Hyper-pigmentation is characterised by dark spots or dark patches on the skin. It is relatively common and usually harmless, but for cosmetic reasons, it is undesirable for those who have it. Hyper-pigmentation has different types. Age spots, liver spots, freckles, sun spots and mask of pregnancy or melasma are all types of hyper-pigmentation.

Types of hyper-pigmentation

Sun-spots and age-spots
This type of skin discolouration medically called lentigines, which may refer to liver spots as well. These blemishes are associated with aging and too much sun exposure. Sunspots result from the increased production of melanin as a consequence of prolonged ultraviolet light exposure over the years. UV rays accelerate melanin production and are the reason why we get a tan when we bask in the sun for a longer period of time. The most common areas affected are the face, neck, upper chest, arms and hands. Besides UV rays, simply getting old regardless of UV exposure can lead to an increase in melanin production and cause hyper-pigmentation.

Freckles
Freckles medically called ephelides, they are more common in people with fair skin. Freckles are a result of the overproduction of melanin by melanocyte cells. They may vary in colour from reddish, yellow, tan, light brown to dark brown or black. They may become darker and more visible during the summer months and directly after exposure to the sun. Freckles are a response by the skin’s protective measure against the harmful effects of ultra violet light. Freckles are predominantly seen on sun-exposed areas and will fade or become lighter during winter months or when the skin is protected from UV radiation.

Melasma
It is a skin condition seen in women aged between 20-50, related to both hormonal changes (in hormones such as oestrogen and progesterone) and sun exposure. Melasma is more common during pregnancy, menopause, and while using oral contraceptive pills. The skin darkens in patches of tan to brown colour, primarily on sun-exposed areas such as the face, neck and arms. People with olive and darker skin such as those of Indian, Asian, and Middle-Eastern heritage are more likely to get melasma. Direct sun exposure without sunscreen can trigger melasma and cause dramatic changes in skin pigmentation.

What are the causes of Hyperpigmentation?

Overproduction of melanin, the pigment that gives our skin its natural colour is the main cause of hyper-pigmentation. Also, abnormal size, number and distribution of the melanocytes (melanin producing cells) in skin layers can lead to hyper-pigmentation.
This excess production of pigment is triggered by a variety of factors. Although the main one links back to sun exposure, hormonal imbalances, ageing, skin injuries or skin inflammation and genetic predispositions, as well as some medication can also cause hyper-pigmentation of the skin.

Sun Exposure
Sun exposure is the leading cause of hyperpigmentation, as sunlight is what triggers the production of melanin in the first place. Melanin acts as your skin’s natural sunscreen by protecting you from harmful UV rays, which is why your skin tans in the sun. Excessive sun exposure can disrupt the normal process of melanin production and cause hyper-pigmentation.

Hormonal influences
This factor is the main cause of a particular kind of hyperpigmentation known as melasma or chloasma and is particularly common in women during or after pregnancy. The production of the female sex hormone estrogen is increased during pregnancy, which may stimulate the overproduction of melanin by melanocytes while the skin is exposed to sunlight.
Taking birth control pills may also cause the development of hyperpigmentation because they cause hormonal changes similar to those that occur during pregnancy.

Medications
Medications are a frequent cause of sudden skin pigmentation in sun-exposed areas. Medications that can cause skin pigmentation include anti-malarial medications, anti-seizure medications, and minocycline. Ingestion of metal preparations that contain mercury, silver, lead or gold can also contribute to hyperpigmentation.

Skin injuries or inflammation
Irritation or injury to the skin such as burns, cuts, abrasions and even common pimples may cause skin inflammation. Skin inflammation stimulates the pigment cells (melanocytes) to produce more pigment in both upper and lower layers of the skin resulting in a mark being left on the skin surface that is darker than the rest of the skin. This type of skin discolouration is known as post-inflammatory hyperpigmentation. This is a condition that usually clears with time, although it can sometimes last for months to even years.

Ageing
As people age, a discolouration of the skin is normal as a result of genetic programming and structural changes in the cells. With ageing, the ability of DNA damage to repair itself becomes imbalanced and may lead to an irregular distribution of melanocytes as well as an increase or decrease in melanin production. A decrease in melanin production appears as white or discoloured spots on the skin and is known as hypopigmentation.
Overproduction of melanin can form dark spots on the skin, known as hyperpigmentation and it can be seen on any part of the body that has been exposed to the sun for a long period of time.

How to remove unwanted skin pigmentation?

Medical peel
This treatment involves applying peeling agents such as glycolic acid or alpha hydroxy acid on the area in order to remove dead skin cells and sun damaged spots. During the treatment, a chemical solution is applied to your skin to exfoliate and rejuvenate your skin. Based on your skin type, it may be combined with steam to increase the depth of penetration by the peeling agent.
Skin peel is ideal for all skin types with more consideration for dark skin.
Skin redness for a few hours and skin dryness and tightening for a few days are normal after having a peel. Depending on the percentage of the peel and duration of your treatment, you may experience mild to moderate flaking or peeling of the treated area for a few days as well. Although you will see improvement after each session, more treatments are required in order to remove deeper pigmentation.

VPL Laser pigmentation removal
It is one of the most effective treatments that can remove skin pigmentation permanently. The light emitted to your skin breaks down the excess melanin in hyperpigmented areas and lightens the appearance of pigmented skin without damaging the surrounding tissue.
Since the light is strongly absorbed by the melanin in the epidermis, this treatment is only suitable for people with skin types 1-4 with no significant tan.
The intensity of the treatment is based on your skin type and the depth of the pigmentation, the mildest treatments work just on the skin’s epidermis (surface layer), while higher intensity and longer wavelength are used for deeper penetration.
Skin redness and swelling for a few hours are normal after any laser treatment. Pigmented area may become darker and develop a crust for a few days or so and then will gradually lighten or shed off.

Microdermabrasion
Microdermabrasion is a non-invasive resurfacing treatment that can minimise freckles and pigmented spots by removing dead skin cells. The diamond coated head with a gentle vacuum is designed to exfoliate the top layer of your skin which results in the lightening of pigmentation such as age spots and sun spots. It’s suitable for all skin types and colour. While it can improve the appearance of skin discolouration, the results are usually modest, and milder hyperpigmentation conditions are better served by this procedure.
Skin redness for a few hours and skin dryness for a few days are possible side effects of microdermabrasion treatment.

Products to treat skin Pigmentation
Vitamin A and C are two essential vitamins that you need to include in your everyday skincare routine if you are suffering from skin pigmentation or you are prone to get freckles.
Vitamin A increases your skin cells turnover and helps to speed up the skin cells growth to normal which in turn thickens the skin. It repairs ultra-violet damage to the skin such as sunspots and age spots, and improves the appearances of skin imperfections.
Vitamin C, like other antioxidants, increases the effectiveness of your sunscreens and boosts your skins defence against UV exposure. It has a lightening effect on your skin because it slows down the production of melanin (skin pigments), so it’s very helpful for those who want to lighten sunspots or are prone to freckles and facial pigmentation.
It also has an exfoliant property which improves the appearance of uneven skin tone such as melasma (pregnancy pigmentation), sunspots, age spots and post-acne marks.
Vitamins A, C and E are depleted by UV-A and UV-B radiation even on a cloudy or rainy day; however the effects are milder than on a sunny day so don’t forget to apply your sunscreen on the top to get the most benefits from your skincare products.
 
Please keep in mind that treatment modality is different for every individual. A combination of different treatments with topical creams may be required to get the best result, depending on your skin type and the type of your skin pigmentation. The earlier you receive the treatment the more effective your results will be.
Elham
Clinic manager
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