Hyperpigmentation: The complete guide by Dr AJ Sturnham

What is hyperpigmentation?

Hyperpigmentation is a common skin condition that can affect all skin types and ages. Hyperpigmentation can be classified as localised, or diffuse, meaning it appears in small patches on the skin or as a larger area of altered pigmentation.
Most cases of diffuse hyperpigmentation are caused by systemic conditions, such as autoimmune disease or metabolic disorders, such as B12 or folate deficiency. Localised hyperpigmentation tends to represent a direct injury or inflammation to the skin.
Melasma and post-inflammatory hyperpigmentation (PIH) are the most common presentations seen in dermatology clinics. Anything that causes inflammation in the skin can potentially send a signal to our melanocytes, the cells that produce brown melanin pigment as part of an immune response. This inflammation can be caused by UV damage, acne spots and outbreaks, harsh chemicals on the skin and even hormonal fluctuations, such as those in pregnancy or when taking the contraceptive pill.

What causes hyperpigmentation and is there any skin type/colour that is more prone to getting it?

Melanocyte instability is the main reason we develop hyperpigmentation. These pigment producing cells, that live at the dermoepidermal junction and basal layers of our skin, can become hyperactive if triggered and start over producing melanin. This leads to hyperpigmentation and sun spots. The more baseline melanin you have in your skin (i.e the darker your skin type) the more risk you have of developing hyperpigmentation in the first place.

How can you avoid hyperpigmentation?

Prevention is better than cure – so wearing a day cream with a minimum of SPF 30 daily, and increasing to Factor 50 in hotter climates, will help to prevent UV damage induced pigmentation – the main causative factor for hyperpigmentation.
Remember we are exposed to UV rays every single day, all year round, even on those grey and drizzly days, so don’t go unprotected.
Use pigment stabilising ingredients in your daily skincare, to stabilise your melanocytes (pigment producing cells). This will make them less likely to overproduce melanin (sun spots and pigment spots), whether the trigger be UV damage, hormones or outbreaks. These ingredients will also help to break down unwanted pigmentation, without bleaching the skin. Ascorbic acid (20%) and Alpha Arbutin, derived from the Bearberry plant, are excellent natural ingredients and my top picks in your serums, to use morning and night.
Choose skincare with natural skin brighteners such as sunflower, rich in B vitamins, Niacin and Pantothenic acid, which naturally brighten and improve skin tone.

Can you ever get rid of hyperpigmentation completely?

Hyperpigmentation is multifactorial. There may be genetic, metabolic, hormonal and environmental factors, all acting as triggers. It is important to understand that there is no single therapy available to cure hyperpigmentation.
The strategy involves using melanocyte stabilising skincare, protective skincare to reduce new pigmentation and clinical therapies, such as lasers, to break down the old pigmentation. It is often difficult to achieve the perfect balance of pigment reduction whilst maintaining cutaneous integrity and epidermal health. The bottom line is that it is important to keep an open mind regarding a multi-therapy approach, possibly involving a combination of ‘at home’ and ‘in clinic’ based procedures. With this approach, we can generally achieve adequate reduction and even complete resolution in many patients. The most challenging treatments are those patients with post-inflammatory pigmentation and a darker skin type. There may be some residual pigmentation, but it is reduced to a level where self-confidence is restored.

What skincare ingredients are good at treating hyperpigmentation?

My strategy to address pigmentation is focussed on three main goals:
– Firstly I want to stabilise the pigment production cells, the melanocytes, and calm down their production of melanin (brown pigment).
– Secondly I want to speed up the breakdown of the existing inflammatory pigmentation. To do both things I use a combination of 15% L-ascorbic acid, Alpha Arbutin 2% and Resveratrol 1% in serum or cream form. A daily dose of Vitamin A (retinol) 0.5-1% in third generation form, works well for most patients. Vitamin A is a fabulous multi-tasker and in a good quality cosmeceutical formulation, works to reduce cell damage, boost repair, regulate oil production, boost collagen formation and reduce pigmentation. It has a melanocyte stabilising and melanin breakdown effect. It needs to be used in a night cream or serum to work best, as it is destabilised by UV rays. For the same reasons, all products rich active strength vitamin A should come in opaque packaging.
– Thirdly, it goes without saying that protection from melanocyte triggering UV damage is integral to the success of your treatment programme. Look for a combination of mineral and chemical blocking agents such as titanium dioxide and ethyl salicylate to provide adequate broad spectrum protection.

Dr Anita’s Top Tips:

Don’t use bleaching agents on your skin to try to lighten pigment. This can potentially worsen pigmentation and lead to scarring.
Never use a retinol serum in the day – UV rays destabilise ingredient plus increases your risk of photosensitivity.

Are there any treatments for hyperpigmentation that you’d recommend?

The skin is a complex organ and is composed of several layers, which all have an important role in keeping the the skin healthy and functioning effectively. I believe that in order to have healthy skin and to reduce pigmentation, you need to ensure that the skin’s foundations are strong.
So many treatments focus solely on treating the pigment in superficial epidermal skin layers, without addressing deficiencies in the deeper layers. It is for this reason that issues such as pigmentation persist. The ultimate skincare programme will treat your skin layer by layer. Nourishing, rejuvenating and repairing both the deep and superficial layers together.
I place all patients on a 6-week ‘melanocyte- stabilising skin prep’ period before starting the lasers, to ensure that the skin doesn’t see the laser as an attack and produce more pigmentation, as a protective response.
I find a combination of Clearlift Q-switch laser and AFT laser works well to breakdown pigmentation at the dermoepidermal junction and the older, more superficially lying pigmentation.
In the case of melasma or PIH, topical treatment options may also include prescription strength retinoids, azelaic acid and chemical peels.
Reassurance and time are also essential elements of a successful treatment programme.
Dr AJ Sturnham