Mary Dealy, RN, FNP
Hyperpigmentation is an umbrella term used to cover any number of conditions where one patch of skin becomes noticeably darker than the surrounding skin of the same area. This term covers a number of more specific conditions such as liver spots, freckles and melasma.
Although different types of hyperpigmentation can be caused by various factors such as acne scarring, medications or inflammation from other conditions, the main cause of hyperpigmentation is sun exposure. When we leave our skin untreated, harmful UV rays from the sun cause damage. This damage manifests itself in many ways, from harmless freckles to more severe conditions like skin cancer. Many of these conditions fall under the category of hyperpigmentation.
One specific type of hyperpigmentation is melasma, a condition that affects over 5 million Americans. Although it also is a type of condition characterized by darker patches of skin, melasma is differentiated from other forms of hyperpigmentation mainly by its cause; rather than just being sun-related, melasma is caused in part by hormonal changes within the body. This is why melasma is often referred to as “the mask of pregnancy,” as pregnant women are much more likely to have this condition. In fact, melasma is found much more prevalently in women – pregnant or not – partly because of this hormonal cause.
Melasma is also referred to as a “mask” because it almost always targets a person’s face, resulting in dark patches of skin on a person’s chin, cheeks, nose, upper lip or other cranial areas. Melasma can sometimes be found in other parts of the body, typically those prone to more sun exposure, such as the shoulders.
The exact cause of melasma is not known, however we do know that it is caused by a combination of genetics, hormones, and sun exposure.
Evidence from various epidemiological studies have shown strong correlation between family history and the development of melasma. Family history rate as high as 61% has been reported in some studies. The following ethnicities are more susceptible to melasma: African/African-American, Middle Eastern, Mediterranean, Indian, Asian Latin American, or Hispanic. Also It has been found that the melanocytes (cells that produce melanin, or skin pigment) are larger and produce more melanin in patients with the condition than those without.
Hormones, specifically estrogen and progesterone, are known to exacerbate the condition – although the exact connection is not fully understood. The hormones act on the melanocytes, or pigment producing cells, causing them to make more pigment. Women are at increased risk in developing melasma if they take birth control pills or hormone replacement therapy, or those that are pregnant. Approximately 25% of women will develop melasma as a direct result of taking birth control, and of these approximately 90% will also experience a worsening of melasma during pregnancy.
Sun exposure also contributes to the cause of melasma. UV rays kick the melanocytes (the skin cells that produce pigment) into overdrive, causing increased coloring.
How are these conditions treated?
Melasma can often correct itself. This happens when a trigger, such as pregnancy or oral hormone medications, is removed – when a woman delivers her baby or stops taking hormones, melasma can fade.
Hyperpigmentation not caused by hormones will need to be treated with medications such as hydroquinone, Retinol, and Vitamin C serum, and of course sunscreen every day is a must.
Hydroquinone works by inhibiting the production of melanin in the skin cell. This ultimately leads to a decrease in the number of melanocytes (pigment forming cells) and therefore decreased amount of melanin leading to lighter skin. Concentrations vary from 2% to 5% and are applied daily. It takes a full 6 weeks of treatment for the results to become evident. It is a prescription strength medication and treatment should be monitored closely by your clinician.
A retinol, is often used in conjunction with hydroquinone. It works by suppressing the enzyme that is needed to produce melanin. Often these two medications along with Vitamin C are used topically in conjunction to successfully treat this condition.
Microneedling is a cosmetic procedure that involves puncturing the surface of the skin with tiny sterile needles. These needles are able to reach the deeper dermis of the skin that is often affected by hyperpigmentation. This “micro-trauma” forces the surrounding skin to make brand-new skin that hasn’t yet been agitated by hormones or the sun.
Chemical peels treat melasma in a manner similar to microneedling. Peels react with the dead skin cells present on the outer layer of the skin to exfoliate the area, and like microneedling, trigger the body’s natural healing process, promoting cell turnover and brand new healthier skin.
And lastly – sunscreen. The benefits of sunscreen cannot be overstated. Your skin is a very delicate organ and as previously stated, skin cells respond to UV rays by producing more melanin. SPF blocks the harmful rays of the sun, therefore keeping melanin production in the normal range.
At BeautoxEtc, we offer complete evaluation and treatment for hyperpigmentation. Book a complimentary consultation today.