Hyperpigmentation

Symptoms Of Hyperpigmentation

The main symptom of hyperpigmentation is the development of darkened areas on the skin. These can occur in patches, vary in size and can develop anywhere on the body. The symptoms of the condition vary depending upon the type. The most common types of hyperpigmentation are:

1. Sunspots

Sunspots, solar lentigines or age spots are seen quite commonly. They are also called liver spots but are not related to any liver disorder. They are caused due to excessive exposure to the sun over time. 

Sunspots appear as brown, black or tan spots and are spread across the face, back of the hands and skin that has been exposed to the sun for a long time. 

2. Melasma

Melasma also known as chloasma is characterised by the presentation of hyperpigmented brown to greyish brown patches on the face including the cheeks, upper lip and forehead, as well as the forearms. It sometimes affects arms, neck, tummy, back or any part of skin that is exposed to sunlight. 

Melasma is also called the ‘mask of pregnancy’ because it primarily affects pregnant women. It is also seen in women taking oral contraceptives. Non-pregnant women and dark-skinned men can also get affected. It is more prevalent and lasts longer in people with dark skin.

3. Post-inflammatory hyperpigmentation (PIH)

It is caused due to an injury or inflammation of the skin. It presents as patches or spots of darkened skin. It usually occurs after an inflammatory skin condition such as the presence of acne or eczema. It usually occurs on the face or neck.

Causes Of Hyperpigmentation

The most common cause of hyperpigmentation is excessive production of melanin pigment. There are different conditions or factors that can alter the production of melanin in the body that lead to hyperpigmentation such as:

1. Excessive exposure of the sun 

Prolonged exposure towards the sun can cause the body to produce more melanin to protect the skin from the harmful rays of the sun. This results in patches or dark spots that are also known as sun spots or age spots. They are usually seen during middle age and increase in number with age.

There is a direct correlation between skin pigmentation seen in people with the geographical distribution of ultraviolet radiation. Dark-skinned people are mostly present in areas that receive higher amounts of UVB radiation and light-skinned people inhabit areas that are further away from the tropics. 

2. Skin inflammation 

People can experience the darkening of the skin after inflammation of that area. This includes inflammation caused due to acne, psoriasis, lichen planus, atopic dermatitis, and allergic contact. Post-inflammatory hyperpigmentation is more severe in cases of recurrent inflammation as compared to short-term acute inflammation. The resulting hyperpigmentation can last for months to years and can hamper a person's quality of life. 

3. Melasma

Also known as 'chloasma' or the “mask of pregnancy,” occurs in pregnant women. It is a common skin problem that causes dark discoloured patchy hyperpigmentation. It typically occurs on the face and is symmetrical, with matching marks on both sides of the face. 

Melasma is seen mainly in women across all age groups and races. Men can also get affected by melasma. It is more prevalent and lasts longer in people with dark skin.

The exact cause behind melasma hasn’t been determined yet but some factors are directly linked with the same. This includes an increase in estrogen levels during pregnancy or due to the usage of oral contraceptive pills. Melasma usually resolves on its own after pregnancy or when a woman stops taking birth control pills.

Some people may also have a genetic predisposition towards melasma or may suffer from conditions such as thyroid or liver disorders. UV exposure exacerbates the development of melasma. 

Melasma can appear on the skin at any point in time, and your day-to-day skin care routine may not be enough to combat its appearance.

Read this to learn about how to get rid of  melasma.
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4. Reaction to certain drugs

Using medications such as tricyclic antidepressants and antimalarial drugs can cause hyperpigmentation. This can result in patches of skin to make a greyish hue. Sometimes, the chemicals present in topical treatment can cause hyperpigmentation too. 

5. Addison's disease

Addison's disease is a medical condition that affects a person’s adrenal glands. The adrenal glands are located above the kidneys and produce hormones that influence every tissue and organ of the body. Addison's disease is an autoimmune disorder in which the immune system starts to attack the adrenal glands themselves. This can also result in hyperpigmentation of elbows, knees, folds of skin, lips, knuckles, and toes. Some other symptoms of Addison's disease include fatigue, muscle weakness, nausea, and vomiting. 

6. Hemochromatosis 

This is a medical condition that is inheritable and causes the body to retain too much iron. It can result in hyperpigmentation of the skin in which the skin starts to look more tanner or darker than usual. Other symptoms of the condition include stomach pain, joint pain, fatigue, and weight loss. 

7. Acanthosis nigricans

Hyperpigmentation of intertriginous areas like the nape of the neck, and armpits is associated with insulin resistance leading to diabetes and metabolic syndrome (cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes).

8. Linea nigra

It is the presence of a hyperpigmented line found on the abdomen during pregnancy.

9. Peutz–Jeghers syndrome

This is an autosomal dominant (passed through the families) disorder characterised by hyperpigmented macules on the lips and oral mucosa and gastrointestinal polyps.

10. Smoker's melanosis 

This can be seen with the naked eye as a brown to black pigmentation of the oral tissue i.e. the gums, cheeks or palate as well as in the larynx. It is most often seen in the lower gums of tobacco users. 

11. Mercury poisoning

This particularly causes darkening of the outer layer of the skin, resulting from the topical application of mercurial ointments for skin-whitening.

12. Porphyria 

It is a group of liver disorders in which substances called porphyrins build up in the body, negatively affecting the skin. This causes local skin damage and resultant hyperpigmentation in the long run.

13. Metabolic causes 

These include vitamin deficiencies such as Vitamin B12 and folic acid.

14. Cancer

Although not as common, in many cases of malignancy, especially related to melanoma, diffuse hyperpigmentation is seen. This is more common in patients with metastatic disease and/or those patients who present with melanoma of an unknown origin.

Risk Factors For Hyperpigmentation

Some common risk factors of hyperpigmentation include:

• Prolonged exposure towards the sun 

• Darker skin tone that is more prone to changes in the pigmentation 

• Use of oral contraceptives or pregnancy seen in the cases of melasma

• Certain medications that can increase the skin’s sensitivity towards sunlight 

• Trauma that wounds the skin such as a burn injury

• Inflammation plays an important role in hyperpigmentation post-acne

Sun exposure is the most common cause for hyperpigmentation. Protect your skin by choosing the right sunscreen. Read more about tips to choose the right sunscreen.
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Diagnosis Of Hyperpigmentation

Hyperpigmentation can be caused due to multiple factors and can be diagnosed. Some of the diagnostic tests include:

1. Physical examination

A skin specialist known as a dermatologist can determine the cause behind your hyperpigmentation. They can perform a physical exam or biopsy in which a small sample of skin is taken and sent to a lab for further investigations. Melasma can usually be identified by a doctor by just looking at the skin.

2. Complete medical history

Hyperpigmentation can be caused by certain medications and also some health conditions. A detailed medical history can help in confirming the diagnosis.

3. Woods lamp

The woods lamp is an examination in which ultraviolet light is used to show fluorescence. This device is used by a dermatologist to diagnose the different pigmentations of the skin. The exam will be conducted in a darkened room that will allow wood light to lighten the affected area for some seconds. The doctor will look for changes in colour or fluorescence. Normal skin will not show fluorescence whereas the presence of fungal, bacterial infections, or pigment disorder will. 

Prevention Of Hyperpigmentation

There is no sure short way to prevent hyperpigmentation. However, there are some ways through which you can reduce your risk of developing hyperpigmentation. They are:

• Apply sunscreen as it protect your skin against the harmful rays of the sun. The most recommended SPF level is 50.

• Cover your face with hats or caps, if you are going out in the sun. 

• Avoid going out when the sun is at its strongest, especially in the afternoon.

• Add Vitamin C to your beauty regime.

• Limit scratching or touching your skin frequently.

Specialist To Visit

Hyperpigmentation is harmless but it can have an effect on your mental well being as well as physical wellness, if associated with another underlying condition. Doctors that can help you in reducing your hyperpigmentation or diagnosing any other health condition are:

• Dermatologist

• General physician

If you are noticing any of the symptoms, seek advice from our world-class medical professionals. 
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Treatment Of Hyperpigmentation

There are various treatment modalities available to reduce and treat hyperpigmentation. They include:

1. Topical creams 

Many people opt to use over-the-counter topical creams that contain ingredients that can lighten the skin. This includes creams that contain kojic acid, azelaic acid, hydroquinone, retinoids, and Vitamin C.

Topical prescription creams with hydroquinone can lighten the skin. Hydroquinone remains a workhorse of melasma and hyperpigmentation management and is often considered the topical “gold standard”. However, it is not advisable to use topical hydroquinone for a long time since it can cause the skin to darken further called ochronosis. Always consult a dermatologist before using a cream containing hydroquinone to get the right guidance on how you can use the cream.

Creams containing retinoids or kojic acid can take a couple of months to show their effect. 

2. Chemical peels 

An effective way of treating hyperpigmentation is chemical peels. This technique involves applying a chemical solution to the skin that leads to the area's exfoliation and peeling. The skin that regenerates in that area is smoother and less wrinkled. 

Usually, chemicals such as glycolic acid, salicylic acid, and trichloroacetic acid are used for chemical peels. If you are using a topical retinoid, talk to your doctor before using an over-the-counter peel. You may need to stop retinoid use for seven days before the peel. Superficial chemical peels use alpha-hydroxy acid or other mild acids that only penetrate the outer layer of the skin and improve mild skin discoloration. 

Medium strength chemical peels use glycolic or trichloroacetic acid that can penetrate the outer and middle layers of the skin. This treatment reduces age spots and moderate skin discoloration. Deep chemical peels use trichloroacetic acid or phenol. The chemical penetrates the deeper layer of the skin and can help in reducing shallow scars and age spots. 

3. Dermabrasion 

This medical procedure uses a wire brush or diamond wheel that can level the superficial layer of the skin. The areas that are treated with dermabrasion heal and allow new skin to regenerate. Dermabrasion foremost injures the skin and patients who opt for the procedure should be prepared for how they will look right after the treatment and during the time the skin regenerates. The patient needs to talk to their doctor and have realistic expectations from the treatment. The result of dermabrasion can take up to several weeks or months to become evident. 

4. Laser resurfacing 

Laser resurfacing is a popular medical procedure that uses a laser device to improve the way the skin appears to be. It is also used to treat minor flaws and remove layers of skin. Carbon dioxide or CO2 laser is the most commonly used laser that can treat minor wrinkles, scars, and other conditions. Erbium laser is used to improve superficial and deep lines on the face, hand, and chest. It causes fewer side effects than the CO2 laser. Laser toning using YAG laser and intense pulse light can be used to treat hyperpigmentation such as melasma and post-inflammatory hyperpigmentation.

Home-care For Hyperpigmentation

Hyperpigmentation is not a serious condition, but it can take a toll on your mind because of the appearance. Here are a few tips that can help you with it. They are:

• Always follow the instructions given by your dermatologist.

• If you have been advised to apply a topical cream or use a particular face wash, do so religiously and be patient for the results to become evident. 

• Apply sunscreen while going out including on cloudy days. 

• In case you have acne or other forms of facial injury, do not poke or touch that area. 

• Scratching or picking at that area will increase the inflammation of that region which will lead to darkening of the skin. 

• Use over-the-counter products that contain spot eradicating ingredients such as arbutin and niacinamide. 

• It is important to carefully read the information leaflet of the medicine since applying too much of any product can lead to irritation of the skin.

• You can try natural ingredients like aloe vera, green tea extract, and sandalwood to lighten the skin. 

Complications Of Hyperpigmentation

Hyperpigmentation is the harmless darkening of skin and doesn't cause any particular complication. In case your hyperpigmentation doesn't improve within a few months, consult a doctor to rule out any underlying medical conditions. 

Alternative Therapies For Hyperpigmentation

Home remedies

Hyperpigmentation can be lightened with ingredients found at home. Natural facepacks can work wonders. However, it is always better to consult with your dermatologist before using these home remedies. 

1. Aloe vera 

Aloe vera is a plant that contains aloesin, a compound that can lighten hyperpigmentation. The compound works by reducing the production of melanin in the skin. Applying aloe vera has been found to relieve melasma in pregnant women. You can use natural aloe vera or aloe vera gels that are available in the market.

2. Licorice (Mulethi) 

This extract may reportedly lighten hyperpigmentation. Licorice extract has antioxidants and anti-inflammatory agents that can cause skin lightening. 

3. Green tea

Green tea contains antioxidants and anti-inflammatory properties that can improve hyperpigmentation.

4. Turmeric (Haldi)

Regular application of turmeric which is rich in antioxidants helps in lightening the dark patches. It also reduces the occurrence of pimples that can later lead to hyperpigmentation.

5. Potato (Aloo)

Potatoes contain an enzyme called catecholase which is known to lighten skin pigmentation, dark spots and blemishes. 

6. Tomato (Tamatar)

Tomato paste rich in lycopene that protects the skin against short-term and long-term effects of sun damage. 

7. Milk (Dudh)

Milk, buttermilk, and even sour milk have lactic acid that helps to lighten skin discoloration.

8. Sandalwood (Chandan)

This is an age-old remedy used by all the elderly people to get the glow. Sandalwood helps to lighten hyperpigmentation spots as it contains natural skin-lightening agents.

Living With Hyperpigmentation

Hyperpigmentation of skin is harmless, however, it can affect a person's mental health and make them conscious of how they look. This can affect a person's quality of life and dishearten them. However, there are some effective ways of managing hyperpigmentation. 

• Avoid going out in direct sunlight and if you do so always apply a sunscreen that contains SPF 30 or above. Remember to reapply sunscreen every two hours. 

• Wear hats or caps that will protect you from harsh UV rays.

• Use gentle, fragrance-free products that do not contain any ingredients that can exacerbate inflammation or irritation of the skin. 

• Avoid waxing areas that have melasma as that can cause skin inflammation.

• Increase intake of foods rich in Vitamin A & antioxidants. Vegetables like spinach, carrots, lettuce, broccoli, red bell peppers & sweet potato to help reduce and prevent pigmentation.

• Consume lots of citrus fruits. Vitamin C has antioxidant properties that helps in reducing damage caused by harmful UV rays and prevents dark spots.

• Deficiency of Vitamin B12 is a common cause for skin pigmentation. Meeting your daily requirement can help in managing pigmentation.

• Drink plenty of water to keep your skin supple and to get rid of toxins. You should be drinking at least 2-3 litres of fluids in summer.

• Always consult a dermatologist for correct diagnosis of any underlying cause and proper treatment of hyperpigmentation.