A Guide to Skin Pigmentation

You may not be familiar with the term ‘hyperpigmentation’, but you’ll know the condition: reddish-brown marks, patches, or dots on your skin that seem to have no cause and are really difficult to get rid of.

So what are these mysterious marks: are they freckles? Moles? Scars? Or something else entirely? Should we be concerned about them—and how can we get rid of them? 

The good news is that hyperpigmentation is pretty common, and it is treatable. We found out everything you need to know about hyperpigmentation and assembled it in one go-to Guide for your reference. Here we explain how hyperpigmentation occurs, why you have it, and how to get rid of it.

What is hyperpigmentation?

Hyperpigmentation refers to marks on the skin that are noticeably darker than the surrounding skin. 

It might look like spots, patches, or streaks, and it can range in size from very small—like the size of a freckle or a pimple—to larger patches of hyperpigmentation that cover a lot of skin.

There are several different kinds of hyperpigmentation, and several different causes.

It can be caused by inflammation of the skin, like acne, eczema, or allergic reactions; and it can also be caused by trauma to the skin, like cuts, burns, surgery, or incorrect usage of microdermabrasion or laser tools1. When hyperpigmentation occurs as a result of skin inflammation, it can be called post-inflammatory hyperpigmentation, or PIH.

PIH can occur among people with acne, who may notice it as their pimples and acne lesions begin to heal. If you’re someone who picks at or pops pimples, you might notice they turn into little red or brown spots as they heal because of this trauma to the skin; and if you’re someone whose acne is particularly red and inflamed, you might also notice some hyperpigmentation after that inflammation has faded.

Melasma

Melasma is a common form of hyperpigmentation, and although it can affect anyone it’s more common in women than men. Melasma can look like dark blotches on the hands, face, or body, and can be caused by sun exposure, pregnancy, hormone changes, and some medications. Usually symmetrical, it is more common in darker skin types and often there is a family history. This helps distinguish it from post-inflammatory hyperpigmentation due to acne.

Photoageing

Photoageing is also a common cause of hyperpigmentation. Photoageing refers to the ageing effect the sun can have on our skin, and it can be associated with pigmentation changes as well. Solar lentigines, or ‘age spots’, are flat, dark blotches or spots on the skin that occur after long-term sun exposure5. Like most other forms of hyperpigmentation, solar lentigines are harmless but some people can find them unsightly and may want to get rid of them. As always, any new or changing lesions on the skin that you are concerned about should be reviewed in person by a doctor who does skin checks.


How does hyperpigmentation occur?

To know exactly why and how hyperpigmentation happens, we need to look at our skin on a cellular level.

Pigment cells called melanocytes are located at the base of the epidermis, which is essentially our top layer of skin. Trauma and inflammation of the skin can cause these cells to produce more pigment in the skin, and severe trauma or inflammation can actually disturb the bottom layer of the epidermis and cause the pigment to ‘leak’ into the dermis (our second layer of skin)1,2.

When this happens, the pigmentation of our skin changes and appears darker, and the result is hyperpigmentation.


Why do some people have it and others don’t?

There’s not always a clear reason why one person can have hyperpigmentation and another won’t, but there are a few factors that make hyperpigmentation more common in some people than it is in others. One of the big ones is the colour of your skin: people with darker skin are more likely to experience hyperpigmentation than people with lighter skin, due to the amount of melanin already in the skin1.

Hyperpigmentation can also occur as a result of excess hormones, such as estrogen during pregnancy2, and it can be caused and exacerbated by certain medications, like antibiotics or chemotherapy1. Hormonal hyperpigmentation will often gradually fade away as the body’s hormones return to normal. (In the case of pregnancy, this would happen after the baby is born!) Hyperpigmentation caused by medication may also fade after the course of medication is finished. If you’re pregnant or taking medication and concerned about hyperpigmentation, the best thing to do is speak to your doctor about it and ask what steps they would recommend you take to reduce it.


Should I be worried about hyperpigmentation?

You don’t need to worry about hyperpigmentation, but because some kinds of hyperpigmentation can be mistaken for moles or freckles, we do recommend having a yearly mole check with a GP. They can tell you definitively what any marks on your skin are, and whether or not they need further investigation.

Skin pigmentation of any kind—whether it’s PIH, moles, scarring, or anything else—that changes rapidly, bleeds, swells, or hurts should also be mentioned to your doctor.

Especially within Australia, where skin cancer is so common and our levels of UV radiation are so high3, we can’t understate the importance of keeping on top of your skin health. Sunscreen is important for all of us to wear, but especially those who have hyperpigmentation that they’d like to clear up. Protecting your skin from the sun will help prevent more hyperpigmentation from occurring, and can help fade the marks that are already there2


Can I get rid of hyperpigmentation?

The answer is yes! Hyperpigmentation can fade over time, but it can also be helped along by some active skincare ingredients that you can get over-the-counter or by prescription from a doctor.

Here are some ingredients that are scientifically proven to help fade hyperpigmentation: we’ve listed them out and explained what they are and how to use them, and we’ve included some links to relevant scientific studies as well.


Retinoids

Retinoids are a gold-standard skincare ingredient: they can reduce the appearance of wrinkles, combat acne, and yes, they can help clear hyperpigmentation as well! Retinoids are strong, so they can cause minor irritation to the skin when you first begin using them: some mild flaking, redness, and a temporary increase in acne is to be expected. If you find retinoids too strong, you can apply a moisturiser before applying your retinoid serum to create a barrier against the skin. You can find out all about retinoids in our Guide to Retinoids!

  • In people with darker skin, retinoids were found to be effective at treating hyperpigmentation. Those who used a retinoid to treat hyperpigmentation in this study saw an improvement within the first four weeks of use, with a final result of 40% lightening of hyperpigmentation.
  • This study measured how effectively a common retinoid works against melasma, and found that after 40 weeks of daily application, 68% of people who used the retinoid noticed an improvement in their melasma—some noticed that it had decreased by 36%!


Niacinamide

We are huge fans of niacinamide, and this ingredient works really well to clear hyperpigmentation and create smooth, glowing skin! Niacinamide is often found in serums, although it works really well with other active ingredients like retinol and azelaic acid, so it can be combined with them in one product for easy use. Have a read of our Guide to Niacinamide for everything this ingredient can do.

  • In this study, a skincare regime containing niacinamide was found to be significantly more effective in reducing hyperpigmentation than a regime without niacinamide.


Azelaic acid

Azelaic acid is a naturally-occuring acid that works wonders for skin. We recommend it for people whose skin is recovering from acne lesions, as it can help fade and heal acne marks, reduce inflammation, and refine the skin’s texture. Like niacinamide, azelaic acid works well with other ingredients and can be used alone or in a combination product. Those who find retinoids too strong for their skin may want to consider azelaic acid instead, as it is extremely mild and suitable for sensitive skin. Niacinamide and azelaic acid are also both safe to use during pregnancy and breastfeeding.

Check out our Guide to Azelaic Acid for more about this ingredient!

  • This study tested several products containing azelaic acid, and found that all of them were effective in significantly reducing hyperpigmentation and melasma. 

This study focused on patients with darker skin, and found that azelaic acid decreased hyperpigmentation, smoothed skin, and was judged to be effective by patients.

References

  1. Australiasian College of Dermatologists, Post-inflammatory hyperpigmentation, <https://www.dermcoll.edu.au/atoz/post-inflammatory-hyperpigmentation/>, accessed 8th October 2020.
  2. DermNet NZ, Pigmentation disorders, <https://dermnetnz.org/topics/pigmentation-disorders/>, accessed 10th October 2020.
  3. Cancer Council NSW, Skin cancer, <https://www.cancercouncil.com.au/skin-cancer/#Who-is-at-risk>, accessed 10th October 2020.
  4. DermNet NZ, Melasma, <https://dermnetnz.org/topics/melasma/>, accessed 11th October 2020.
  5. DermnNet NZ, Solar lentigines, <https://dermnetnz.org/topics/solar-lentigo/>, accessed 11th October 2020.

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