Causes of Hyperpigmentation

We see more hyperpigmentation as we grow older. As the skin ages, the number of melanocyte cells decreases. The remaining melanocyte cells increase in size and their distribution becomes more focused and their overproduction of melanin causes age spots, especially in those over the age of 40. Although aging is a factor there are also a number of other triggers that can cause discolouration. These can be:

• Sun & UV damage
• Stress
• Acne
• Pregnancy
• Hormonal changes
• Medications
• Medical conditions
• HEV Light (High Energy Visible Light)

Types of Hyperpigmentation

• Solar Lentigo - pigmentation spots resulting from exposure to ultraviolet (UV) radiation / sun exposure
• Post-Inflammatory Hyperpigmentation (PIH) - pigmentation caused by any injury to the skin, for example spots left behind after a pimple heals
• Melasma (also called chloasma, or the “mask of pregnancy,” when it occurs in pregnant women) - Although it isn’t totally clear what causes melasma darker-skinned individuals are more at risk than those with fair skin. Estrogen and progesterone sensitivity have been associated with the condition, for example birth control pills, pregnancy, and hormone therapy. Stress and thyroid disease are also thought to be causes of melasma.

Treating Hyperpigmentation

There is no quick fix for hyperpigmentation. You will need to think about the level of commitment you can give to the process as the treatment will need to be a combination of home and salon treatments. These will need to fit in with your social calendar, lifestyle and budget.

Although there are many different treatments available on the market to treat hyperpigmentation and the best solutions should both exfoliate the skin's surface to sweep away darkened cells to reveal healthy, glowing cells that lie underneath and also help prevent new spots from forming.

In my experience the best starting point is to use products containing tyrosine inhibitors. Tyrosine is the enzyme which controls melanin production and Tyrosinase Inhibitor products will reduce the enzyme from over stimulating so there is no further overproduction of pigment in the skin.

The tyrosinase Inhibiting ingredients to look for in products are:

• Hydroquinone - hydroquinone, is a fast-acting anti-hyperpigmentation agent but one that comes with quite a few side effects, especially if used for a longer period of time. Extreme caution should be taken while using hydroquinone and one should avoid trying over-the-counter versions containing this ingredient.
• Kojic acid - a skin lightening agent used extensively in skin lightening skin care products. It penetrates deep within skin layers and inhibits tyrosinase activity to reduce melanin production.
• Tranexamic acid - this is a lesser known skin-lightening agent. Tranexamic acid is used in ointments and skin creams for its effect on decreasing the activity of tyrosinase and melanogenesis.
• Vitamin C (L-ascorbic Acid) - Vitamin C is the topmost skin brightening and lightening agent that inhibits tyrosinase enzyme and reduces melanin production at the cellular level. It is widely used in serums to reduce and treat hyperpigmentation.
• Liquorice - Liquorice or Glycyrrhiza glabra is actually the herbal root of the Glycyrrhiza plant and is extensively used in skin-lightening products and helps to brighten up skin. It also has anti-microbial properties.
• AHAs (Lactic acid, Mandelic acid) - AHAs work by gently exfoliating the top layer skin to remove dead skin cells revealing healthy, younger looking skin, free from hyperpigmentation.
• Niacinamide - reduces the transfer of melanin from the melanocytes to the skin cells.
• Retinol / Vitamin A - Retinoids are chemically related to vitamin A which regulates cell growth. It helps by unclogging pores and preventing acne breakouts. It boosts collagen production and speeds up the cell renewal process reducing the appearance of fine lines and wrinkles. When used consistently, retinoids can keep your skin clear and acne free, even out skin tone, reverse sun damage and pigmentation, improve wrinkles and mild scars and prevent premature aging. These factors along with the exfoliating properties, make retinoids the gold standard for acne and anti-aging treatments.
• Green Tea extract - may improve hyperpigmentation due to its potential antioxidant and anti-inflammatory properties.
• Ferulic acid - an antioxidant that binds directly to the tyrosinase enzyme, inhibiting its activity, and slowing down the production of melanin. It also smooths out fine lines and wrinkles.
• Quercetin - an antioxidant, a flavonoid compound, which inhibits the activities of tyrosinase enzyme. A lot of citrus fruits, grapes, berries, apples and honey are rich sources of quercetin.
• 4‐n-butylresorcinol - a strong tyrosinase inhibitor and is a very skincare ingredient to inhibit melanin production.
  Mulberry extract - a natural ingredient extracted from mulberry leaves which has strong tyrosinase inhibiting activity. It is a very safe skin lightening agent.
• Alpha arbutin - extracted through plant sources such as cranberries, bearberries, it’s considered to be a good anti-hyperpigmentation agent that helps to clear dark spots without irritating the skin.
• Azelaic Acid - this is one of the naturally occurring ingredients that is produced by skin’s microbiome and can be obtained from barley, wheat and other grains. It belongs to the family of carboxylic acids. It is considered to be a wonderful ingredient for acne-prone skin because of antibacterial and anti-inflammatory properties. Also, it helps in exfoliating the skin as well. You can find azelaic acid in prescribed medicines and some over-the-counter and cosmetic products. Azelaic acid can be used to treat hyperpigmentation and melasma. This acid is known to target the pigment-producing cells-hyperactive melanocytes. This makes it perfect for treating dark spots and hyperpigmentation, making the skin even-toned. Moreover, it exfoliates the skin and sloughs off the dead skin cells, revealing a smoother skin.

Where to start

A good approach is to start by using a home prescription of skin products for 3 months before beginning clinic treatments. Always try the gentle approach first to build up skin tolerance then progress to more advanced treatments.

Of the many different ways to help to fade existing pigmentation from the skin the best results are achieved by the use of chemical peels. This approach is dependent on whether the skin is ready for it and is in its optimum health so that the recovery time is minimised.

Treatments to avoid

In my personal opinion as someone who has been working with clients for several years I'm not the biggest fan of microdermabrasion as it is far too harsh. The treatment initially brings very quick results but there is a risk that it can cause Post Inflammatory Hyperpigmentation (PIH) over the long term. Another hyperpigmentation treatment to avoid is any kind of laser treatment as it is not easy to target specific areas. Finally I would advise against micro needling at home because of the hygiene concerns and issues with the angle of the needles and consistency of the rolling pressure.

How quickly will I see results?

Epidermal pigmentation is mostly brown and fades out in several months. Dermal pigmentation has a grey‐brown colour and is much harder to remove. One of most difficult types of hyperpigmentation to remove is Melasma.

Pigmentation will often get worse before it gets better and on average it will take around 12 months to reprogram the melanin-producing melanocytes to change and re-educate themselves to not produce as much melanin.

If you struggle with hyperpigmentation you may have this condition forever and even if we visibly improve your skin and you will still need to protect your skin daily. If, for example, you drop your guard for a few days and you forget to apply SPF all of your hard work could be undone, which is why you will need to be committed to protecting your skin at all times!

Hyperpigmentation Prevention

In addition to using products which will help to prevent the excessive production of melanin there are other measures that will help to protect against hyperpigmentation.

• As sun exposure is the primary cause of hyperpigmentation it is essential that you protect your skin from the sun’s rays. This means using a suitable SPF even on cloudy days and wearing hats and sunglasses for added protection. Don’t neglect delicate areas in need of extra protection such as eyelids and consider using powders containing SPF over makeup. Avoid the sun altogether to be extra safe!
• Avoiding picking spots which could potentially cause Post-Inflammatory Hyperpigmentation (PIH)
• Know your triggers, if oral contraception is a trigger consider speaking to your doctor about trying a different combination.
• Some supplements to consider: Vitamin D (as we are protecting ourselves from the sun), Vitamin A, Antioxidants and most importantly Vitamin C which is crucial in skin protection.

Always remember to choose cosmeceutical medical grade skin care products. This is important because:

~ They are the correct concentration ~

~ The delivery system is optimised to make the ingredients work ~

~ Clinical studies have been done to support results ~