Hyperpigmentation, dark spots, blotches, or areas on the skin, occurs when the body over produces pigment. There are three main kinds of hyperpigmentation caused by three different factors . No matter what type of hyperpigmentation you have there are many solutions to this skincare problem.
The three main types of hyperpigmentation are melasma, sun (sometimes called age) spots, and post inflammatory hyperpigmentation. Melasma is caused by hormonal changes in the body; pregnancy and birth control pills can cause melasma. Sun spots or sun damage is, obviously, caused by sun exposure. The last type of hyperpigmentation is post-inflammatory hyperpigmentation. This discoloration of the skin occurs after injury or irritation to the skin or after an acne lesion (pimple) has healed.
As already mentioned there are a number of treatments for hyperpigmentation. First and foremost you must use a sunscreen, spf 30 or higher, daily and be sure to reapply throughout the day. Sun exposure will only make your hyperpigmentation worse (i.e. darker) so it is important to protect the skin on a daily basis. Daily use of sunscreen will also prevent new sun spots from forming.
There is only one FDA approved agent to reduce hyperpigmentation and this is hydroquinone. Only products with hydroquinone in them can be legally labeled “lightening” products. All other products that claim to help lighten hyperpigmentation without hydroquinone are usually labeled “brightening”, “bleaching”, and even “illuminating”. Please remember that there is no legal definition of or oversight over the words “brightening”, “bleaching”, or “illuminating” found on product labels. Be sure to turn the product you are looking at around and read the ingredients list.
Hydroquinone is a chemical lightening agent that comes in strengths of 1 to 2% in OTC products and 3 to 4% in prescription products like TriLuma. To use a hydroquinone product you apply the cream, gel, or solution just to your dark marks twice a day for no longer than six months. Hydroquinone works by inhibiting the tyrosinase enzyme which forms pigment in the skin as well as disrupting the synthesis of the melanin protein in the skin. Because of its impact on the melanocyte it is thought that hydroquinone disrupts basic cellular processes including DNA and RNA synthesis. Though hydroquinone has shown to be effective in treating hyperpigmentation it is far from a perfect ingredient and is surrounded by controversy. For example, its use has been banned in the European Union and in Japan, and as recently as 2006 the FDA reported its intention to ban the use of hydroquinone in non-prescription products. As of April 9, 2009 the Cosmetic Ingredient Review Board has listed hydroquinone under “ingredients found safe with qualifications” on its website and writes: “≤1% in aqueous formulations; but only for brief discontinuous use followed by rinsing from skin and hair; and should not be used in any type of leave-on, non-drug cosmetic product”, but as of yet no ban on hydroquinone has gone into effect in the US. The reason for all this concern about hydroquinone is that the ingredient has both potential mutagenic and cancer causing properties. In addition to these upsetting issues some people are allergic to hydroquinone or develop contact dermatitis from using this ingredient. All of these concerns and issues render hydroquinone an effective but unsatisfactory ingredient for some for treating hyperpigmentation. Personally I feel that when hydroquinone is used for short periods of time, 3 to 6 months, there is no reason to be concerned over its use. OTC products contain such a small percentage of hydroquinone, 1 to 2%, that I feel there is no need for alarm when you choose to use such a product. (I have a list of links at the end of this post if you want to read more in-depth about hydroquinone.)
If you do not want to use hydroquinone, many alternatives exist. Ingredients that are skin brighteners include: kojic acid, arbutin, licorice root, bearberry, soy, mulberry, vitamin C, niacinamide, and azaleic acid. The current trend in products to treat hyperpigmentation is to combine several of the above mentioned ingredients in one product for better results.
Non-prescription products containing hydroquinone take a long time to work, as do the non-hydroquinone alternatives. Prescription products usually work much faster. The more superficial your hyperpigmentation is the easier it will be to remove. Please also note that people with darker skin tones are more prone to hyperpigmentation, particularly post-inflammatory hyperpigmentation. If you have darker skin you need to be more gentle when treating your hyperpigmentation so that you do not cause more irritation and/or hyperpigmentation to your skin.
There are other ways to treat hyperpigmentation; regular exfoliation can help get rid of hyperpigmentation. For example you could use products containing glycolic acid, an alpha hydroxy acid, which works by exfoliating the uppermost layers of the skin. More superficial dark marks can be removed with this type of exfoliation. Glycolic acid can be found in face washes, creams, gels, lotions, and chemical peels. The form and concentration of the glycolic acid you should use will be determined by the severity of your dark marks and your skin’s reaction to the acid since glycolic acid can cause irritation to some people.
Another treatment for hyperpigmentation is a series of chemical peels that include ingredients such as glycolic acid, lactic acid, hydroquinone, kojic acid, licorice root, mulberry extract, bearberry extract, azelaic acid, and ascorbic acid (Vitamin C). The peels will use one or more of the above mentioned ingredients. A series of chemicals peels can make quite a difference in the appearance of the skin and can definitely improve hyperpigmentation. Side effects from chemical peels include redness and peeling for a few days after the peel. To get the best results from your chemical peels it is a good idea to combine the esthetician or doctor administered peels with home products that treat hyperpigmentation.
Another great treatment option for hyperpigmentation are laser treatments. Lasers such as the Ruby and Q-switched ND:YAG reach the dark spots deep in the skin, converting light to heat, and literally blow up dark spots which then flake off the skin. Though the procedure only takes a few minutes redness and scabbing can occur; recovery time is about a week. Intense Pulsed Light (IPL) treatments can also help hyperpigmentation with no downtime.
Just as there are a number of causes and types of hyperpigmentation there are also many different treatments. Do a little research and give some thought to how your skin reacts to different ingredients before deciding what treatment option is best for you. Eventually you should have no problem finding the right solution for your hyperpigmentation.
Sources and Further Reading:
- Dr. Susan Taylor’s Rx for Brown Skin Chapter 8: Problems with Pigmentation
- Milady’s Standard Fundamentals for Estheticians, 9th edition
- Hydroquinone: Is the Cure Worse Than The Problem? Skin Inc., 2009
- Uneven Pigmentation: What Can Be Done? The New York Times, May 2009
- The Skin Fixers: 6 Dermatologists Prescribe Solutions to Your Complexion Concerns – Your Problem: Discoloration O, The Oprah Magazine August 2009
- Paula Begoun’s online Ingredient Dictionary: Hydroquinone
- Simple Skin Beauty by Dr. Ellen Marmur, pages 208-209
- Spotlight on Spots Day Spa Magazine
- Why Pigment Happens – And What You Can Do About It - Dr. Leslie Baumann