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Hyperpigmentation is a common skin care condition in which dark-colored patches or spots develop on the skin resulting from excess melanin production. Examples of hyperpigmentation include brown spots, age spots, sun spots, dark spots, and melasma. Hyperpigmentation makes your skin appear uneven on the surface. This skin issue often interferes with client’s overall self-confidence contributing to issues of low esteem and poor self-image.  Evidence of sun damage and excess pigment result in skin that is less youthful looking. Blotchy brown areas such as Melasma, freckles and sun spots all co0ntribute to an aged appearance.  Eliminating or lightening these dark spots or patches of skin  can subtract years from  the face, neck, chest, arms and hands, resulting in skin with more uniform color 

The major causes of Hyperpigmentation include: 

UV Sun damage 

Post-inflammatory hyperpigmentation 

Hormonal changes 

Some medical conditions 

Certain medications 

Acne scarring 

Skin trauma 

The most common hyperpigmentation I treat are sunspots (also called lentigines), post-inflammatory hyperpigmentation (marks from pimples, bug bites, or prior inflammation), and Melasma. 

  Sun damage 

In most cases, hyperpigmentation is caused by unprotected and prolonged UV sun exposure. The UV rays stimulate the pigment cells i.e., melanocytes to produce melanin which causes hyperpigmentation. 

Post-inflammatory hyperpigmentation 

Post-inflammatory hyperpigmentation (PIH) is a reactive hypermelanosis of various skin types, which occurs as a sequela of acne, infection, inflammation, or skin injury. Characterized by brown or black spots in the skin, it tends to be more difficult to treat. Although it tends to be a self-limited and temporary condition, PIH remains a frustrating problem that can have significant psychosocial effects on patients, especially those with darker skin types. Laser therapy is one of the effective treatments for PIH, and various wavelength lasers and light devices have been utilized in PIH therapy. 

Melasma 

Also referred to the mask of pregnancy. Melasma is the most common type of skin pigmentation that usually affects pregnant women. Hormonal changes during pregnancy result in increased melanin production which appear as grey or brown spots on the face. Dermatologists explain that unprotected sun exposure is also a significant cause of melasma. 

Hyperpigmentation can affect all skin types and clients of all ages. There are two classifications, localized or diffuse, meaning it appears in small patches on the skin or as a larger area of altered pigmentation. Treatment requires a bit of effort and often responds to a combination of treatment strategies. While some types of hyperpigmentation, like that which results from having popped a rather large zit, will slowly fade, even this can still take several months. And then there are other types like the kind produced by prolonged sun exposure, that will require much more effort and treat for it to ever fade. 

Most cases of diffuse hyperpigmentation are caused by systemic conditions. These conditions can include Addison's disease, hyperthyroidism, or hemochromatosis. Diffuse hyperpigmentation may also occur due to a medication side effect. 

On the other hand, localized hyperpigmentation tends to represent a direct injury or inflammation to the skin and is the more commonly type seen in dermatology practices.  Anything that causes inflammation in the skin can potentially send a signal to melanocytes, the cells that produce brown melanin pigment as part of an immune response, to produce more melanin. Such inflammation can be caused by UV damage, acne breakouts, harsh chemicals on the skin, and even hormonal fluctuations, such as those which occur during pregnancy or when taking the oral contraceptive pill.  

Hyperpigmentation is multifactorial: There may be genetic, metabolic, hormonal and environmental factors, all acting as triggers, reminding us that there is no single therapy available that will completely cure hyperpigmentation. But with a more holistic, multitherapy approach, you can achieve impressive results. Using a combination of at-home and in-clinic based procedures, a client can achieve an adequate reduction and even complete resolution of their pigmentation issues. The most challenging treatments are those patients with post-inflammatory pigmentation (PIH) and a darker skin type. There may be some residual pigmentation, but it is reduced to a level where self-confidence is restored," which does give us all some hope. 

Unfortunately, some individuals are more prone to hyperpigmentation than others. Melanocyte instability is the main reason one develops hyperpigmentation. These pigment-producing cells that live at the dermal-epidermal junction and basal layers of our skin can become hyperactive if triggered and begin to overproduce melanin, leading to hyperpigmentation and sunspots. The more baseline melanin you have in your skin (i.e., the darker your skin tone, the more at risk you are for developing hyperpigmentation. 

While hyperpigmentation is extremely common and can affect all skin types, it is notoriously difficult to treat. Wearing sunscreen religiously can help prevent it and can keep it from getting worse, but it does not erase the damage once it occurs. . 

Can Hyperpigmentation be Avoided?  

As with most skincare concerns, prevention is key. Eliminate potential problem areas by caring for blemishes and wounds as soon as they soon appear. Wound care is extremely important because areas of healing, such as a scratched bug bite or a popped pimple, are prone to infection and inflammation—making it more likely for hyperpigmentation to occur. Cleansing the skin using a gentle cleanser and refraining from picking at scabs or squeezing an acne zit or scrubbing with a harsh cleanser or facial scrubber is of paramount importance. The most challenging clients are those patients who develop post-inflammatory pigmentation (PIH) and have darker skin types. There may be some residual pigmentation left following treatment, but it is reduced to a level where self-confidence is restored,  

Prevention is Key   

Tips to prevent hyperpigmentation or dark patches from forming include: 

Wearing a broad-spectrum sunscreen with SPF greater than 30 

Keeping your skin hydrated 

Considering regular glycolic acid peels 

Nourishing your skin with niacinamide 

Stop popping your pimples 

Wear a broad-spectrum sunscreen 

SPF protection from melanocyte-triggering UV damage is integral to the success of your treatment program. Look for a combination of mineral and chemical UV blocking agents such as titanium dioxide and ethyl salicylate to provide adequate broad-spectrum UV protection. Preferred sunscreens are those containing mineral blocks containing micronized zinc and titanium dioxides. Sun exposure is one of the most controllable factors in addressing and treating hyperpigmentation. Patients prone to hyperpigmentation should avoid direct sun exposure, wear hats and other occlusive clothing, and always apply a sunblock of SPF 30 or greater prior to going outside into the sun 

Sunscreen at least SPF 30, will help encourage fading by blocking UV radiation, which typically keeps and produces more pigment in skin. W Broad-spectrum sunscreens containing zinc oxide and titanium dioxide block UVA and UVB rays from penetrating into your skin. One should apply sunscreen every morning — even when it’s cloudy — and reapply as needed throughout the day. Be sure to use sunscreen with SPF 30 or higher. In addition, wearing sun-protective clothing and avoiding sun exposure during peak hours between 10 am through 2 pm is vitally important in preventing hyperpigmentation. 

Keep your skin hydrated 

It has been shown in a recent clinical study that topical use of hyaluronic acid helps in skin regeneration and rejuvenation. Another study has elaborated that hyaluronic acid improves cellular turn over which decreased age spots and skin pigmentation. It has been observed that the use of Ceramide and Hyaluronic Acid-based moisturizers help to improve the skin complexion and skin barrier function. 

Consider performing regular glycolic acid peels 

Glycolic acid has been identified as one of the most effective natural treatments to treat melasma. dark patches, and post-inflammatory hyperpigmentation. It is the most common type of AHA (alpha-hydroxy acids). AHA's are natural chemical exfoliants that slough off dead cells from trhge outer layer of your skin, ultimately revealing a fresh laye of skin. With the regular use of AHA's based skin care products, patients have observed a noticeable change in their complexion and skin texture. In addition to this, AHA's also provide anti-aging effects to your skin. 

Nourish your skin with niacinamide 

According to a research study published in British Journal of Dermatology, 5% concentration of niacinamide has significantly helped to improve hyperpigmentation in a little under four weeks. Niacinamide is a form of vitamin B3 which has an incredible impact in diminishing the dark patches and hyperpigmentation from the face. Being a potent source of antioxidants, it helps to give you a youthful glow. Clinical research studies reveal that niacinamide helps reinforce the skin barrier, ultimately preventing premature skin aging. 

Stop popping your pimples 

Popping and scratching pimples can harm your skin in many ways. Touching your face so often can worsen your skin inflammation which finally results in darker patches and acne scars after the pimple has healed completely. Hence, try to keep your hands off your face to prevent hyperpigmentation. 

How To Get Rid of Hyperpigmentation 

In general, treating all hyperpigmentation the same is absolutely the wrong approach, as the different causes and conditions should be treated differently. No matter how diligent you are with sunscreen, sunspots can continue to develop over the years, and while we are able to treat brown spots with chemical peels and lasers, maintenance is key. There are a number, effective treatment options available to treat and manage hyperpigmentation, allowing you to attain the glowing and flawless complexion of your dreams.  

Treatment Options for Hyperpigmentation include: 

Hydroxy acids 

Retinoids 

Chemical peels 

Laser Skin Rejuvenation 

IPL therapy 

Microdermabrasion 

Dermabrasion 

Topical Lightening creams 

Options for each skin tone 

Consulting a dermatologist 

Hydroxy and topical facial acids 

These acids, work by exfoliating or shedding, the top layer of your skin. 

Whenever you exfoliate your skin, new skin cells emerge to take the place of the old ones. This process helps even out your skin tone and makes the skin smoother overall. Many facial acids are available over the counter at beauty supply stores and drugstores. Popular options include: 

alpha hydroxy acids such as glycolic, lactic, citric, malic, or tartaric acid 

azelaic acid  

Kojic acid 

salicylic acid  

vitamin C serums (in the form of l-ascorbic acid) e.g., SkinCeuticals CE Ferulic 

Face acids work extremely well in treating mild hyperpigmentation on fairer skin tones. Search for an acid content of 10% or less. Higher concentrations can increase your risk of side effects and are best left to professional peels performed in-office or medical spa setting 

Retinoids 

Derived from vitamin A, retinoids are among some of the oldest OTC topical skin care ingredients used in antoiagy and skin scare. Their small molecular structure allows them to penetrate deep into the skin and treat the layers below your epidermis. Retinol is effective in treating hyperpigmentation when applied at night.  OTC Retinol formulations ranging from 0.5 percent to 1 percent work quite well and function as fabulous multi-taskers.  One should avoid using retinol during the day—as UV rays destabilize it and increase your risk for photosensitivity, I personally recommend using skincare products that include pigment-stabilizing ingredients. Retinoids can come in either a prescription grade or OTC formula. However, OTC versions tend to be weaker and therefore less effective. If you do not see any results after a couple of months, talk with your dermatologist or medical provider about prescribing retinoid tretinoin (Retin-A). OTC retinoids may be safe for all skin tones, but you should double-check with your dermatologist if you have darker skin and plan on using these products long term. 

If you have multiple skin concerns, you may be interested in trying: 

Differin gel: Previously available by prescription only, this retinoid helps to address both acne and hyperpigmentation. 

Chemical peels 

Chemical peels are among the most popular in-office treatments for treating hyperpigmentation and are used in conjunction with topical prescription creams. Chemical peels utilize acids at stronger concentrations to treat the desired area of skin. They reduce the appearance of hyperpigmentation by removing the epidermis or top layer of your skin. Deeper peels may also penetrate the middle layer of your skin (dermis) to produce more dramatic results.  

Chemical peels may be effective for clients with 

age spots 

sun damage 

melasma 

blotchy skin  

also work best for fairer skin tones, and they may provide faster results than face acid products. 

Chemical peels enhance and increase the rate of skin cellular renewal—inducing the hyperpigmented skin to be replaced by new skin cells. Reducing the pigment that exists already in the skin is best performed using a combination of in-office chemical peels combined with a regimen of topical retinol and Arbutase. The retinol helps to even out pigment cells while the Arbutase contains hydroxy acids which accelerate and speed skin cellular turnover as well as act asa  brightening agent. Patients may stay on these topicals for extended periods safely. In the case of melasma or PIH, topical treatment options may also include prescription-strength retinoids, azelaic acid, and chemical peels. 

Deeper chemical peels can be performed to lift excess pigment and help with long-term hyperpigmentation. For that, I typically recommend the VI Peel or TCA peel along with stronger resurfacing lasers (such as Fractional, which may have longer downtime but lead to more dramatic results. 

Despite many chemical peels being available over the counter, you might consider getting a professional-grade peel preformed at your dermatologist’s office or reputable medical spa. These are higher in concentration, and they yield quicker, more dramatic and effective results. Due to their strength, in-office peels may also increase your risk for side effects. Discuss with your dermatologist or skin care expert provider about your individual risks. 

Possible risks with both at-home and in-office chemical peels include   

redness 

irritation 

blistering 

infection 

scarring 

allergic reaction 

If you are out in the sun on a regular basis, chemical peels may not be the best treatment option for you. Chemical peels cause your skin to be more photosensitive to the sun’s UV rays. If you do not apply sunscreen and use other UV protection, the sun may worsen your hyperpigmentation. You will need to take extra precautions for at least one week following a chemical peel.   

If you’re looking for a professional-grade peel to use at home, consider Exuviance Performance Peel AP25 At-Home Facial Peel. A glycolic acid peel, this product may be used up to twice a week. It can also help reduce the appearance of fine lines and wrinkles. If you have a darker skin tone or want a stronger peel, talk with your dermatologist. They can discuss the professional peels which are available and help you decide on the right peel for you. 

Laser Skin Resurfacing  

Lasers are not always the most effective at eliminating hyperpigmentation, but there are certain conditions where lasers are incredibly effective. Light- and laser-based therapies include broad-band light (BBL),  Q-switched lasers,  Nd:Yag lasers, picosecond lasers, and fractionated resurfacing lasers.  At Regenesis, we offer more advanced options for treatments, and can formulate an individualized treatment plan to address and treat your hyperpigmentation issues. The best course of treatments for patients involves the use of medical lasers. Laser Skin Resurfacing treatment uses targeted beams of light to reduce hyperpigmentation. There are two types of lasers: ablative and non-ablative. 

Ablative lasers are the most intense, and they involve removing the entire top layer of your skin and hence require considerable downtime. Non-ablative procedures, on the other hand, target the dermis to promote collagen growth and tightening effects. As only a partial degree of the skin outer layer is removed, there is minimal to no downtime. Ablative lasers are stronger, but they may cause more side effects. Both destroy elements in your skin to ensure that new skin cells grow back tighter and more toned. 

  Ablative lasers may work better for people with fairer skin. For some people, non-ablative versions may cause the skin to darken instead of lightening. Your dermatologist will work with you to assess your discoloration and overall skin tone to select the best option for your skin.  

Melasma is one of the most frustrating conditions for both patients and dermatologists. It is a chronic pigmentary condition caused by a number of factors such as genetics, sun exposure, and hormones from birth control or pregnancy, but melasma tends to recur easily, whether it’s from the sun, heat, and/or hormonal changes. Treatment options must include vigilant sun and heat protection with sunscreen, sun avoidance, antioxidants, as well as over-the-counter brightening topicals—including hydroquinone, vitamin C, kojic acid, niacinamide, azelaic acid, and retinoids—as well as oral medications, namely Tranexamic acid, and a series of in-office procedures such as chemical peels and light laser treatments, like PICO Genesis laser skin treatment. PICO Genesis lasers quickly penetrate the skin and treat hyperpigmented areas to result in more even-toned skin. This process targets pigment below the surface of the skin. Skin penetration by lasers means that users can see results faster and often more predictably. The main advantage of the PICO technology used in PICO Genesis laser is that the laser uses such a fast pulse that it can treat the skin without heating the skin. he energy produced is so quick that the skin does not even have time to heat up. Yet it’s able to ablate or get rid of that pigment This laser is a nonthermal laser and is the laser of choice to treat Melasma. Thermal lasers like IPL therpay can exacerbate and worsen melasma. There is virtually to downtime. Visible Results are evident with fewer sessions There is less post-Treatment redness. Treatment sessions are quick and can be performed in (about twenty minutes. 

Intense pulse light therapy (IPL Photofacials) 

IPL Phototherapy is a type of non-ablative stimulates collagen growth within the dermis. It usually requires multiple sessions. IPL is used for overall pigmentation issues, but flat spots especially respond to this treatment. It may also help reduce the appearance of fine line wrinkles, spider veins, and enlarged pores.  IPL works best for people with fairer skin and is recommended only for patients with Fitzpatrick skin types I to IV.  For those with Fitzpatrick skin types V and VI, I recommend PICO Genesis laser treatment to correct pigment as this laser is safe to use on all skin types. IPL Therapy is not suitable for treating melasma as visible light, and ultraviolet (UV) radiation all trigger and increase melanin production. Melasma treated with IPL often becomes more intense following treatment.  

Microdermabrasion 

Microdermabrasion is an in-office procedure used to treat hyperpigmentation that affects the epidermis only (superficial scarring). 

During the procedure, your dermatologist will use a drill-like handheld tool with a wire brush or another abrasive attachment. The tool is then swiped across your skin to rapidly — but gently — remove the epidermis. 

You may require multiple sessions to achieve your ideal result. It also works well for people with fairer skin. Microdermabrasion works best on superficial scars. Your dermatologist can help you determine whether this treatment is right for you. 

Dermabrasion 

Dermabrasion also involves the removal of  the outer layer of the skin called the epidermis, but its effects continue down to involve part of the skin’s dermis. While dermabrasion is sometimes used to smooth out wrinkles, the procedure has been historically used to address skin texture concerns. These include: 

• Acne scarring  • Age spots  • Chicken pox scars   • Surgical scarring  • Sun damage 

As with microdermabrasion, a dermatologist will use a drill-like handheld tool with a wire brush or other abrasive attachment. They’ll move the tool across your skin to rapidly — but gently — remove your entire epidermis and the top part of your dermis. Dermabrasion may be an effective treatment option if you’re looking to decrease pigmentation at a faster rate than microdermabrasion. 

This treatment tends to work best for those with fairer skin tones. However, further hyperpigmentation because of the procedure can occur with all skin types. The new patches of hyperpigmentation may lighten after about eight weeks. 

Topical Lightening Creams 

Lightening creams are over the counter (OTC) treatments that work with select ingredients to help decrease pigmentation. Many of these creams are available in stronger prescription forms. These are typically applied once or twice daily to help lighten  skin over time. Topical treatments for lightening also come in gel formulations. 

Common ingredients found in effective OTC lightening products include: 

• Licorice extract  • Vitamin B-3 (niacinamide)   • Niacinamide 

The FDA warns that skin lightening products can be dangerous when they contain the potentially harmful ingredients hydroquinone or mercury.  In 2006, the FDA proposed restrictions on products containing the bleaching agent hydroquinone due to reported concerns about potential carcinogenicity and a link to ochronosis. Dermatologists safely prescribe hydroquinone-based creams to help with hyperpigmentation, or dark spots. The FDA banned the sale of over-the-counter hydroquinone products in 2020 and ordered removal from shelves, but many remain on the market online and in shops 

Lightening creams or gels work best for flat pigmented lesions, such as melasma or age spots. These tend to be effective for patches of discoloration on most skin types. OTC products are accessible (and sometimes more affordable) options for treating hyperpigmentation, but these can take longer to achieve results compared to professional treatments. Skin tone can play a role in the intensity and length of hyperpigmentation treatments. Patients with fair, medium, and dark skin tones can use some of the same therapies, but people with darker skin need more time for the treatment to work. 

There isn’t a one-size-fits-all approach to skin resurfacing. Fair skin responds well to most hyperpigmentation treatment. Those with darker skin tones tend to be more resistant and require more time to reach the goal of treatment. For clients with darker skin tones, High beam laser treatments and IPL phototherapy may be unsuitable due to their risk of developing hyperpigmentation. Patients with medium skin tones mat respond well to chemical peels and microdermabrasion.  

Darker skin might benefit from: 

Glycolic acid 

Kojic acid 

OTC lightening creams 

Microdermabrasion 

Lower-strength chemical peels 

Laser treatments, but only when used at lower intensities over a larger number of sessions 

The use of topical treatments generally take longer to achieve visible results. Patience is key with any treatment option. And ultimately, when it comes to treating hyperpigmentation one of the most important tools in your arsenal is simply patience. Reassurance and time are essential elements of a successful treatment program. Patience, diligence, and precautions are the most important things to consider during skin pigmentation treatment. It is believed that hyperpigmentation is a dermatological concern that can't be cured permanently. However, the use of good topical products and laser skin treatments and sun safety measures are imperative to attaining an even skin tone.  

To evaluate if we can treat your pigmentation, please call 504.400.6480 to schedule your complimentary consultation.