Common causes of hyperpigmentation are caused by harsh environmental, medical, genetics or hormonal imbalance factors.

This leads to age spot, sun spot, malesma, liver spot. You know if you have hypigmentations because the area of your skin discolourises and look different from your ideal complexion compared to other parts of your body.

What’s hypigmentation?

Hyperpigmentation is caused by an increase in melanin secretion. Melanin is the natural pigment that gives your skin, hair and eyes their color. A number of factors can trigger an increase in melanin production.

Causes of  hyperpigmentation 

 Skin Injury

Focal hyperpigmentation is most often post-inflammatory in nature, occurring after injury (eg, cuts and burns) or other causes of inflammation (eg, acne, lupus). This  hyperpigmentation is commonly due to phyto photodermatitis, which is a phototoxic reaction that results from ultraviolet light combined with psoralens (specifically furocoumarins) in plants (eg, limes, parsley, celery— see Chemical photosensitivity). This pigmentation can also result from neoplastic processes (eg, lentigines, melanoma), melasma, freckles etc.

 Inflammation

Another form of hyperpigmentation is post inflammatory hyperpigmentation. These are dark and discoloured spots that appear on the skin following acne that has healed.

Moles

 Moles are common hyperpigmentation of the skin where the lesion discolour the skin. This is usually developing during childhood.

Moles treatment

Surgery

Applying banana peels

Use of frankincense oil

Use of hydrogen peroxide

Aloe vera gel

Freckles

One cause of hyperpigmentation is freckles. They are seen as a result of overproduction of melanin.  Freckles are small brownish spots on your skin, due to over exposure to the sun.

Freckles treatment

Wear sunscreen before going out

Laser treatment can fade freckles

Use of topical depigmenting creams

Applying retinoid creams

Chemical peel

Melasma

Melasma is more prevalent among dark skin people and lasts longer

because melasma  increases with frequent sun exposure, due to overproduction of melanin by hyperfunctional melanocytes. Other than sun exposure, other factors include autoimmune thyroid disorders, photosensitizing drugs.

In women, melasma fades slowly  and incompletely after childbirth or cessation of hormone use.

In men, melasma rarely fades.

The mainstay of melasma management is strict sun protection. Patients should use sunscreen

with a sun protection factor (SPF) of 30 or higher, wear protective clothing and hats, and avoid direct sun exposure. During and after therapy, strict sun protection must be checked.

Melasma treatment

Treatment depends on whether the pigmentation is epidermal or dermal.

Hydroquinone 2 to 4%

Tretinoin 0.05 to 1%

Topical corticosteroid 

Hydroquinone depigments the skin by blocking the enzymatic oxidation of tyrosine 3,4-dihydroxyphenylalanine and inhibiting melanocyte metabolic processes. Hydroquinone

should be tested behind one ear or on a small patch on the forearm for 1 week before use on the face because it may cause irritation or an allergic reaction. 

Tretinoin promotes keratinocyte turnover and can exfoliate skin that contains epidermal pigment. 

Corticosteroids help block synthesis and secretion of melanin. 

Azelaic acid 15 to 20% cream can be used in place of or with hydroquinone and/or tretinoin.

Azelaic acid is a tyrosinase inhibitor that reduces melanin production (and is considered safe for use during pregnancy). 

Topical kojic acid works effectively for fading pigmentation, it is a chelating

agent that blocks tyrosine conversion to melanin.

Chemical peels.

Laser treatments also have been used but are not standard therapy.

Tranexamic acid

Lentigines (lentigo)

Lentigo is a type of hyperpigmentation cause by sun damage. It is flat, tan to brown, oval macules. They are commonly caused by chronic sun exposure (solar lentigines; sometimes called liver spots but are not related to hepatic dysfunction and occur most frequently on the face and back of the hands. 

Drugs

Other causes of  hyperpigmentation can result from drugs and also has systemic and neoplastic causes such as lung carcinomas and melanoma with systemic involvement. After eliminating drugs as a cause of diffuse hyperpigmentation, patients should be tested for the most common systemic causes. These causes include Addison disease, hemochromatosis, and primary biliary cholangitis. The search for underlying cancer should be based on a review of systems.

Typical inciting drugs include antibiotics (sulfonamides, tetracyclines, trimethoprim, and fluoroquinolones), nonsteroidal anti-inflammatory drugs, and barbiturates.

Treatment of drug-related hyperpigmentation

Discontinue the  oral  use of the drug.

Avoid sun exposure.

 Avoid medications, such as oral contraceptives (birth control pills) and drugs that cause sensitivity to light.

Cancers

Chemotherapy and immunotherapy can also change the color, pigment of the skin but it’s less common. Skin cancer may appear as a nodule, rash or irregular patch on the skin surface. Hyperpigmentation is as the result of an uneven distribution of melanin around the skin surface looking like darker patches different from other areas of your body not affected.

Treatment of Chemo hyperpigmentation

Retinols 

Chemical peels

Laser therapy

 Sun exposure

Over exposure of the skin to sun, risk sun damage because your melanin is triple and becomes super active when exposed to the sun. Sun can cause your skin to tan, resulting in an uneven skin tone different from other parts of the body not exposed to the sun. sun is one number culprit of hyperpigmentation.

Hormonal influences

Genetics, such as a family with freckles. Hormone changes, such as during puberty or pregnancy can alter skin colour and cause pigmentation of the skin.

Age 

As the body ages, melanocyte distribution becomes less diffuse and its regulation less controlled by the body. UV light stimulates melanocyte activity, and where concentration of the cells is greater, hyperpigmentation occurs.

Acne

Severe acne and breakout can cause hypigmentation. Acne after treatment get healed and form acne scars. This scars leaves stains like dark spot and patches on the skin. Melanin is produced as a means of healing up acne wounds.

Treatment of acne hyperpigmentation

Retinols

AHA / BHA products

Chemical peels

Kojic acid

Vitamin C

Burns

Skin hyperpigmentation changes can happen to you, if you suffer severe burns from heat or injuries from deep bruises and cuts. Healing processes leads to darker skin as your skin tries to recover from burns and injuries suffered.

High Melanin

Melanin is produced by melanocytes at the lower layer of the epidermis. Melanin is a class of pigment responsible for producing color in the body in places such as the eyes, skin, and hair.

How is hyperpigmentation treated?

Depending on the causes of hyperpigmentation, your dermatologist may suggest lifestyle changes such as:

Avoiding sun damage by staying out of the sun, wearing sunscreen and wearing protective

clothing.

Stop any medications that may be causing it.

Taking vitamins.

Over-the-counter topical therapy

(creams or ointments you put on your skin):

Azelaic acid.

Corticosteroids.

Glycolic acid (alpha-hydroxy acid).

Hydroquinone.

Kojic acid

Salicylic acid.

Skin bleach.

Tretinoin.

Vitamin C or B3 (niacinamide).

Other treatments may include:

Chemical peels.

Cryotherapy.

Laser skin resurfacing.

Pigmented lesion laser.

Can I treat hyperpigmentation at home?

Many products claim to lessen hyperpigmentation. See a dermatologist to recommend what works for you.

How can I cope with age spots, sun spots, liver spots and other forms of hyperpigmentation?

The appearance of hyperpigmentation can make you feel self-conscious.

Avoid sun damage.

Be patient with any treatments you’re trying, as they can take months to show improvement.

Don’t pick at any imperfections, such as pimples.

Take care of your skin by washing, exfoliating and moisturizing regularly to help improve your skin overall texture and appearance.