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A Dive into the Cause, Diagnosis, and Treatment of Hyperpigmentation

Written by Victoria Tabak


Hyperpigmentation – one of the leading reasons individuals seek treatment from a skin care professional – has been a major skin concern for decades. It is a condition that affects men and women alike, regardless of background and skin type. Fortunately, with the right understanding of cause, common disorders, and available treatment options, there is hope for individuals facing the condition.

What makes one person’s skin pigment or color different from another? With the exception of genetics and cultural background, in the intercellular layers of the skin, there exists an entire universe of the biological makeup of what affects the appearance of someone’s skin color. The flow of blood and lymph, the presence of veins, capillaries, lipids, and proteins, the thickness of the skin itself, and everything else in between are all differentiating factors that enable skin color individualism. Over time, the characteristic qualities of the skin change. Some reasons include chronological aging, environmental impact, hormone fluctuations, nutrition, diet, sun exposure, and many other uncontrollable factors, like stress. As a result, pigmentation disorders inevitably develop or, if already present, worsen. Hyperpigmentation is among one of the most prominent skin concerns for men and women of all backgrounds.



PIGMENT GENESIS

Hyperpigmentation is the appearance of darkened areas of skin – typically brownish in tone, sometimes with a hint of red – caused by the hyperactivity or the excessive production of pigment. First, it is important to understand how the brown pigment is created from the beginning through a process known as melanogenesis. The thyroid hormone, tyrosine, is converted by the tyrosine enzyme, tyrosinase, into dihydroxyphenylalanine (DOPA) through oxidation, which, then, is converted to dopaquinone, the ultimate catalyst for melanin synthesis. The melanin generating process led by the melanocyte cells occurs within the melanosomes. Melanosomes are the cellular subunit organelle granules in the stratum basal leading into the stratum spinosum layers of the epidermis. The melanin then makes its way into the upper epidermis, carried by the keratinocyte cells, actuating visible skin color.

There are two different types of melanin generated through melanogenesis – eumelanin and pheomelanin. Eumelanin has significant skin protecting properties.

Eumelanin is critical as the skin’s primary shield against ultraviolet radiation from harmful solar rays. Eumelanin actively absorbs the ultraviolet impact on the skin along with the accompanying free radicals; hence, aggressively protecting cellular structure and well-being. Pheomelanin, on the contrary, exacerbates the skin-damaging side effects of sun exposure and actually increases the body’s production of free radicals.


THE FITZPATRICK SCALE


A uniform way to assess, and determine, a client’s skin type is by the Fitzpatrick classification scale. The scale was developed by Harvard Medical School dermatologist Thomas Fitzpatrick in 1975 to gain an understanding of a person’s skin color and likely reaction to sun exposure. It is also particularly useful in assessing and anticipating how well skin will respond to certain kinds of facial treatments or procedures. Being knowledgeable about the different skin types offers a resourceful foundation to recommend the most appropriate and effective hyperpigmentation treatment. There are six skin types, according to the Fitzpatrick scale, from very fair skin – which is type I – to the darkest skin – type VI. Type III is the most common. Types IV to VI are typical among people of African descent, who tend to be less sensitive and susceptible to sunburn and sun exposure.

Across the world, skin color varies among different ethnicities. Generally, the distribution of the melanosomes is proportional in both light and dark skin; but, traditionally, hyperpigmentation is a much greater concern for darker skin types. Darker skin has larger melanocytes, whereas light skin has smaller-sized clusters of melanocytes. This means that lighter skin is better at blocking enzymatic pathways to slow tyrosinase action triggered by ultraviolet exposure. Dark skin, on the other hand, is more vulnerable to sun damage, despite the fact that it is less sensitive to the sun because there is greater tyrosinase stimulation.




COMMON HYPERPIGMENTATION DISORDERS

Several factors cause hyperpigmentation, but sun exposure is universal. It is directly responsible for worsening the condition of skin already predisposed to pigmentation, plus triggering the development of new conditions. Some of the most common forms of hyperpigmentation disorders include solar lentigos, melasma, and post-inflammatory hyperpigmentation.

Solar lentigos are also known as liver spots or age spots. Although solar lentigos develop over time and are usual among a mature demographic, typically 50 years or older, they are not actually caused by aging. Rather, chronic sun exposure is accountable for actinic photo-induced aging. The dark lesions are found throughout areas of skin that cumulatively had the most exposure to the sun over time. Essentially, skin that is better protected, such as the forearms or other areas usually covered, remain impervious. Age spots are not just an aesthetic concern; they raise serious health risks surrounding skin cancer, including melanoma and basal cell carcinoma. Proactively protecting skin before spots develop is essential.

Hyperpigmentation, unfortunately, is an undesirable side effect during pregnancy or among women of childbearing age who develop melasma, also referred to as “mask of pregnancy” or chloasma. Elicited by hormone fluctuations, melasma develops because the melanocyte-stimulating hormones are elevated. It is a chronic condition and, typically, people with melasma have considerably greater sensitivity to the sun. The slightest amount of unprotected sun exposure easily forces melanin to the surface of the skin.

The presence of dark patches on the forehead, nose, cheeks, and chin are melasma-defining. This type of hyperpigmentation can clear up on its own within a few months post-pregnancy, but it is likely skin lightening treatments will be necessary. The demand for treatment of melasma is quite large and strongly desired, particularly by women who are emotionally affected by the condition. The best precaution is to use sun protection with a minimum SPF of 30 and reapply it often.

Abnormal pigment alteration, also known as dyschromia, is worsened by a condition known as post-inflammatory hyperpigmentation. It develops from something as minor as post-acne blemishes, an allergic reaction, eczema, or even an injury-causing trauma to the skin. Skin that is irritated, or inflamed, is most susceptible to counter reacting because of hyperpigmentation treatment. Skin practitioners must carefully plan a suitable course of skin therapy for clients suffering from post-inflammatory hyperpigmentation. Inappropriate treatment can precipitate or induce hyperpigmentation.




CAUSES OF HYPERPIGMENTATION

To emphasize, the greatest culprit of hyperpigmentation is ultraviolet exposure that progressively provokes cellular sun damage. In turn, it causes actinic keratosis, which are patches that build up on sun-exposed areas of the body. The precancerous cells are thick, crusty, and scale-like. Actinic keratosis patches are most common in lighter skinned people.

Other external hyperpigmentation-causing forces are the impact of environmental air pollution, smoking, and the use of drugs or medications. These are factors that influence overall cell wellness. Smoking, in particular, deprives cells of oxygen, literally suffocating and destroying cellular structure and quality. Compromised health of cells worsens the appearance of the skin, but also it heightens skin sensitivity to the sun.

As previously discussed, hormone-fluctuations associated with pregnancy are one type of hormone-causing hyperpigmentation scenario. Other incidences where hormone imbalances can affect skin pigmentation is the drop in estrogen levels during menopause. Hormonal equilibrium is also shifted during menstruation, ovulation, and even during times of high stress. Any hormone stimulating events can ultimately influence the tyrosine thyroid hormones, which in turn would activate and increase melanin production, a precursor to hyperpigmentation



PREEMPTING TREATMENT RESPONSE

A Wood’s lamp is one useful tool that professionals can use to examine skin and sun related damage. It offers professionals a method to assess how deep the skin damage goes, which provides insight on whether skin will respond to certain kinds of skin lightening treatments. Typically, epidermal damage has a much better prognosis than when it is deeply dermal. Under a Wood’s light analysis, epidermal damage will appear much darker, while dermal will appear faint. If the predominant appearance is light, meaning greater dermal damage, the client may not experience optimal results with treatment. When the examination reveals mostly darker areas, signifying mostly epidermal damage, it is almost certain that the client will have successful treatment results.


INGREDIENTS IN SKIN LIGHTENING

Hydroquinone, naturally, is one of the constituents of propolis, the resin collected from tree buds by bees. Most likely, it is a phenol, a widely used chemical ingredient considered safe for skin lightening by the medical community. It has powerful tyrosine inhibiting action, which allows for effective hyperpigmentation lightening results. A two percent hydroquinone concentration is the highest available as an over-the-counter before requiring a prescription by a dermatologist. Hydroquinone efficacy can be amplified when combined with other skin lightening ingredients such as a two percent kojic acid or five percent alpha hydroxy acids.

Although hydroquinone is safe and one of the strongest skin care ingredients in the battle against pigmentation, there are mixed feelings about it. This is why Mother Nature has been very generous in sourcing other natural alternatives. A natural ingredient that is comparable to hydroquinone is kojic acid derived from fungi. It can potentially deliver a similar tyrosinase blocking effect. The down side is, as effective as kojic acid may be, it does accompany certain risk of skin sensitivities. One point to keep in mind is that, when investing in hyperpigmentation repairing therapy, the more intense a treatment or product, the higher probability there is that certain sensitivity may occur. Shiitake mushrooms are an ingredient option also part of the fungi family, but without the concern of any adverse reactions. They provide brightening and astringent benefits to the skin, but milder and gentler.

Azelaic acid is a dicarboxylic acid derived from grains like wheat, rye, and barley. In comparison to kojic acid, azelaic acid exhibits milder tyrosinase inhibiting action. It is an in