Hyperpigmentation: Dermatologist's tips for common women's skin issue

Dr. Shreya Andric is a dermatologist based in Sydney. She is passionate about skin health and her mission is to educate the public on how to care for their skin, and also clear up the vast amount of misinformation out there on this topic.

While Dr. Andric has independently chosen the products that appear in this article, she does not receive revenue from the links. Some of the links may return revenue to Yahoo Lifestyle Australia.

Hyperpigmentation is a term used to describe disorders characterised by darkening of the skin. This is a very common problem and can affect people of all skin types.

Disorders of hyperpigmentation usually result from an increase in melanin production, and occasionally from an increase in the density of active melanocytes (pigment cells).

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The three most common causes of hyperpigmentation are:

Melasma

A very common condition characterised by symmetric, hyperpigmented patches with irregular borders, which most often occurs on the face in women. It is seen more frequently in people of slightly darker skin types but can affect all skin types.

It is thought to be secondary to hyperfunctional melanocytes (ie. over-excited pigment cells) that are stimulated by exacerbating factors, such as sun exposure, heat and hormones (eg. pregnancy, oral contraceptives). It can wax and wane throughout life.

Post-inflammatory hyperpigmentation (PIH)

This occurs due to an excess of melanin pigment following inflammation within the skin (eg. acne, psoriasis, eczema) or injury (eg. burns or friction). It can occur anywhere on the body, including inside the mouth or on the nails, and the colour can range from light brown to dark brown or grey-blue to grey-brown.

In general, PIH eventually resolves as long as the underlying condition is treated effectively, but this may take months or even years. It may also be exacerbated by sun exposure.

Sunspots/freckles

These are secondary to sun exposure over time. Freckles develop early in life and may fade, whereas sun spots develop later in life and usually increase in size.

My number one tip when it comes to treating pigmentation is to get the correct diagnosis. Differentiating between the above causes is not always straightforward so find out what you are treating before you dive in. If the cause is post-inflammatory, it is important to treat the underlying condition to minimise those post-inflammation changes.

You may have noticed a running theme between the above three causes – sun exposure! Obviously, prevention is better (and easier) than treatment but anyone with these conditions should:

• Avoid sun exposure and tanning beds

• Apply a broad-spectrum sunscreen (ideally SPF greater than 30 with physical blockers such as zinc oxide or titanium dioxide) every single day, and reapply every 2-3 hours. Look for iron oxide as an inactive ingredient. The Skinceuticals Physical Fusion UV Defense is a great option.

• Wear sun-protective hats and clothing

• Wear camouflage makeup – the tint in the makeup is thought to provide extra protection

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Other than sun protection, there are various active ingredients in skincare that have been found to be very effective for treatment of hyperpigmentation:

Hydroquinone

This is the gold standard. It is very safe and effective but needs to be used in the correct way so I would advise seeing your dermatologist to discuss this. It suppresses how much melanin your skin makes and the effects take weeks to kick in.

It does make the skin more sun-sensitive but you should be sun protection anyway! Only use it for 2-3 months at a time under dermatologist supervision - if used inappropriately it can result in irreversible hyperpigmentation called exogenous ochronosis (this usually occurs with higher percentages).

Retinols and Retinoids

These are proven to increase cell turnover, even out pigmentation and stimulate collagen production.

Azelaic acid

Azelaic acid works by decreasing melanin production. It is most effective between 15-20% and can be applied twice per day but can sometimes be irritating. If so, then you can reduce the frequency to once daily only. It is safe in pregnancy.

Kojic acid

This is a chemical produced from different types of fungi. It inhibits an enzyme necessary in the production of melanin and also delivers some anti-oxidant protection. It works well with and enhances the effects of hydroquinone and glycolic acid.

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L-ascorbic acid

L-ascorbic acid is the most biologically active and well-studied form of Vitamin C. It will not be effective in treatment of hyperpigmentation when used alone but is a great additive. It interacts with copper ions to stop formation of melanin. The ideal percentage is 10-15%.

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Glycolic or salicylic acid peels

Chemical exfoliants such as glycolic acid peels (starting at 30% and increasing as tolerated) can be done every 4-6 weeks. Read more about glycolic and salicylic acids here.

Maintenance regimen

Long-term maintenance should involve continuation of your daily sunscreen and sun-protective measures as well as regular use of a topical retinoid (nightly) and topical alpha-hydroxy acid (eg. glycolic acid 1-2 times per week).

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