Hyperpigmentation – Causes, symptoms and how to get rid of it

Hyperpigmentation Skin

Skin conditions and diseases are more common than we think. They are ranked the fourth most common health illness. One of those skin conditions is hyperpigmentation. 

It is estimated that by 2024, the global pigmentation disorder treatment market will reach over $8 billion. This is almost a 50% increase from the market value in 2017. 

Hyperpigmentation is a harmless and common skin condition whereby the skin becomes darker in patches. This can form due to excess sun exposure, hormonal changes, treatments and a few other causes which you can learn about here. As well as that, you will find out the different types of hyperpigmentation, symptoms, causes, how to diagnose and treat it. 

What is hyperpigmentation?

Hyperpigmentation is essentially when your skin colour becomes darker and uneven in certain areas. Patches or spots typically form around the face, arms, decolletage, hands and other areas that are often exposed to the sun. 

These spots are more commonly known as age spots or sun spots, due to them being caused by exposure to sunlight and higher production of melanin. 

Melanin is the scientific term for the pigment in the skin that turns skin darker. When the skin is exposed to sunlight, more melanin is produced which results in darker skin. 

More often than not, the melanin in your skin gives it a darker and even skin tone. However, if the melanin cells get damaged or become unhealthy, it has a negative effect on the melanin production. This is when hyperpigmentation occurs and the areas that have been or become damaged will become dark patches or spots.

There are several types of hyperpigmentation. The three most common are Melasma, sunspots and post-inflammatory hyperpigmentation. Each different type is caused by a variety of factors, from lifestyle to hormonal, drugs to trauma and diseases. 

Melasma is due to hormonal changes which can be influenced by contraceptive pills, pregnancy and hormone therapy. Other hormonal factors that can cause Melasma are deemed to be more unavoidable but less common, this includes stress and thyroid disease. According to studies, 90% of those who get Melasma are women

The most common areas for hyperpigmentation from Melasma are the face and stomach, usually the nose, forehead and cheeks. 

In comparison, another type of hyperpigmentation that occurs in the same areas of the body are sunspots. Also referred to as solar lentigines or liver spots, which are the most common. These occur when the skin is exposed to too much sun over time. 

The skin’s response to excessive sun exposure is to create excess melanin. This creates brown areas on the skin, typically on places of the body that are regularly exposed to sun, just like how Melasma is commonly placed. 

The third common type is post-inflammatory hyperpigmentation, referred to as PIH. This is caused by what is left behind after an inflammatory wound, such as pimple, rashes or acne. 

Hyperpigmentation occurs this way due to too much melanin being produced in the skin whilst it’s healing, which leaves behind a dark spot that can range in colour from brown, red, white, black or purple. 

It is most common from spots and acne and typically appears on the face. However, PIH can occur in other areas of the body and be due to other factors such as sunburn, laser resurfacing and chemical peels. 

These three types of hyperpigmentation can occur naturally, some types are preventable. All types can be diagnosed and treated. 

Symptoms of hyperpigmentation 

Melasma

Physical symptoms

The symptoms you can from hyperpigmentation all depends on which type it is. Here are the physical symptoms for each of the three types discussed. 

Melasma

The main symptom to look out for are large patches of darkened skin. These will usually appear on areas of the face and stomach. The most common way to notice symptoms of Melasma are if the patches are symmetrical. For example, if one appears on your right cheek, there is usually another on the other side of the body, in this case it would be the left cheek. 

The symptoms and areas of the body it can affect won’t always be the face. It can occur on the neck, arms and stomach too. 

Sunspots

Sunspots are typically seen to appear as brown, black or tan spots or patches on the body. The most common areas for sunspots to appear are on the face, hands and areas of the body exposed to the sun often. 

The size can vary from a tiny dot to a coin size and shape. These are quite easy to notice and are most common in those regularly over exposed to sun. 

Post-inflammatory hyperpigmentation (PIH)

Physical symptoms are the most common way to notice PIH. After an inflammatory wound has healed, that area of the body will be left with a discoloured patch of skin. 

If you have had a recent pimple, acne breakout or rash, this is where the patches will occur. They are easily recognisable and more often than not, most inflammatory wounds will leave behind some hyperpigmentation. 

Mental symptoms

The mental symptoms of hyperpigmentation are not an easy way to understand the skin condition has developed. The symptoms do not necessarily occur at the beginning either. 

Usually, it’s more common to have mental symptoms during or after the hyperpigmentation has occurred and been diagnosed. This is due to the physical effect and impact the condition has and how it leaves the patient feeling. 

Researchers in India studied 272 patients, 86 of them had Melasma caused hyperpigmentation. These 86 patients were given health questionnaires to test for anxiety, depression and other psychiatric issues. The results concluded that of the 86 Melasma patients, 11.6% had anxiety, 12.8% had depression and 8.1% had somatoform disorder. 

The increase of mental health disorders due to physical conditions are common amongst any age or gender. Hyperpigmentation can occur on anyone and the mental impact it has is down to the individual’s mental state and ability to cope with the condition. Certain types of hyperpigmentation are treatable, which helps some individuals deal with it easier. 

Hyperpigmentation: Causes and risks factors

Hyperpigmentation can be caused by many factors. Most of them are physical causes which are commonly lifestyle and medical causes and all due to an increased production of melanin. The few mental causes are known due to scientific studies and research, all of which will be explained here. 

Physical causes

Medication use

Certain medications can trigger hyperpigmentation. Due to medication being obligatory if an individual needs it for certain conditions and health issues, this is one of the few causes that is hard to prevent and avoid developing the skin condition. 

The medications that can cause hyperpigmentation include antimalarials, chemotherapy drugs, antibiotics, antidepressants and anti-seizure drugs. Taking these medications or drugs can cause the skin to turn grey, another skin colour which can be recognised as hyperpigmentation. 

Sun exposure

Sunspots are the type of hyperpigmentation caused by sun exposure. It may seem that the sun exposure can cause or leave dark spots immediately, however they develop overtime. 

Prolonged sun exposure leads to increased melanin production in order to try and protect your skin from the sun. Increased melanin levels can usually prevent immediate effects such as sunburn, but can later cause skin damage and conditions like hyperpigmentation. 

Skin inflammation 

Skin and wound inflammations on the body and face sometimes leave darker or discoloured patches behind, which is the aftermath of the inflammation known as hyperpigmentation. 

The cause of hyperpigmentation through skin inflammation cannot be prevented due to the skin developing spots, acne, rashes and inflamed wounds naturally.

Melasma 

Melasma is a type of hyperpigmentation and it’s triggers are still a mystery to doctors. As Melasma is most common in women, it has been identified that the main cause is a change in hormones. 

It has been coined the “mask of pregnancy” as Melasma is most common in pregnant women or those who take birth control pills. Both factors interfere with hormones and a change in hormones is the main cause. 

The reason for hyperpigmentation occurring from hormonal changes is due to the female sex hormones, Estrogen and progesterone, stimulating the overproduction of melanin which caused dark patches of skin. 

Those with darker skin are more likely to get it, as are those who have Melasma run in the family. 

Medical conditions

There are some serious cases of hyperpigmentation which can be used by existing medical conditions, called Addison’s disease and Hemochromatosis. 

An overview of each of these medical conditions will help you understand how and why hyperpigmentation can occur. 

Addison’s disease is an uncommon disorder that happens when the body does not produce enough of certain hormones, which affects the adrenal glands that are located above the kidneys. 

Hyperpigmentation caused by Addison’s disease appears on folds of skin, lips, elbows, knees, knuckles, toes and on the inside of the cheek. 

The other common medical condition associated with hyperpigmentation is Hemochromatosis, a inherited condition whereby the body contains too much iron. Unlike other causes, this condition can cause hyperpigmentation unexpectedly and the symptoms to look out for are weight loss, fatigue, joint and/or stomach pain. The darker patches of skin will occur alongside these symptoms. 

Mental causes 

There are a few mental causes that can trigger hyperpigmentation, which is usually stress, depression and anxiety. These mental health issues come from various factors in life and how the body reacts can sometimes result in hyperpigmentation. 

Mental conditions are not considered to be a main instigator or valid reason when it comes to the cause of hyperpigmentation. This is down to mental conditions developing after the hyperpigmentation occurs. 

The physical appearance of the various types of hyperpigmentation can cause an individual to become stressed, anxious or depressed about it, as proven in a few case studies and investigations. 

Diagnosis of hyperpigmentation 

To diagnose hyperpigmentation, it is best to see someone in a primary care practice, such as a doctor or dermatologist. Professional advice is the best aid for guaranteeing a correct diagnosis of the condition as well as receiving the best care for the type of hyperpigmentation. 

It is best to book the next available appointment your doctor or dermatologist has, whether it is urgent or not. It is best to get the concern seen as soon as possible to prevent any more issues from occurring. 

Both sources of professional advice will need to complete a medical examination. Some types of hyperpigmentation can be diagnosed just by looking at it. A visual exam will be done by using a light. Moreover, a physical exam is done by taking a skin biopsy that will be sent to a laboratory for medical examination. Biopsies help to diagnose a more complex case of hyperpigmentation. 

If the diagnosis is considered urgent, the best way to do this at home without an appointment is to visit a pharmacy and seek advice for the best over the counter medication. Do not consider self diagnose via online sources to be accurate or a guarantee. The best diagnosis is by seeking professional help. 

Treatments and how to get rid of hyperpigmentation 

Hyperpigmentation is one of the few skin conditions that is harmless. However, most people wish to get rid of it. There are certain medicines and home remedies that can reduce the appearance. 

It is also important to consider things to avoid getting hyperpigmentation, or prevent it worsening. These include avoiding sun exposure, using SPF daily and avoiding picking at the skin. 

The following treatments are recommended to treat hyperpigmentation. 

Medicinal treatments

Medicines can be used to treat hyperpigmentation which can help reduce or get rid of the dark patches over time. 

The most commonly prescribed medicinal treatment are topical creams. This is due to most topical creams containing an ingredient that can lighten the skin, called hydroquinone. It is advised not to overuse hydroquinone or use it for a prolonged period of time as it can result in have opposite effects and darken the skin.

Therefore, it is advised to only use hydroquinone topical creams if told to by your doctor or dermatologist and always respect the dosage amount. 

Other ingredients that actively help treat hyperpigmentation are azelaic acid, corticosteroids, Kojic acid, retinoids and vitamin C. These are all ingredients to look for when finding the best topical cream to treat hyperpigmentation. 

In some cases, cosmetic procedures can be done to help treat hyperpigmentation. Laser therapy, intense pulsed light, chemicals peels and microdermabrasion are all cosmetically proven to help reduce hyperpigmentation. Laser therapy and chemical peels are the most popular cosmetic procedure, due to it being readily available and it’s end results. Both have similar effects. 

Laser therapy is a more precise cosmetic procedure than chemical peels. This involves a dermatologist zapping affected areas with a high energy light. With a few laser therapy treatments, patients start to see skin lightening in the affected areas. Depending on the type or level of hyperpigmentation, laser therapy can either penetrate the skin’s surface later to provide a mild therapy, or an intense level can penetrate the deepest layers of skin. 

A chemical peel is where a dermatologist will apply a chemical solution to the skin which works to exfoliate and remove dead skin cells. The exfoliation technique encourages the growth of new skin cells once the dead ones have been removed. 

The type of cosmetic procedure a patient needs will be assessed and advised by a dermatologist. Again, cosmetic procedures are another type of treatment that can cause side effects so it is best to get advice from a professional first. 

Home remedies for hyperpigmentation 

Aloe Vera Skin

Aloe Vera 

A compound found in Aloe Vera called Aloesin is known to inhibit the production of melanin, therefore can help treat hyperpigmentation. There are many ways to buy Aloe Vera, such as plants, gels or capsules. 

It has not been scientifically proven but one study found that the use of Aloe Vera capsules has seen results in relieving Melasma in pregnant women. The randomised controlled study by Planta Medica saw a 32% improvement of 90 pregnant women who took Aloe Vera gel extract capsules. Aloe Vera is not yet a conclusive home treatment, but has seen effective results

Yoghurt or milk

Lactic acid is a popular ingredient used in chemical peels. Chemical peels are a medical procedure known to treat hyperpigmentation and its active, lactic acid, is also found in dairy products such as yoghurt and milk. It is best applied directly to the skin with cotton wool and left to soak for a few minutes. After application it is advised to rinse well and apply a moisturiser to lock in hydration. You can repeat this one or two times a day and after a few weeks, some skin spots may appear reduced. 

Vitamin C

You can apply vitamin C from its most natural source straight to your skin, from fruits such as oranges, grapefruit, papaya and lemon. You can apply the juices from these fruits onto your skin by mixing it in with a moisturiser. The juices may increase the antioxidants on your skin’s surface level which could help lighten the appearance of dark spots overtime. 

Vitamin C in its purest form is known to prevent tyrosinase, which is the enzyme that produces melanin. In effect, this may inhibit the increase of melanin production to therefore prevent dark spots from appearing. 

To note, vitamin C may lighten dark spots but cannot lighten normal skin that doesn’t have hyperpigmentation. It is advised to combine vitamin C with other home treatments to increase its effectiveness. 

SPF

From clinical experience, the best SPF to wear is at least factor 30 and must have a physical block, which means it needs to contain the ingredients titanium dioxide or zinc oxide. Both chemicals are active ingredients and form as a physical block for sun exposure. The sunscreens that are broad-spectrum and prevent UVA and UVB rays are what to look for when purchasing an SPF.

Daily use of SPF is recommended and is the number one home treatment to use on a regular basis. It can also protect your skin against pollution and harmful toxins. 

Licorice

Licorice is an extract that is undermined in the skincare world. It’s main active ingredient called glabridin is a natural skin protector. Glabridin helps protect the skin for UVB rays that can help block rays and therefore prevent melanin production.

Licorice also has properties that have anti-inflammatory, skin whitening and antioxidant effects which is ideal for PIH sufferers, those prone to acne and those looking to reduce the appearance of hyperpigmentation at home. 

Green tea 

Green tea has long been studied for its effect on hyperpigmentation. Whilst there is a small amount of conclusive information for treating hyperpigmentation, the ingredient is still known to have antioxidant and anti-inflammatory properties that are beneficial for this skin condition. 

The main study for green tea is with its main active ingredient, epigallocatechin-3-gallate (EGCG). This is its antioxidant compound that may lead cells to not overproduce pigmentation. 

In a study done on 60 women that have melasma, the results showed that lesions cleared by over 60% by using a 2% green tea extract mixed with a cream. 

If you would like to try this home remedy, it is best taken orally as an EGCG supplement or apply a wet green tea bag to the affected area.

Face masks

Face masks that contain ingredients above are considered beneficial for hyperpigmentation sufferers. Regular use of face masks is advised to help improve the skin’s texture and may encourage the dark spots to reduce.

No particular face masks have been clinically tested to be most effective, but they may aid in fading the appearance of the dark patches. When considering which face masks to use, brands such as Dermablend and Vichy are clinically tested to be safe for hyperpigmentation. It is always best to check ingredients and ask for advice. 

Therapy for hyperpigmentation 

Hyperpigmentation and its physical appearance can have psychological effects on individuals. Due to this, some patients are recommended to try therapy

The most common and advised reason for receiving therapy is to help the patient with psychogenic excoriation, a condition where patients pick their skin repetitively. Skin lesions such as spots, acne and scabs are what caused post-inflammatory hyperpigmentation and if picked, it can cause the dark patches to worsen. 

This therapy is important to pinpoint the underlying issues the patient uses psychotherapeutic techniques to improve the quality of life and mental health for their future. 

In other cases, therapy techniques such as hypnosis are used for health conditions in order to reduce stress levels. Stress is a mental symptom and contributing factor of hyperpigmentation and patients who try hypnosis may be able to deal with it easier, or may even be able to prevent it from happening again if it developed to the mental health stress.

The skin and mind have a close bond. Interest in this relationship has been developed into a field called psychodermatology. Studies and research by clinical psychologist Dr. Ted A. Grossbart aims to demonstrate that when the mind becomes stressed, the skin can suffer. 

The aim of psychodermatology and these studies isn’t to substitute traditional medicine. Instead, it is used to identify the mental and emotional underlying issues patients have due to skin conditions

Identifying these issues can unveil how and why patients suffer with the scars hyperpigmentation can leave behind both physically and mentally and therefore help them to recover and overcome their negative stress and emotions. 

Another therapy method that may encourage a patient to reduce hyperpigmentation and their concerns with it is through acupuncture. Acupuncture is a traditional Chinese Medicine procedure that uses small needles to penetrate the skin which can reduce inflammation, ease pain and help with hormones. It is known as a therapy technique that can help with many skin conditions. 

According to skin experts, acupuncture could help even out skin tone, lighten hyperpigmentation patches and reduce redness by regulating hormones. Internally, acupuncture helps boost collagen which is what levels out hormone levels. Hormones are a main cause of melasma and the regulation of them could inhibit the development of the dark patches and therefore prevent hyperpigmentation from occurring. 

If you are looking for a more gentle at home home remedy that is considered as an emotional therapy is cosmetic camouflage. Whilst this will not treat the affected areas, it may regain confidence and help with the mental effects it has caused. It is an option some may consider to be effective. 

Several brands sell clinically and chemically proven cosmetics that benefit the skin’s condition as well as acting as a coverup of skin pigmentation. These included Dermablend, Cover FX and Covermark. All brands use ingredients that won’t cause any harmful effects. 

All therapy techniques are successful depending on the individual and it is best to seek professional advice before committing to any cosmetic therapy such as acupuncture. 

How to prevent hyperpigmentation

Wanting to prevent skin conditions is a natural process all patients would think about. If people could prevent a skin condition, or any medical condition from occurring, they would. For skin conditions such as hyperpigmentation, it could be considered that there are a few ways it could be prevented. 

Sunscreen Hyperpigmentation

It is important to know that some types of hyperpigmentation are not preventable. However, some can fade or even disappear on their own it has been claimed. 

Melasma has been reported to disappear on its own. Some women who stop taking birth control pills claim that their hyperpigmentation disappears. It is not confirmed that stopping birth control pills and other medication that can cause hyperpigmentation will prevent it from occurring, but there have been several reports. 

People can encourage fading or help reduce the appearance of Melasma in the same way they can other types of hyperpigmentation.

To take action on a daily basis the ways to prevent the skin condition is by avoiding skin exposure to the sun, applying an SPF of a factor higher than 30 and also have a skin care routine by using regular home remedies that were mentioned above.

Regular use of cosmetic treatments such as SPF, aloe Vera, face masks and vitamin C is considered effective. 

Consequences of hyperpigmentation 

Like with any health condition, hyperpigmentation has its consequences. Most of them are physical, which are typically short or mid term if treatment is done. Hyperpigmentation is a harmless condition and is quite common, therefore there are many ways it can be treated. It does not pose any real threat to your health and by seeking advice as soon as possible, there are usually not any long term consequences. It is important to follow the advice of pursuing medical help to ensure there are no underlying issues. 

The short and mid term consequences may involve the inhibition of the condition, trying to diagnose and treat it to reduce or disappear. If underlying issues do occur, which is rare, then the condition may pose some long term effects. 

Typically, the long term effects of the skin condition may involve the patient’s mental state. Depression, stress and anxiety is a cause of hyperpigmentation but can also be an end result. If the appearance of the dark patches feel unsightly to the patient or the treatments have no effect, this can cause a negative emotion strain. 

There are therapies and help patients can try, but there is no guarantee that these will work. 

Conclusion

Hyperpigmentation is a skin condition that is common amongst all ages and genders, and is considered not to be harmful if you seek medical help when you notice symptoms or physical appearance changes in the skin. With the right diagnose and treatment, the skin condition can be reduced or removed using medication, home remedies and therapy. Many of the treatments have been studied by researched, ensuring they are safe to use. 

Hyperpigmentation is a worldwide condition that has no health risks, so any individuals who see symptoms are advised not to stress about it. It is advised not to self diagnose and remember it is important to seek professional help from a doctor or dermatologist. They will help diagnose the issue of concern and give the best treatment options. 

If you have experienced or are experiencing hyperpigmentation and have any therapy, treatment or home remedy recommendations, please feel free to give your feedback. All help and advice is helpful and appreciated by professionals and patients. 

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