Oftentimes, we jump from one serum to another trying to fade dark spots but it all ends up in little to no significant results. As inescapable as hyperpigmentation may seem, understanding the science behind melanin (skin pigment) formation and the treatment pathways will save us a lot of money and frustration. Let’s get a bit science-y, shall we?
Post-inflammatory hyperpigmentation (PIH), age spots, melasma –whatever form excess pigment presents as– can be attributed to a response to inflammation, ultraviolet (UV) exposure, or hormonal fluctuations (as seen in pregnancy).
What triggers excess melanin production?
In addition to giving the skin and hair color, melanin also protects our skin from photodamage. A practical example is the tan you get after being exposed to that toasty summer sun.
Injury and trauma (enter: skin peeling, picking, laser therapy) are also major triggers. For instance, your elbow got bruised and in the process of healing, it turned a few shades darker. You had an inflamed breakout and after the pimples cleared up, it left dark marks behind. All these processes involve inflammatory mediators, which can increase the amount of melanin deposited on the surface of the skin.
How is melanin formed?
Melanin is produced by melanocytes (melanin-producing cells) through a complex process called melanogenesis, and this process can be altered by a lot of factors. A key player is tyrosinase– an enzyme that catalyzes the first step in melanogenesis. The inhibition of tyrosinase activity is the most reported mechanism for altering melanogenesis, hence the birth of tyrosinase inhibitors like gold standard hydroquinone, kojic acid, and more.
It is also worth mentioning that melanin is produced in the deepest layer of the epidermis– stratum basale (at this point, the color is not really visible) and transferred to the outermost layer of the epidermis– stratum corneum. Inhibiting melanin transfer from the melanocytes to keratinocytes (where pigment becomes visible) is another pathway for reducing excess pigment on the skin. Hello Niacinamide!
Although hyperpigmentation shows up in various forms, the universal treatment approach can be categorized into two major pathways:
- Increasing the rate of skin cell turnover
- Inhibition of melanogenesis; which includes but not limited to tyrosinase enzyme, melanin transfer and melanin internalization by keratinocytes
and of course, protection from UV rays. Hello, sunscreen!
Increasing skin cell turnover: through chemical exfoliation, the pigmented superficial layers of the skin can be gently sloughed away, encouraging newer, less pigmented cells to the surface. Alpha hydroxy acids (AHAs) like glycolic and lactic acid, when used at safe concentrations do a great job in this department.
Inhibition of melanogenesis: ingredients that inhibit tyrosinase enzyme activity such as Hydroquinone, Arbutin, Kojic Acid, Butylresorcinol, Azelaic Acid, N-acetyl glucosamine (NAG). Retinoids have several mechanisms by which they depigment the skin and Niacinamide alters the transfer of melanin to keratinocytes. They’ve all proven to improve hyperpigmentation when applied topically.
Protection from UV rays: as mentioned earlier, UV irradiation is one of the major triggers of excess melanin production. In order not to sabotage the progress of our hyperpigmentation journey, sun protection is paramount; from broad-spectrum sunscreens to UV protective clothing.
How do I select the right product for my hyperpigmentation?
Yes, ingredients matter but the overall product formulation is more important. Given the complexity of skin and melanin formation, it’s best to choose products that are formulated with different ingredients that address more than one treatment pathway.
It is also important to choose formulas with the right concentration for your skin type. Certain ingredients are amazing at depigmenting the skin but when used at high concentrations, may trigger trauma (injury to the skin) resulting in more hyperpigmentation. Glycolic acid is a good example.
How deep into the skin?
Another important factor to consider when choosing treatment is the layer of the skin affected. A dermatologist or skin specialist is in the best position to diagnose this but on a surface level, epidermal hyperpigmentation tends to be brown to black while dermal has a grey to purple undertone. The layer of the skin affected helps to determine the appropriate treatment choice. Chemical peels and lasers may be required for dermal hyperpigmentation as there’s a limit to what topical creams can achieve.
Common mistakes to avoid while treating hyperpigmentation
Neglecting exfoliation: it’s easy to overlook exfoliation when tackling dark spots. AHAs make a significant difference in improving hyperpigmentation. Beginner-friendly options are mandelic and lactic acid (s).
Layering over cocktailing: Choosing single ingredient-based serums over formulas with a blend of depigmenting ingredients sometimes does more harm than good. From the potential irritation that comes with layering different serums to not maximizing melanogenesis inhibition on different levels. Where possible, it’s best to choose multitasking formulas with a cocktail of lightening ingredients.
Inadequate treatment: for instance, using products that are too weak for dark spots deep into the skin. Plain ol’ niacinamide and vitamin C serums, I’m looking at you!
Inadequate sun (UV) protection: this includes not wearing the right amount of sunscreen, neglecting sunscreen application indoors, UV protective clothing…
In case you needed another reason to wear sunscreen; depigmenting agents such as AHAs, hydroquinone, and retinoids increase the skin’s sensitivity to the sun. We don’t want to sabotage the hyperpigmentation progress now, do we?
Over exfoliating: either by using a higher concentration of acids or increased frequency. It is unnecessary and could cause more injury to the skin. More trauma = more hyperpigmentation and we don’t want that.
Impatience and lack of commitment: the most common mistakes. Healthy adult skin takes an average of 28 days to turnover. Hyperpigmentation treatments could take up to 12 weeks to yield visible results. Commitment also involves sticking with the treatment, repurchasing, and using it frequently as prescribed.
Neglecting the underlying cause: treating hyperpigmentation without addressing the root cause. For instance, treating PIH while your skin is actively breaking out and inflamed. Exfoliating away your neck and underarms not knowing it is due to Acanthosis nigricans. Yes, some illnesses and medication cause hyperpigmentation, that’s why it’s important to seek professional help when over-the-counter cosmetics fail to yield results.
Hydroquinone misuse/abuse: Using a high concentration of hydroquinone (> 2%) without professional supervision or longer than the prescribed period; could lead to dermatitis, reverse hyperpigmentation, or exogenous ochronosis. To avoid this, it’s best to switch to a non-hydroquinone depigmenting agent after 3 months.
The part we have all been waiting for. This post is already long enough so let’s save the recommendations for Part 2.
A Review of Post Inflammatory Hyperpigmentation
Human Skin Pigmentation: melanocytes modulate skin color in response to stress