What is hyperpigmentation?
Hyperpigmentation—brown patches, marks, splotches—can be caused by excessive sun exposure, hormone imbalances, inflammation and injury to the skin. It most commonly appears on the face, neck and décolletage. It’s also notoriously difficult to treat.
Dr Nazirin says “Before you can treat your pigmentation, you need to know what type you have. Those with fair skin are more prone to sun-induced pigment and people with olive complexions can be more susceptible to post-inflammatory pigment. Women who are pregnant, who take the oral contraceptive pill, or who are on hormone replacement therapy or IVF are more likely to suffer from hormone induced pigmentation, aka melasma or chloasma.”
According to Dr Nazirin, “Hyperpigmentation will often appear as we become older as our melanocytes (the cells that produce pigment) increase in size as we age. Younger skin can be at risk of pigment from sun damage—that cute spray of freckles across the nose and cheeks can become more dense, causing uneven tone and darkness to the face, and melasma caused by the pill is very common in younger women.”
Unlike most types of skin trauma, pigmentation pops up quite literally overnight and is triggered by a multitude of factors. Black and brown skins are also more prone to pigmentation because of the increased levels of melanin that exists in our skin – which makes it beyond difficult to treat.
For the most part, women of colour dream of a more even skin-tone rather than a brighter and lighter one. Irregular dark and light patches on your skin can make shopping for makeup more effort than it’s worth, and it’s a knock on one’s self confidence more than once.
“For anybody who has a little bit of melanin—’skin of color’ is broad—any trauma to the skin from acne to external trauma can result in discoloration,” says dermatologist, Dr Nazirin Ariffin who is also the founder of Nazirin Skin Clinic. “And not everything that’s brown is treated the same way,” she adds. “Microscopically, underneath the skin, there may be differences for what’s causing it to be brown.” Dr Nazirin recommends finding a dermatologist who’s comfortable with your skin tone to help you distinguish the different types of brown marks. Here, some of the most common spots you may be seeing—and the best way to minimize them.
Common Causes Of Pigmentation On Dark Skin
It’s no secret that our skin can shape shift throughout different seasons, but we shouldn’t underestimate the impact that genetic and hormonal changes can have on our complexions. ‘The female hormones oestrogenand progesterone are at play here and sometimes can overstimulate melanin – especially when sat unprotected in the sun and during pregnancy – resulting in pigmentation problems known as melisma or choalsma’, says Dr Nazirin. A key point to note is that darker skin-tones are just as prone to sun damage as their lighter counterparts. That’s why wearing a strong SPF (Sun Protection Factor) daily – to protect the skin from harmful UVA and UVB rays – is paramount for fighting pigmentation.
‘Inadequate sun protection causes melanin cells to go into overdrive producing more dark pigment to protect the skin,’ Dr Nazirin explains. ‘Sometimes this is not a linear process and can leave skin with lentigines and a mottled appearance over time.’
What is Post Inflammatory Hyperpigmentation (PIH)?
And then there’s that really fun skin condition known as Post Inflammatory Hyperpigmentation which is the acute effect of skin conditions – such as acne, eczema and psoriasis – that leave dark scars on the skin stimulated by trauma. “Think brown spots after acne that can linger forever or possibly a curling-iron burn or bug bite that turns brown after it heals and seems to stay for months or even years,”
‘Usually by looking at the primary skin condition and controlling factors within that, it is easier to tackle PIH’, says Dr Nazirin. ‘For instance, if discolouration is because of repeated breakouts, addressing clogged pores and excess oil on the skin will reduce incidences of breakouts, thus impacting on the propensity to hyper-pigment.’
Now, this may sound complex, but it’s actually a fairly simple concept that can make shopping for products to combat pigmentation a breeze, once digested. ‘When you’re looking at warmer skin-tones on the Fitzpatrick scale, it quickly becomes evident that they don’t seem to tolerate very low pH’s or very powerful Ha’s (Hyaluronic Acid), so instead of responding with redness, dark pigments are released as a defencemechanism,’ explains Dr Nazirin. ‘There is an extremely different physiological response to the stimulus between darker skin-tones and lighter skin-tones – which is why we prioritise inclusivity and work within the safe PH levels of 3.5 to 4.’
How to deal with Post Inflammatory Hyperpigmentation (PIH)
Post-inflammatory pigmentation will fade over time even with no treatment, says Dr Nazirin, but it can take months or even longer with pigmented scars. To ease the discoloration, she recommends treatments like chemical peels microdermabrasions or lasers, which, while pricier, will show faster results. For the most effective at-home treatments, Dr Nazirin says to incorporate a morning vitamin-C treatment and sunscreen with zinc (SPF 20 or higher) or zinc + titanium. At night, add a retinol solution, and consider a lightening serum.
Heads up: All topical treatments take six to eight weeks to work because that’s how long it takes the skin regenerate itself through skin-cell turnover. And beware, “a lot of the scar creams out there are actually for flattening scars and making them less visible,” warns Dr. Nazirin. “They’re not really addressing the pigmentation, so that’s why they’re not really going to work on post-inflammatory pigmentation.”
You’re going to see this more in types III, IV, and V, says Dr Nazirin: “It will appear as patches on the face that are lacy or shaped like puzzle pieces.” These splotches show up on cheeks, forehead, and the upper lip—and it can get worse in pregnancy or on birth control pills, because estrogen stimulates pigment production. Men can experience it as well, though it typically occurs on their neck, chest, arms, and hands. “Another sign to look out for is upper-cheek freckles,” says Dr Nazirin. “This is macular melasma—the spots will look more smudgy, and there are some bigger light-brown patches as well.”
How to deal Melasma: It is one of the more frustrating issues to deal with because it always recurs, even with topicals, peels, and lasers, says Dr Nazirin. She likes the same treatment as the one for post-inflammatory pigmentation, but know that you’ll need to get those peels or lasers (or both) every two to four months to keep it at bay, as well as daily topical vitamin C and retinoids in between treatments.
“Heat, exercise, underlying rosacea, and all types of UV and infrared radiation are thought to make melasma worse, so controlling these is essential,” says Dr Nazirin. “I typically do not use hydroquinone, though the exception is a very short-term treatment (five to six weeks max). Melasma is a long-term problem requiring a long-term solution.”
Also called lentigos, these small to medium-size spots, which start to show up when we get older, are the skin’s reaction to damage. “These blotches on the face, neck, chest, and hands come with age and usually start in your thirties,” says Dr Nazirin. “You may notice a texture change (crepey texture or wrinkling) and visible red discoloration (telangiectasia, which is a cluster of tiny blood vessels), which are all from sun damage.”
How to deal Sun Spots: Obviously, SPF is the best way to prevent sun-related spots. So how can you make sure you’re really protecting your skin? Dr Nazirin again recommends a zinc-based block; they’re highly effective, but not 100 percent. “And ‘using what’s in my makeup’ is usually not enough,” says Dr Nazirin. That’s why it’s also so important to wear a hat and seek shade. If you want to remove or lighten sun spots, Dr Nazirinrecommends Q-switched pigment-specific laser treatment. A regular routine of topical vitamin C and nighttime retinoids will also help here.
The key thing here is the texture: These rough spots mimic sun spots but really represent keratosis, says DrNazirin. “They’re usually more warty when they occur on the body but can be more flat when they occur on the face, chest, and hands.” They’re genetic, but they also come with age; they can start in your thirties but are more likely in your forties, fifties, and beyond.
How to deal: Seborrheic keratosis usually requires a peel, cryotherapy (freezing), laser, and often a combination of these. Dr Nazirin adds that “healing can take longer and involve a pink spot, brown spot, or even scar for larger issues of seborrheic keratosis.”
If you have any of these skin conditions, please consult a board-certified dermatologist.