Hyperpigmentation

Hyperpigmentation is a condition where certain patches or areas of our skin can appear darker than others. This can be due to intrinsic and extrinsic factors. While gorgeously freckled skin is beautiful, sometimes this hyperpigmentation can be the result of damage or disease, and it can effect your confidence to have this discolouration.

So let’s tackle the science behind the pigment in our skin!

What is the science behind hyperpigmentation?

The colour of your skin is due to pigment (melanin) produced by melanocytes. It is a misconception to think that darker skin tones have more melanocytes - all human skin types have the same number of melanocytes. The difference in darker skin tones is that the melanocytes are more active, and produce more melanin. This process is called melanogenesis and is controlled by two physiological pathways.

1. Constitutive pathway - you have a baseline pigmentation that is genetically determined, giving you your skin type (Fitzpatrick I-VI)

2. Facultative pathway - this is increased pigmentation due to extrinsic factors (UV radiation/sunlight or drugs) and intrinsic factors (inflammatory conditions, autoimmune conditions, and endocrine or nervous system disorders.)

Understanding the science and biology behind hyperpigmentation allows medical-grade skincare ingredients to specifically target the factors actually causing it, which is why it is so effective.

What are different types of hyperpigmentation?

1. Melasma/chloasma - symmetrical, blotchy skin pigmentation usually due to fluctuations in hormones (pregnancy, the pill) or UV radiation.

   It is most common in women and typically affects the forehead, cheeks, and upper lip. This can cause a lot of distress in some patients, especially if the melasma is deep and affecting both the epidermal and dermal layers of the skin. This can be a chronic condition for which there is no absolute cure, but that does not mean that a good skincare regimen can’t keep it under control and at a minimum.

   It will be important to determine whether the melasma is at an epidermal or dermal level as the higher the pigment sites in the layers of the skin, the more easy it will be to tackle with topical treatments. These can include hydroquinones, kojic acid, arbutin, azelaic acid, hydroxy acids, and retinols.

2. UV-damage - caused by exposure to UV radiation, resulting in solar lentigos (age spots) and uneven skin tone.

   Even though these changes are often referred to as being “age-related,” they are a consequence of sun exposure and nothing to do with age. They bottom line is this will not develop if you have used adequate sun protection throughout your life. They can be treated with topical ingredients like hydroquinones, hydroxy acids, and retinols. Chemical peels and lasers can be extremely effective as well.

3. Post-inflammatory Hyperpigmentation (PIH) - found in skin that has undergone trauma or inflammmation.

   This can occur in people who have darker skin tones or in those with Asian ancestry. It is important that your aesthetic practitioner is aware of this, and if you are susceptible that your skin is appropirately prepared ahead of time. This can be a difficult condition to treat as further treatments can lead to more inflammation, which will not help the situation. Gentler topical treatments and ingredients like hydroquinones, kojic acids, and retinols can be helpful.

4. Diseases - certain conditions can cause change in pigmentation (Addison's, Cushing's, hypothyroidism)

5. Drug Reactions

6. Ephelides (Freckles)

How do we treat hyperpigmentation?

Again, the cornerstone here is prevention and that is best done with consistent and regular application of sunscreen. However, once hyperpigmentation has developed, that doesn’t mean there is nothing we can do about it.

We have some powerful lightening skincare ingredients in our arsenal that can be extremely effective in tackling hyperpigmentation, some of which have been mentioned above. These ingredients are in a general class of ingredients none as tyrosinase-inhibitors - ingredients that block the enzyme that makes melanin (pigment).

Hydroquinone is a prescription ingredient that is extremely effective in blocking the melanin producing pathways in our skin. It needs to be used with caution and advice from a medical professional, as there are side effects and possible adverse outcomes if used incorrectly. However, it represents one of the gold standards for tackling hyperpigmentation. There are also many non-prescription ingredients that can be found in medical-grade skincare lines that can aid with excess pigmentation. Chemical peels and laser treatments can also be very effective for hyperpigmentation.

An important thing to note whenever there is discussion about “skin lightening” or “skin brightening” ingredients in medical-grade skincare. This is absolutely not a product intended to “whiten” or “bleach” the skin. What we mean is that we are restoring the natural pigmentation and colour in the skin, whatever that may be, and removing the excess pigmentation that is the result of skin damage or pathology.