Hyperpigmentation is a common condition in which patches of skin become darker in color than the normal surrounding skin. Treatment using various skin care products and procedures has given our patients excellent results.
Melanin gives the skin its pigment and is produced by a type of skin cell called a melanocyte. If you have overactive melanocytes, they will produce darker pigmented areas called hyperpigmentation. There are several types of hyperpigmentation, the most common causes being: sun-related (freckles), pregnancy and hormone related (melasma), and medical problems (hyperpituitarism and Addison’s disease).
The primary reason for hyperpigmentation is the melanocyte is over-producing pigment. The pigment production it can be arrested or inhibited with topically applied “bleaching creams”, and abnormal pigment that has already been produced can be removed with PhotoFacial IPL and exfoliating peels.
Hyperpigmentation Treatment Options
Superficial hyperpigmentation is treated with exfoliating home care products containing glycolic acid, esthetician chemical peels, and intense pulsed light (PhotoFacial). Please see our section on PhotoFacial for more information on this superb technique.
Deeper, dermal hyperpigmentation is usually treated with “bleaching” creams in addition to exfoliating treatments. The best known “bleaching” agent for hyperpigmentation is Hydroquinone, which inhibits enzymes the cells use to produce melanin. While Hydroquinone is the most common topical agent, Kojic acid or licorice root, and several others can be used successfully in combination.
Hydroquinone is generally used alone (usually 4% strength) and can be successfully combined with other agents such as tretinoin (Retin-A) and topical corticosteroids. Tretinoin is effective in regulating the epidermis because it helps Hydroquinone penetrate better. Steroid is an anti-inflammatory; sometimes if you have inflammation it can cause hyperpigmentation. So, with a steroid we can lessen inflammation and use the hydroquinone as a bleaching agent.
An agent gaining popularity is Kojic acid. This is especially beneficial for people who develop irritation from Hydroquinone. Kojic acid seems to affect hyperpigmentation along a different chemical pathway than hydroquinone. We often recommend patients use one product in the morning and a different one at night, then in a couple of months switch the treatments around. We just cannot be sure how any individual will respond.
There are several other modalities that are effective at reducing hyperpigmentation, so working out the best regime for each individual patient comes with experience. For instance, lactic acid may help by increasing the exfoliation of the pigmented cells. We may add glycolic acid or pigment balancing peels. Liver spots or sun spots (localized oval shaped brown spots) respond well to PhotoFacial (IPL). Typically, we treat the patient for a couple of months and then reevaluate.
All doctors unequivocally agree if a patient wants to get good results with any of these topicals, using a good quality sunscreen is critical. If a patient is not going to use a broad-spectrum sunscreen consistently, the patient shouldn’t bother using topical agents. The main problem with bleaching creams, whether prescription or over the counter, is that they work if you are avoiding sunlight. You can use these creams for six to eight weeks and get a wonderful result, but short time in the sunlight may put you back where you started. Therefore, we spend a great deal of time helping the patient to avoid issues, so they obtain the best, longest lasting improvement.