Hyperpigmentation

Hyperpigmentation can be an embarrassing and frustrating problem. Unsightly spots and discolorations appearing on the skin may be a source of constant self-consciousness. While each person’s pigmentation is different, almost all sufferers of hyperpigmentation are eager for a cure, or at least effective treatment.

As modern skin science reaches the cutting edge and more and more people avoid other skin problems and signs of aging, will hyperpigmentation soon be a thing of the past as well?

What is Hyperpigmentation?

Hyperpigmentation is a darkening of the skin, usually caused by increased melanin (dark skin pigment). This may occur in the outer layer of skin (epidermis), deeper layer of skin (dermis), or both. Hyperpigmentation may be caused by melanocytes (melanotic hyperpigmentation) or proliferation of active melanocytes (melanocytic hyperpigmentation).

Hyperpigmentation may cause localized “spots” on the skin (i.e. age spots), or may appear in a more diffuse manner with a variety of areas being affected. Although hyperpigmentation can affect any area of the body, different varieties do tend to appear on certain areas more- for example, melasma generally occurs on the face, while other varieties may target the hands or torso.

What Causes Hyperpigmentation?

Hyperpigmentation may be caused by sun damage, inflammation, or other skin injuries, including those related to acne. People with darker skin tones are also more prone to hyperpigmentation. This is especially true if they have been exposed to excess sunlight.

Hyperpigmentation is also related to a large number of other disorders, including (but not limited to): Addison’s Disease, fungal infections, Cushing’s Disease, Smoker’s melanosis, and Melasma.

What Treatments are Available to Treat Hyperpigmentation?

Hydroquinone is one of the most well-established topical agents used in treating hyperpigmentation, with a considerable number of clinical studies documenting its effectiveness in skin lightening. It works by inhibiting the enzyme tyrosinase, which is key in the production of melanin. Hydroquinone does not destroy previously synthesized melanin and therefore does not bleach skin.

Although Hydroquinone is considered by many to be the most effective treatments against hyperpigmentation, it also has its disadvantages. It usually takes several weeks after treatment to see real results, because skin must go through its natural exfoliation process in order to allow the existing melanin to migrate out of the skin. This process could be quickened with the use of powerful exfoliating agents, like alpha-hydroxy acid, but since both Hydroquinone and skin exfoliants have the potential to irritate skin, combining them greatly increases the risk of irritation. More seriously, Hydroquinone treatments have been linked to certain types of cancer in some studies, although the results remain inconclusive.

Somewhat similar to Hydroquinone are two other hyperpigmentation treatments: Arbutin and Kojic acid. These two treatments are similar in that they also block the enzyme tyrosinase in order to halt the production of melanin, but each is unique. Arbutin offers a somewhat gentler option, slowly releasing Hydroquinone for a treatment that seems to have less side effects. It remains unclear whether Arbutin is as effective as Hydroquinone, however, especially since many companies are using Arbutin-contaning plant extracts in place of pure Arbutin in order to avoid patent issues. Kojic acid is a naturally occurring substance produced by fungi species and it has been shown to be as effective as Hydroquinone in treating hyperpigmentation, but it too as been linked to some forms of cancer by clinical studies.

Azelaic acid is a naturally occurring chemical, classified in the group of dicarboxylic acids. While it is commonly prescribed to treat various forms of acne, azelaic acid has also prescribed off-label to treat hyperpigmentation, especially in cases where the patient has an unfavorable sensitivity to Hydroquinone. While azelaic acid is an appealing option for many and in some cases has been shown to be even more effective than Hydroquinone, it is not effective in treating freckles or age spots.