Hyperpigmentation

The main symptom of hyperpigmentation is the development of darkened areas on the skin. These can occur in patches, vary in size, and can develop anywhere on the body. The symptoms of the condition vary depending upon the type. The most common types of hyperpigmentation are:

• Sunspots: Sunspots, also known as solar lentigines or age spots, are commonly seen. They are sometimes referred to as liver spots, although they are not related to any liver disorder. Sunspots are caused by excessive exposure to the sun over time and appear as brown, black, or tan spots. They are typically found on the face, back of the hands, and areas of skin that have been exposed to the sun for extended periods.
• Melasma: Melasma, also known as chloasma, is characterized by hyperpigmented brown to greyish-brown patches on the face, including the cheeks, upper lip, and forehead, as well as the forearms. It can also affect the arms, neck, abdomen, back, or any area of skin exposed to sunlight. Melasma is often referred to as the ‘mask of pregnancy’ because it primarily affects pregnant women. It is also observed in women taking oral contraceptives, and non-pregnant women and dark-skinned men can also be affected. The condition is more prevalent and tends to last longer in individuals with dark skin.
• Post-inflammatory hyperpigmentation (PIH): This type of hyperpigmentation is caused by an injury or inflammation of the skin. It presents as patches or spots of darkened skin, usually occurring after inflammatory skin conditions such as acne or eczema. It commonly appears on the face or neck.

The most common cause of hyperpigmentation is excessive production of melanin pigment. There are different conditions or factors that can alter the production of melanin in the body that lead to hyperpigmentation such as:

• Excessive exposure to the sun: Prolonged exposure to the sun can cause the body to produce more melanin to protect the skin from harmful rays. This results in patches or dark spots known as sun spots or age spots, typically seen during middle age and increasing with age. There is a direct correlation between skin pigmentation and the geographical distribution of ultraviolet radiation. Dark-skinned individuals are often found in areas with higher UVB radiation, while light-skinned individuals inhabit areas farther from the tropics.
• Skin inflammation: Darkening of the skin can occur after inflammation in that area, including inflammation caused by acne, psoriasis, lichen planus, atopic dermatitis, and allergic contact. Post-inflammatory hyperpigmentation is more severe in cases of recurrent inflammation compared to short-term acute inflammation. This hyperpigmentation can last for months to years and may affect a person's quality of life.
• Melasma: Also known as 'chloasma' or the “mask of pregnancy,” melasma occurs in pregnant women and causes dark discolored patchy hyperpigmentation, typically on the face in symmetrical patterns. It is more prevalent in women of all ages and races, although men can also be affected. The exact cause of melasma is not fully understood, but factors such as increased estrogen levels during pregnancy or the use of oral contraceptives are linked. Melasma usually resolves after pregnancy or when birth control is discontinued. Some individuals may have a genetic predisposition or suffer from thyroid or liver disorders. UV exposure can exacerbate melasma, which may appear at any time, and a regular skincare routine may not suffice to prevent its appearance.
• Reaction to certain drugs: Medications such as tricyclic antidepressants and antimalarial drugs can cause hyperpigmentation, resulting in patches of skin that appear greyish. Additionally, chemicals in topical treatments may also lead to hyperpigmentation.
• Addison's disease: This autoimmune disorder affects the adrenal glands, which produce hormones influencing every tissue and organ in the body. Addison's disease can result in hyperpigmentation of the elbows, knees, skin folds, lips, knuckles, and toes. Other symptoms include fatigue, muscle weakness, nausea, and vomiting.
• Hemochromatosis: An inheritable condition causing the body to retain excessive iron, leading to hyperpigmentation where the skin appears darker than usual. Other symptoms include stomach pain, joint pain, fatigue, and weight loss.
• Acanthosis nigricans: Hyperpigmentation of intertriginous areas such as the nape of the neck and armpits is associated with insulin resistance, which may lead to diabetes and metabolic syndrome.
• Linea nigra: A hyperpigmented line found on the abdomen during pregnancy.
• Peutz–Jeghers syndrome: An autosomal dominant disorder characterized by hyperpigmented macules on the lips and oral mucosa, along with gastrointestinal polyps.
• Smoker's melanosis: This condition manifests as brown to black pigmentation of the oral tissue, including the gums, cheeks, or palate, and is most often seen in the lower gums of tobacco users.
• Mercury poisoning: This can cause darkening of the outer layer of the skin, often resulting from the topical application of mercurial ointments for skin whitening.
• Porphyria: A group of liver disorders where substances called porphyrins accumulate in the body, negatively affecting the skin and causing local damage and resultant hyperpigmentation over time.
• Metabolic causes: These include vitamin deficiencies, such as Vitamin B12 and folic acid.
• Cancer: Although less common, diffuse hyperpigmentation can occur in cases of malignancy, particularly related to melanoma. This is more prevalent in patients with metastatic disease or those with melanoma of unknown origin.

Some common risk factors of hyperpigmentation include:

• Prolonged exposure to the sun
• Darker skin tone that is more prone to changes in pigmentation
• Use of oral contraceptives or pregnancy, particularly in cases of melasma
• Certain medications that can increase the skin’s sensitivity to sunlight
• Trauma that wounds the skin, such as burn injuries
• Inflammation, which plays an important role in post-acne hyperpigmentation

Hyperpigmentation can be caused by multiple factors and can be diagnosed. Some of the diagnostic tests include:

• Physical examination: A skin specialist known as a dermatologist can determine the cause behind your hyperpigmentation. They can perform a physical exam or biopsy, in which a small sample of skin is taken and sent to a lab for further investigations. Melasma can usually be identified by a doctor by just looking at the skin.
• Complete medical history: Hyperpigmentation can be caused by certain medications and some health conditions. A detailed medical history can help in confirming the diagnosis.
• Woods lamp: The Woods lamp examination uses ultraviolet light to show fluorescence. This device is used by a dermatologist to diagnose different pigmentations of the skin. The exam will be conducted in a darkened room, allowing the Wood's light to illuminate the affected area for a few seconds. The doctor will look for changes in color or fluorescence. Normal skin will not show fluorescence, whereas the presence of fungal or bacterial infections, or pigment disorders will.

There is no sure way to prevent hyperpigmentation. However, there are several methods to reduce your risk of developing it:

• Apply sunscreen to protect your skin against the harmful rays of the sun. The most recommended SPF level is 50.
• Cover your face with hats or caps when going out in the sun.
• Avoid going out when the sun is at its strongest, especially in the afternoon.
• Add Vitamin C to your beauty regimen.
• Limit scratching or touching your skin frequently.

There are various treatment modalities available to reduce and treat hyperpigmentation. They include:

1. Topical creams
   Many people opt to use over-the-counter topical creams that contain ingredients that can lighten the skin. These include creams with kojic acid, azelaic acid, hydroquinone, retinoids, and Vitamin C. Topical prescription creams with hydroquinone can effectively lighten the skin and are often considered the topical “gold standard” for melasma and hyperpigmentation management. However, prolonged use of hydroquinone is not advisable as it may lead to a condition called ochronosis, where the skin darkens further. Always consult a dermatologist before using a cream containing hydroquinone for proper guidance. Creams containing retinoids or kojic acid may take a couple of months to show effects.
2. Chemical peels
   Chemical peels are an effective treatment for hyperpigmentation. This technique involves applying a chemical solution to the skin, leading to exfoliation and peeling. The regenerated skin in the treated area is typically smoother and less wrinkled. Commonly used chemicals for peels include glycolic acid, salicylic acid, and trichloroacetic acid. If you are using a topical retinoid, consult your doctor before using an over-the-counter peel, as you may need to stop retinoid use for seven days prior to the peel. Superficial chemical peels utilize alpha-hydroxy acid or other mild acids that penetrate only the outer layer of the skin, improving mild skin discoloration. Medium-strength chemical peels use glycolic or trichloroacetic acid, penetrating the outer and middle layers of the skin to reduce age spots and moderate discoloration. Deep chemical peels employ trichloroacetic acid or phenol, penetrating deeper layers to help reduce shallow scars and age spots.
3. Dermabrasion
   Dermabrasion is a medical procedure that employs a wire brush or diamond wheel to level the superficial layer of the skin. Treated areas heal and allow new skin to regenerate. This procedure injures the skin, so patients should be prepared for their appearance immediately after treatment and during the regeneration period. It is essential to discuss expectations with a doctor, as the results of dermabrasion may take several weeks or months to become evident.
4. Laser resurfacing
   Laser resurfacing is a popular medical procedure that utilizes a laser device to enhance the skin's appearance. It is also employed to treat minor flaws and remove layers of skin. The carbon dioxide (CO2) laser is the most commonly used type for treating minor wrinkles, scars, and other conditions, while the erbium laser is effective for improving superficial and deep lines on the face, hands, and chest, causing fewer side effects than the CO2 laser. Laser toning using YAG laser and intense pulsed light can also be used to treat hyperpigmentation, including melasma and post-inflammatory hyperpigmentation.

Hyperpigmentation is not a serious condition, but it can affect your mental well-being due to its appearance. Here are a few tips that can help you manage it:

• Always follow the instructions given by your dermatologist.
• If you have been advised to apply a topical cream or use a particular face wash, do so consistently and be patient for the results to become evident.
• Apply sunscreen when going outside, even on cloudy days.
• In case you have acne or other forms of facial injury, avoid poking or touching that area.
• Avoid scratching or picking at the affected area, as this can increase inflammation and lead to further darkening of the skin.
• Use over-the-counter products that contain spot-eradicating ingredients such as arbutin and niacinamide.
• Carefully read the information leaflet of any medicine, as applying too much of any product can cause skin irritation.
• Consider trying natural ingredients like aloe vera, green tea extract, and sandalwood to help lighten the skin.

Hyperpigmentation is the harmless darkening of the skin and does not cause any particular complications. In case your hyperpigmentation does not improve within a few months, consult a doctor to rule out any underlying medical conditions.

Hyperpigmentation can be lightened with ingredients found at home. Natural face packs can work wonders. However, it is always better to consult with your dermatologist before using these home remedies.

• Aloe Vera: Aloe vera is a plant that contains aloesin, a compound that can lighten hyperpigmentation by reducing melanin production in the skin. Applying aloe vera has been found to relieve melasma in pregnant women. You can use natural aloe vera or aloe vera gels available in the market.
• Licorice (Mulethi): This extract may reportedly lighten hyperpigmentation. Licorice extract has antioxidants and anti-inflammatory agents that promote skin lightening.
• Green Tea: Green tea contains antioxidants and anti-inflammatory properties that can improve hyperpigmentation.
• Turmeric (Haldi): Regular application of turmeric, which is rich in antioxidants, helps in lightening dark patches and reduces the occurrence of pimples that can lead to hyperpigmentation.
• Potato (Aloo): Potatoes contain an enzyme called catecholase, which is known to lighten skin pigmentation, dark spots, and blemishes.
• Tomato (Tamatar): Tomato paste is rich in lycopene, which protects the skin against both short-term and long-term effects of sun damage.
• Milk (Dudh): Milk, buttermilk, and even sour milk contain lactic acid that helps to lighten skin discoloration.
• Sandalwood (Chandan): This age-old remedy is used by many to achieve a glowing complexion. Sandalwood helps to lighten hyperpigmentation spots as it contains natural skin-lightening agents.

Hyperpigmentation of the skin is harmless; however, it can affect a person's mental health and make them self-conscious about their appearance. This can impact their quality of life and lead to feelings of discouragement. Fortunately, there are effective ways to manage hyperpigmentation.

• Avoid going out in direct sunlight. If you do, always apply a sunscreen that contains SPF 30 or above. Remember to reapply sunscreen every two hours.
• Wear hats or caps to protect yourself from harsh UV rays.
• Use gentle, fragrance-free products that do not contain ingredients that can exacerbate inflammation or irritation of the skin.
• Avoid waxing areas that have melasma, as this can cause skin inflammation.
• Increase your intake of foods rich in Vitamin A and antioxidants. Vegetables such as spinach, carrots, lettuce, broccoli, red bell peppers, and sweet potatoes can help reduce and prevent pigmentation.
• Consume plenty of citrus fruits. Vitamin C has antioxidant properties that help reduce damage caused by harmful UV rays and prevent dark spots.
• Address Vitamin B12 deficiency, which is a common cause of skin pigmentation. Meeting your daily requirement can assist in managing pigmentation.
• Drink plenty of water to keep your skin supple and eliminate toxins. Aim for at least 2-3 liters of fluids during the summer.
• Always consult a dermatologist for a correct diagnosis of any underlying cause and appropriate treatment for hyperpigmentation.