledge. According to dermatologist Joyce Imahiyerobo-Ip, MD, "The concern with hydroquinone is that it can also bleach normal skin, many experience skin irritation, and if it is used for an extensive period of time it can cause paradoxical skin darkening. However, it is a powerful pigment fighter."
PROFESSIONAL TREATMENTS – Chemical peels, microdermabrasion and lasers can reduce pigmentation and reveal brighter, even skin. When seeking laser treatments and peels it's also important to consult with a knowledgeable skincare therapist to determine the best treatment for varying skin tones.
PATIENCE - Patience is required to treat hyperpigmentation. Because all skins are different, it’s difficult to speculate when you might see results. Improvement can generally be seen in 4-8 weeks, but that depends on a lot of factors (how long the pigment has been present, skin tone, etc), so be patient and consistent with your treatment plan.
For most of us, occasional discoloration will happen, but a combination of proper sun care, a skincare routine specific to your skin’s needs and professional treatments can reduce the impact on otherwise clear complexions.