Today’s post is about how to get rid of hyperpigmentation. Hyperpigmentation is one of the most common skin concerns I encounter on a regular basis as Aesthetic Nurse Specialist. It is one of my favorite topics because the treatment modalities vary depending on the type, cause and nature of the problem. Sometimes a patient will come to me and ask for sunspots removal but upon evaluation, it’s actually melasma which for the most part is the trickiest to address. But first, let’s understand few basics so you and I are on the same page.
Hyperpigmentation results from increased activity and accumulation of melanocytes or skin cells that produce melanin. Certain ethnicities and people with darker skin are more prone to developing hyperpigmentation. While hyperpigmentation is presented in different ways, the most common types are the following:
Sun spots (age or liver spots) are characterized by light to dark brown spots that are scattered on the face, arms and hands. Sizes vary from few millimeters to size of a quarter. As the name suggests, sun spots develop as a consequence of years of unprotected sun exposure. Hence, the older you get, the more sun spots you may have especially if sunscreen is not part of your skincare routine.
PIH or post- inflammatory hyperpigmentation develops as a result of post-injury or lesion to the skin such as acne, insect bite, contact dermatitis, medication-induced, among others. It is clinically manifested as macules or patches in a similar fashion as the initial inflammatory process. While they typically resolve, sometimes it takes longer to see complete resolution. It is important to identify and treat the root cause of the problem rather than being reactive. For example, patient A was concerned with multiple dark spots on arms and legs for several years. During assessment, I noticed the constant scratching and severe dry skin. So while the dark spots can be treated aesthetically although very challenging, it is imperative to address the issue that’s causing the PIH: scratching related to dry skin.
Melasma appears as brown to gray patches on the face where sun typically hits: forehead, cheeks, nose, upper lip. It affects about 90% of pregnant women that’s why it is also called mask of pregnancy (chloasma). The exact pathogenesis remains unclear but sun exposure, genetics, hormones, and certain medications all play a significant role.
While some people aren’t concerned with hyperpigmentation, this is actually a big business to a lot of cosmetic companies. The big question is, do topical creams actually work? what about peels, lasers?
For many years, depigmenting agents are considered as first line of treatment. However, it is important to note that success rate depends on the cause, severity and timing of treatment. The earlier it is to start treatment, the better the response. In general, uncomplicated hyperpigmentation or light spots may have great success with the following:
Tretinoin, lactic acid, retinoid, licorice root works before melanin synthesis (pre).
Hydroquinone, kojic acid, arbutin, azelaic acid, l-ascorbic acids works during melanin synthesis (active phase).
Retinoic acid, glycolic acid, linoleic acid, lactic acid works after melanin synthesis (post).
You will find that most skincare products combine the aforementioned ingredients to address the different stages of melanin activity and that’s because melanocytes go through a life cycle. It takes several months or even longer before one can see improvement. Most don’t hence they look for more advanced options such as:
Non-invasive aesthetic procedures like LASER (Light Amplification by Stimulated Emission of Radiation) or IPL (Intense Pulse Light) can also treat hyperpigmentation. Laser can either be ablative or non-ablative and its use depends on the severity as well as patient’s preference. It targets the pigment buried beneath the skin resulting to complete reduction or eradication. Note that while laser or ipl can remove sun spots, neither will prevent re-occurrence. It is also important to mention that not all lasers or ipls can work on melasma or post-inflammatory hyperpigmentation. Hence, it is equally imperative to have these procedures done with the correct machine and qualified provider. Why? because sometimes laser or ipl can exacerbate PIH or melasma! Proper patient assessment plays a crucial part.
Other treatment modalities also include chemical peels, microdermabrasion or other light-based procedures. You will find that most aesthetic clinics, med spas or dermatologists combine treatments to yield optimal results.
Finally, I will bring you back to my number one skincare product of all time, Sunscreen! UV exposure intensifies PIH, melasma and is the culprit to sun spots, photodamage (premature wrinkles) and worse, melanoma. So slather because your skin matter!
Very informative. What brand of sunscreen do you recommend?
EltaMD physical sunscreen. It's the only one that doesn't break me out
This is such a great post! I have been good about using sunscreen as I get older, but was neglectful in my early 20's. I have sun spots under my eyes and I need to try one of the creams you suggested!
Thanks much. Hope you're able to reduce it without having to do procedures later on.
Very great informative post!
I really enjoyed your informative, fact based post. For me, Retinol, Vitamin C, Glycolic Acid made a big difference but it took time and consistency. I would have loved something faster and easier. lol
Thanks much! I swear by glycolic acid, vitamin c, even retinol. I have used these for many years now that's why I can say I don't have sunspots. Plus I'm big on sunscreen and sun avoidance
As always full of insight and great advice. I swear by laser and peels too 🙂
Thanks much! Yes, you know I love me some lasers and peels
I notice this on my arms and I know it's from the past before I was more diligent with sunscreen.
Thank you, Kathryne. Super informative for those of us with hyperpigmentation. Question: what does "ablative vs. non-ablative" mean?
Thanks Allison, my pleasure. Abalative laser i.e CO2, erbium lasers "damage" the epidermis promoting remodeling the skin as well as stimulating collagen and elastin formation in the dermis. It's more intensive with significant downtime and usually reserve for skin problems that have severe texture issues. Non-ablative are less intensive fractional lasers that preserve the epidermis and deliver focused light down to the dermis also for the purpose of collage and elastin formation. More treatments but generally no downtime except few hours of redness
My skin is so prone to hyper pigmentation after acne, it's the reason I dread any little break out!
What have you done so far? or what seems to work in reducing the PIH?
Thanks for this informative post!
Sunscreen is my jam! Loving this post for a "picker" of scabs that then cause post injury redness. 🙂
Oh no! I know it's tempting but try not to…
I got two small melasma spots under my eyes when I was pregnant. I still have them but the Paula's Choice Vitamin C Serum helped to fade them some. I'm really diligent about SPF and sunglasses always now.
Great to know you had such with Paula's Choice. And yes to sunglasses also!
I'm very, very prone to PIH 🙁 Btw, I had my first CO2 sesh two days ago. There's some dryness and scabby feeling, but it doesn't look so bad!
Just keep it moisturized and don't use anything harsh like exfoliants and peels. I'm sure you know this already
I'm being extra careful until the scab formation goes. It's not so bad – I could wear makeup today!
Awesome!
This is a very helpful post, and there is no question that hyperpigmentation is one of the most common concerns! Thank you for posting this.
Sunscreen is a habit everyone needs to get behind. That paired with AHA has been my go-to for improving spots.
Very good combo!
This is really interesting, thank you for the tips x
You are just an encyclopedia of information!
Many thanks, I appreciate your comment
I start treating pigmentation as soon as I notice it, and for me retinoids and alpha arbutin seem to work the besy, even though they do take a while to lift the pigment. I'm sure aesthetic in-clinic treatments are still the best and most effective way.
Same with me, that's why I don't have PIH or even sun spots. Skincare junkies we are
I used to use a hydroquinone product before they took it off OTC status. It worked brilliantly. I miss it.
Many thanks! There is OTC 2%
Hi Kath,
Where can I find the OTC 2%? It used to work so well for my upper lip.
CVS, Walgreens, even Walmart pharmacy. 2% Hydroquinone
Very informative post. I have darker complexion and I’m now starting to be better about sunscreen as I get older.
This was so informative! I have hyperpigmentation from acne and using tanning beds when I was younger. I've really been struggling with it as it doesn't seem to want to fade but I keep trying new products!
Ask around aesthetic clinics or derms near you if you haven't had luck with OTC options. You may benefit from certain lasers to help reduce the problem
So many great options here. As I get older, I'm getting better with SPF! So important 🙂
I agree, we don't like premature wrinkles for sure
I've used Rodan + Fields Reverse regime and found it quite effective.
Good to know!
I'm definitely getting into my anti-aging routine! What do you recommend for 30+ skin that's still acne-prone?
There are several causes of acne but if yours is hormonal-related, none of these OTC will work because you need to treat the real cause, consider a referral to derm, gyn or endocrinologist if yours has not responded to first line treatments. However, if it's occasional breakout or mild to moderate acne, I've had good experience with adapalene. It's a third generation retinoid that helps with acne and since it's related to retinoid, it can also help with aging skin. 0.1% is now available over the counter. I have a separate post about it. Pls check it out under the skincare category of this blog. Pls use sunscreen if you haven't yet, physical sunscreen is more tolerable on people with acne issues. Sun exacerbates acne by triggering inflammatory response that's why it's a must-have.
I have a lot of hyperpigmentation on my face due to many years of birth control. While I used sunblock and avoid outdoors during those heavy UV hours, I still am cursed. Has bothered me for years and tried tons of products, finally learning to just accept it.