Best Practices in the Treatment of Hyperpigmentation
By: Ahmed Abdullah, MD
Posted: April 27, 2012, from the May 2012 issue of Skin Inc. magazine.
Hyperpigmentation is not only a prevalent condition; it’s one that can also be particularly stubborn to treat. In fact, both skin care professionals—who lament the challenges of treating hyperpigmented skin—and clients—who suffer through years of unsuccessful attempts at eliminating it—are challenged by this condition.
Hyperpigmentation affects women and men of all ethnic groups, and features areas of darkened skin. Although it is most common in middle age and beyond, hyperpigmentation can also be seen in much younger clients. Directly caused by either overactive melanocytes, the cells responsible for producing melanin (melanotic hyperpigmentation), or a proliferation of the melanocytes themselves (melanocytotic hyperpigmentation), hyperpigmentation presents no medical threat. However, it can sometimes be a symptom of disease or illness. What’s more, individuals with facial hyperpigmentation may become so concerned with the aesthetic implications of the condition that depression and anxiety may ensue. Thus, the condition deserves serious attention, including a diligent approach to skin analysis coupled with a willingness to apply creative treatment approaches.
Causes of hyperpigmentation
There are three main types of hyperpigmentation, each of which is categorized by their cause.
- Post-inflammatory hyperpigmentation (PIH). This occurs following skin injury from acne lesions, psoriasis, burns, friction and even certain professional skin care treatments. It begins to fade as the skin regenerates itself—a process that can take months or more. On the positive side, PIH generally responds well to treatment.
- Lentigines. These are commonly known as liver spots or age spots. Although they do become more prevalent with age—they are found on 90% of light-skinned individuals over the age of 601—they are not directly caused by the aging process. Rather, lentigines are related to UV exposure.
- Melasma. This is caused by hormonal fluctuations, common, for example, during pregnancy, with thyroid dysfunction, and through use of birth control pills and hormone replacement therapy. It affects an estimated five to six million women in the United States alone and can often be difficult to treat.2
Although not considered a main cause, certain illnesses, as well as the use of certain prescription medications, may cause hyperpigmentation.
Skin analysis
To increase the likelihood of successful treatment, a detailed skin analysis is crucial. Not only should skin care professionals investigate the severity of the condition, they should also look for clues as to the origin of the problem to determine if a separate issue must first be treated. Although the following steps are standard in the skin analyses practices of many skin care professionals, their importance in the evaluation and treatment of hyperpigmentation should be underscored. Subjective information collected from clients helps pinpoint a lifestyle, medical or genetic cause of hyperpigmentation. Key topics to investigate include the following.