Florida based board-certified plastic surgeon, Michael E. Jasin, M.D., gives his expert advice on the causes and treatments of hyperpigmentation.
Hyperpigmentation plagues women and men of all ages, and it can have a major impact on how we look and feel. This discoloration has myriad manifestations and causes, but all hyperpigmentation has one thing in common: Its root cause is the overproduction of a pigment called melanin within the skin. Though a suntan is technically hyperpigmentation, when pigment is concentrated unevenly in spots or patches, the contrast with lighter surrounding skin makes it much more noticeable.
There are three main types of hyperpigmentation, and each has a distinct cause. The most common culprits are hormonal fluctuations, skin trauma and sun exposure, though certain medications (like the antibiotic tetracycline, for example) can have an effect on pigment as well.
- Melasma/Chloasma: Hormonal surges can cause patches of pigment to develop on the central part of the face, including the cheeks, forehead and above the lip. Melasma is most commonly seen in women who take oral contraceptives, and pregnancy can cause the condition as well (in which case it’s called chloasma—or the mask of pregnancy). Though pregnancy-induced hyperpigmentation often resolves itself in the months following childbirth, melasma can be one of the more difficult forms of hyperpigmentation to treat. Melasma affects all skin tones and is more likely to recur than other types of hyperpigmentation.
- Post-inflammatory hyperpigmentation (PIH): Any skin trauma—including acne and insect bites—can leave a pigmented spot behind after healing is complete. Those with olive and darker skin tones most often experience this kind of hyperpigmentation.
- Solar-induced hyperpigmentation: Age spots on the face, chest and hands are a form of hyperpigmentation caused by an accumulation of sun exposure. Like an uneven tan, some areas get darker than others, leading to the freckled appearance that accompanies other visible signs of aging.
There are a wide variety of hyperpigmentation treatments, but the most important first step is addressing the underlying cause. In the event of melasma, patients may wish to consider alternate forms of birth control. In patients who have PIH, getting acne or other causes of inflammation under control can stop the hyperpigmentation cycle. And for those with sun-induced hyperpigmentation (or any type of discoloration for that matter), practicing “safe sun”—i.e. wearing a sunscreen such as SkinMedica’s TNS Ultimate Daily Moisturizer™ + SPF 20
or Environmental Defense Sunscreen™ SPF 30+
every day—is imperative for reversing the effects.
Treatment options are often dictated by the cause of the discoloration, but doctors generally start with a conservative approach as more aggressive treatments can actually make hyperpigmentation worse. SkinMedica’s TNS Essential Serum®
is usually my first recommendation since the blend of growth factors, peptides and antioxidants help repair damage and prompt the skin to start functioning optimally. In many cases, patients see a lightening and brightening of dark spots and the complexion as a whole with this one serum alone. If this isn’t enough, adding topical vitamin C or retinol products is the next step. From there, a skin-bleaching agent such as the 4% hydroquinone found in EpiQuin® Micro has been proven to fade discoloration and is extremely effective for stubborn hyperpigmentation. In-office chemical peels, such as SkinMedica’s Vitalize Peel ®, Illuminize Peel® and Rejuvenize Peel™, offer improvement for hyperpigmentation and other visible signs of skin aging as well. As a last resort, a light resurfacing treatment with an Erbium laser can lift excess pigment and even out skin tone.