How to Get Rid of Hyperpigmentation

Hyperpigmentation is one of the most common skin concerns I encounter on a regular basis as Aesthetic Nurse Specialist. It is one of my favorite topics because the treatment modalities vary depending on the type, cause and nature of the problem. Sometimes a patient will come to me and ask for sunspots removal but upon evaluation, it's actually melasma which for the most part is the trickiest to address. But first, let's understand few basics so you and I are on the same page.

Hyperpigmentation results from increased activity and accumulation of melanocytes or skin cells that produce melanin. Certain ethnicities and people with darker skin are more prone to developing hyperpigmentation. While hyperpigmentation is presented in different ways, the most common types are the following:

Sun spots (age or liver spots) are characterized by light to dark brown spots that are scattered on the face, arms and hands. Sizes vary from few millimeters to size of a quarter. As the name suggests, sun spots develop as a consequence of years of unprotected sun exposure. Hence, the older you get, the more sun spots you may have especially if sunscreen is not part of your skincare routine.

PIH or post- inflammatory hyperpigmentation develops as a result of post-injury or lesion to the skin such as acne, insect bite, contact dermatitis, medication-induced, among others. It is clinically manifested as macules or patches in a similar fashion as the initial inflammatory process. While they typically resolve, sometimes it takes longer to see complete resolution. It is important to identify and treat the root cause of the problem rather than being reactive. For example, patient A was concerned with multiple dark spots on arms and legs for several years. During  assessment, I noticed the constant scratching and severe dry skin. So while the dark spots can be treated aesthetically although very challenging, it is imperative to address the issue that's causing the PIH: scratching related to dry skin.

Melasma appears as brown to gray patches on the face where sun typically hits: forehead, cheeks, nose, upper lip. It affects about 90% of pregnant women that's why it is also called mask of pregnancy (chloasma). The exact pathogenesis remains unclear but sun exposure, genetics, hormones, and certain medications all play a significant role.

While some people aren't concerned with hyperpigmentation, this is actually a big business to a lot of cosmetic companies. The big question is, do topical creams actually work? what about peels, lasers?

For many years, depigmenting agents are considered as first line of treatment. However, it is important to note that success rate depends on the cause, severity and timing of treatment. The earlier it is to start treatment, the better the response. In general, uncomplicated hyperpigmentation or light spots may have great success with the following:

Tretinoin, lactic acid, retinoid, licorice root works before melanin synthesis (pre).

Hydroquinone, kojic acid, arbutin, azelaic acid, l-ascorbic acids works during melanin synthesis (active phase).

Retinoic acid, glycolic acid, linoleic acid, lactic acid works after melanin synthesis (post).

You will find that most skincare products combine the aforementioned ingredients to address the different stages of melanin activity and that's because melanocytes go through a life cycle. It takes several months or even longer before one can see improvement. Most don't hence they look for more advanced options such as:

Non-invasive aesthetic procedures like LASER (Light Amplification by Stimulated Emission of Radiation) or IPL (Intense Pulse Light) can also treat hyperpigmentation. Laser can either be ablative or non-ablative and its use depends on the severity as well as patient's preference. It targets the pigment buried beneath the skin resulting to complete reduction or eradication. Note that while laser or ipl can remove sun spots, neither will prevent re-occurrence. It is also important to mention that not all lasers or ipls can work on melasma or post-inflammatory hyperpigmentation. Hence, it is equally imperative to have these procedures done with the correct machine and qualified provider. Why? because sometimes laser  or ipl can exacerbate PIH or melasma! Proper patient assessment plays a crucial part.

Other treatment modalities also include chemical peels, microdermabrasion or other light-based procedures. You will find that most aesthetic clinics, med spas or dermatologists combine treatments to yield optimal results.

Finally, I will bring you back to my number one skincare product of all time, Sunscreen! UV exposure intensifies PIH, melasma and is the culprit to sun spots, photodamage (premature wrinkles) and worse, melanoma. So slather because your skin matter!

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