William Callaghan. MD (Hyperpigmentation Surgery)
Hyperpigmentation (or skin discoloration) is a condition in which the color of the skin is darker than the surrounding area. It is usually caused by an excess of melanin production. Melanin is the brown pigment that produces skin color. Hyperpigmentation can affect the skin color of people of any race. However, people with darker skin tones are more prone to it.
Types of hyperpigmentation include freckles, melasma (also known as chloasma), and age spots (solar lentigines). Age spots are the most common form of hyperpigmentation. They are small dark spots caused by chronic sun exposure. Chronic sun exposure causes permanent injury to the skin, which then manifests in hyperpigmenation. This is why they tend to appear in the face and back of the hands during middle age and keep increasing. Melasma are larger dark spots usually caused by hormonal changes. They are very common in pregnant women.
Causes of Hyperpigmentation
- • Sun damage
- • Genetics
- • Hormonal changes, such as the ones produced by birth control pills, pregnancy, and menopause.
- • Skin diseases and skin injuries, such as acne, scars, or burns.
- • Medication. Some medicines containing minocycline, tetracycline, or chloroquine, produce hyperpigmentation as a side effect.
- • Diseases. Hyperpigmentation can also be a symptom of some diseases such as Addison’s disease, Scleroderma, or Porphyria, among others.
- • Laser Resurfacing.
- • Intense Pulsed Light (IPL) is a type of laser treatment that eliminates hyperpigmentation by heating up the damaged area. It is fast and effective to remove localized spots. However, it can also cause hyperpigmentation in cases of burns.
- • Chemical Peeling
- • Microdermabrasion
- • Topical therapies (creams and lotions). The most commonly used agents in these products are phenols (i.e., hydroquinone, mequinol), retinoids( i.e retinol and tretinoin), alpha-hydroxy acids (i.e., glycolic acid, lactic acid), glabridin (also known as licorice extract), kojic acid, and azelaic acid.
- • Hydroquinone based products are widely used. Hydroquinone is very effective in reducing hyperpigmentation. Usually a 4% hydroquinone is the minimum concentration that may be effective. One must be cautious when using Hydroquinone since side effects have been reported.
- • Retinoids reduce hyperpigmentation by accelerating cellular turnover and increasing epidermal exfoliation, which leads to a greater loss of epidermal melanin. Retinoids may also reduce melanin synthesis because when speeding up exfoliation melanine has less time to be produced.
Glabridin (also known as licorice extract) inhibits melanin production by inhibiting tyrosinase activity. It also has anti-inflammatory properties. This is still under investigation.
Kojic acid is a natural product found in a type of fungi and produced in the fermentation process of rice to make sake. It seems to inhibit melanin production by blocking an enzyme essential to its production.?Kojic acid’s major drawback is that it can cause skin sensitivity and contact dermatitis in some individuals.
Azelaic acid is a component of grains, such as rye, barely, and wheat. Besides being used to treat hyperpigmentation, it is also effective against acne. It is antibacterial, anti-inflammatory and will protect against free radicals too.
Arbutin is a natural and safe hydroquinone derivative. It is found in the leaves of some berry plants.?It has been shown that arbutin is an effective inhibitor of melanine production by blocking Tyrosinase activity.