What is hyperpigmentation? (Part 1: The Causes)
We’ve all experienced the post-blemish scarring from a stubborn breakout that you probably picked at ( even though we know better). Perhaps you’ve started to see increased sun spots or patchy discolored areas that never existed before. Well, these all fall under the umbrella term of “hyperpigmentation.”
And if you asked many women of color (myself included) about their greatest skincare concerns, majority of the time the response will be hyperpigmentation, aka the nemesis of flawless skin–well one of them. Personally, I wouldn’t mind passing on the dark spots that linger every time I experience an unpleasant breakout. Because this is a hot topic, I decided to make it a two-part post. First, let’s first understand why it happens and what’s going under the surface of the skin before you see the darkened areas
What is hyperpigmentation?
What causes hyperpigmentation?
There are many different factors that can trigger melanin overproduction, leading to hyperpigmentation. Some factors include sun exposure, inflammation or skin infection, injury to the skin and hormonal changes. The factors listed here only touch the surface of what contributes to hyperpigmentation—this is why it is important to consult with a dermatologist or trained skincare professional for a thorough assessment before trying all the million products out there.
Hyperpigmentation can also be caused by certain medications and medical conditions—but we will just stick to the following examples since they tend to be more common: age spots (or sun spots), post-inflammatory hyperpigmentation, and melasma. Nevertheless a trained eye will help accurately diagnose and characterize the underlying medical cause of the hyperpigmentation, beyond those that are acne-related. By the way, Dr. Google and WebMD are not sufficient, because all hyperpigmentation marks are not handled the same.
Sun Damage and Age Spots
Age spots are darkened spots that develop as a result of the cumulative effects of sun damage inflicted on our skin overtime. The spots are pale brown or gray in color and have a clearly defined edge. They typically develop on the areas of the skin most frequently exposed to the sun, such as the face and back of the hands.
Sunlight triggers melanin production, and to protect the skin, it acts like a barrier that scatters ultraviolet (UV) rays, and as an absorbent filter that reduces the penetration of UV through the epidermis, which is the outermost layer of the skin. In more simple terms, melanin actually acts as your skin’s natural sunscreen by protecting us from harmful UV rays. However, overexposure can disrupt this protective process. So… yes basking in the sun comes with a price that may not look as good in your 50-60s as it did during your 20-30s. Additionally, the number of sunspots that can be seen tends to increase with age.
Post-inflammatory hyperpigmentation (PIH)…aka the nemesis of even skin tone, as you can guess from the name refers to darkening of the skin caused by an injury or inflammation. For instance, PIH is how your body reacts when you decide to pick at that breakout even though you knew you had no business doing so and now you have a mark to remember it by (haha). Acne breakout is just one example—essentially any injury or trauma to the skin [whether it’s from a skin condition like ezcema, burns, allergic reactions, infection, insect bites, pseudofolliculitis barbae (aka razor bumps), or inflammatory skin conditions like psorasis] can trigger excess melanin production and cause PIH. Darker skin tones usually are most commonly affected since we have more melanin.
PIH is often classified by dermatologists based on the depth of the hyperpigmentation, as either epidermal (top layer of skin), dermal (deeper layer of skin) or mixed. Epidermal PIH responds the most topical treatment. The affected areas of the skin can be darkened (even more) with sun exposure (hence the importance of sunscreen) and certain medications.
Melasma (also called “chloasma” when it’s associated with pregnancy) is characterized by dark brown patches of irregular shape and skin. It’s often seen on the face but can occur anywhere else on the body. Although it is commonly associated with pregnancy and hormonal changes, melasma can also be drug/chemical-related or UV-related. Additionally, since melasma can be a symptom of another medical condition, it is very important to have a professional evaluation before trying to tackle it on your own (and possible make things worse). Unlike PIH, which responds to several OTC products that have skin-brightening ingredients like vitamin C, kojic acid, niacinamide, hydroquinone, and azelaic acid, melasma is a bit more difficult to treat and requires professional attention. (sidebar: you see how I just shared a sneak peak of the part 2 on the treatment options)
So what’s the key takeaway from Part 1?
- There are a number of factors that contribute to excess melanin production defined by hyperpigmentation. These factors include acne, sun damage, hormonal changes, other inflammatory skin conditions, etc.
- Professional evaluation is highly recommended and will definitely save you a lot of money, as the different types/causes of hyperpigmentation do not necessarily respond to treatment the same way.
If you’re looking for a deeper dive, @brownskinderm and Dr. Simela along with an all-star group of practicing dermatologists are hosting an informative, educational series on hyperpigmentation for the IG community. I’m almost 1000% sure they’ll answer every question you’ve ever had about hyperpigmentation. You definitely want to check it out.
- Kang, H. Y., & Ortonne, J. P. What should be considered in treatment of melasma. Annals of Dermatology. 2010; 22(4), 373-378.