What Are The Different Hyperpigmentation Presentations?
a. Natural pigment variations in skin, for example, pigment demarcation lines like those on the temples, legs, etc. Maybe sen clearly in conditions like pregnancy.
b. Birthmarks
c. Melasma or chloasma is a common pigmentation disease characterized by dark patches on the face that commonly affects women more than men, particularly pregnant women. It usually occurs in states of hormonal imbalance, especially in women using oral contraceptives or undergoing hormone replacement therapy, or due to chronic sun exposure, and sometimes the cause is unknown.
d. Chronic sun exposure
* Freckles – Freckles may begin in childhood and can be genetic in nature. They are darkened spots on the skin caused by the overproduction of melanin granules by the melanocytes. Seen commonly in fairer skin, people living on high altitudes and sunny areas.
* Age spots – Also called lentigines or liver spots, these are rounded patches that occur on the skin in the elderly, developing like large freckles.
* Tanning
* Melasma
* Photodamage
1. Smoker’s melanosis – This is the darkening or pigmentation of the gums or inner parts of the cheeks caused by long-term smoking.
2. Acanthosis nigricans – underlying insulin disturbances are thought to be the cause. Commonly seen as dark velvety pigmentation on the neck, underarms, knuckles, eyelids, nose, etc. a dark transverse nasal crease seen in some individuals is thought to be a part of this disease.
3. Undereye dark circles – Causes are many and discussed on a different page.
4. Diffuse pigmentation on the body in conditions like Addison’s disease,
5. Cushing’s syndrome, atopic dermatitis, etc.
6. Pigmented contact dermatitis – seen usually in sun-exposed areas due to sun mediated allergic reactions
7. Post-inflammatory pigmentation – Example post-acne pigmentation
8. Malignancies
9. – Example hydroquinone
Why does pigmentation develop?
It is caused by the deposition of melanin by the skin color cells referred to as melanocytes. This can be deposited in the upper or lower layers of the skin called the epidermis and dermis respectively. As the melanin accumulates and the body loses its ability to control the activity of the melanocyte hyperpigmentation occurs.
Is there any permanent treatment?
Treatment is available in the form of ointments and oral pills. Other forms of treatment include chemical peeling and laser treatment.
What Are The Treatments Available?
1. Natural skin lightening treatments include preventing exposure of skin to the sun and use of broad-spectrum sunscreen (SPF 30 or higher) at all times, and a wide-brimmed hat, because sunlight will worsen the condition especially in case of hyper-pigmented skin.
2. Hair & Skin Care Expert / Specialist usually recommend the topical use of hydroquinone or retinol (a form of vitamin A) as the treatment of choice in many cases. However, when there is some underlying cause, it has to be corrected appropriately. The use of agents including tretinoin, corticosteroid, vitamin C, licorice, kojic acid, Arbutin, etc. are also being used in skin lightening treatment.
3. Chemical peels, mesotherapy, and microdermabrasion can be used for mild cases.
4. Specially formulated potent pigment reduction creams, strong one-time peels, etc. are also available thought their use will be decided by your dermatologist.
5. Oral skin lightening agents like glutathione with ascorbic acid are available though their efficacy is not known.
6. In resistant cases, fractionated lasers and very low-level Q-switched Nd: YAG lasers can be used. There are certainly other types of laser treatments available depending upon the area, location, and extent of skin involved.
Is The Treatment Painful?
Most of the Pigmentation treatment options are quite painless. However, laser treatment may cause minimal discomfort, but the pain is relieved by applying a local anesthetic cream on the area of skin to be treated.