What is hyperpigmentation?
Hyperpigmentation is a common skin condition that makes some areas of the skin darker than others. The areas appear as darker brown, black, gray, or red spots or patches on the skin. The spots are sometimes called age spots, liver spots, or sun spots.
What causes hyperpigmentation?
Hyperpigmentation of the skin is caused by a variety of different reasons. Hyperpigmentation is most commonly caused by sun exposure or UV radiation and can affect all skin types, especially if you are not wearing appropriate sun protection with sunscreen and clothing.
Another cause of hyperpigmentation can be from melasma. Melasma is an acquired disorder characterized by blotchy, light-to-dark brown macules distributed symmetrically on the sun-exposed parts of the body. This condition commonly effects the LatinX, African American, and Asian populations. Melasma can be exacerbated by heat or sun exposure or hormones. This can affect both men and women.
Other causes of hyperpigmentation are post-inflammatory hyperpigmentation (PIH) that occurs after skin resurfacing treatments, acne scarring, inflamed skin from in-grown hair, excess estrogen, such as in pregnancy, genetics, thyroid disease, and certain medications.
What are distinctions in treating hyperpigmentation in darker skin tones?
Treatment for hyperpigmentation depends on a number of factors including the cause and your skin tone. Therefore, each treatment plan is customized to the patient.
Patients with Fitzpatrick IV – VI skin usually have Mediterranean, Middle Eastern, Indian, Southeast Asian, or African American skin tones.
Often, treatments for hyperpigmentation include skin resurfacing procedures as well as maintenance skincare and possibly oral medications. However, with darker skin tones, there are limitations to treatments that can be used as these patients are more susceptible to post-inflammatory hyperpigmentation (PIH) with more aggressive ablative lasers and deep chemical peels.
How is hyperpigmentation treated in darker skin tones?
The goals of treatment include a combination of decreasing pigment production (melanocytic hyperactivity), exfoliating skin cells to enhance turnover of pigment cells, and decreasing overall
inflammation. Therefore, we often recommend a combination of topical treatment and skin resurfacing.
Topical treatments may include a combination of hydroquinone, corticosteroid, azelaic acid, topical tranexamic acid, retinoids, and/or many other combinations of topical therapies. These are often started about 2-6 weeks before skin resurfacing treatment and are used after healing. The right combination for you will be determined by your provider.
Skin resurfacing often includes a series of superficial chemical peels and/or microneedling with a specialty hyperpigmentation serum. The chemical peel safely removes the top layers of skin, including the dark spots, but is safe for darker skin types. These are often done as a series and spaced 4-6 weeks apart for the best results. Addtionally, a hyperpigmentation serum that contains brighteners such as kojic acid, niacinamide, vitamin C, and other therapies are microneedled and infused into the skin which helps with creating an even skin tone and texture. These treatments are alternated. Depending on your skin type, some patients are candidates for non-ablative fractional laser treatments.
What about prevention?
Wear sunscreen. Skin protection with SPF is always recommended, no matter the color of your skin!