What is hyperpigmentation? The word “hyper” denotes overactivity. Hyperpigmentation refers to a condition whereby the pigment forming cells in the body called “melanocytes” go into hyperactive mode and create excess melanin. Melanin is the coloring material that gives us our skin color. Hyperpigmentation can be in the form of brown/black blotchy areas darker than the rest of the skin or it can be scattered in the form of freckles. Freckles are generally a cumulative process of years of sun exposure, sometimes even as far back as childhood. The larger hyperpigmented areas, on the other hand, can a) pertain to melasma which is also referred to as a pregnancy mask. During pregnancy when there is a steep rise in estrogen levels, excess melanin is stimulated. This will sometimes dissipate after pregnancy but sometimes it can linger on, or b) it can be a direct result of photo (sun) damage wherein the skin has been exposed to the sun without proper protection.
Source of Pigments: Melanin resides in tiny packets in an octopus looking cell called a “melanocyte” that has innumerable arms. These arms resemble hypodermic needles and when the melanocyte is activated, it pushes these melanin carrying packages to the end of the arm which penetrates or punctures the adjoining skin cells, thereby infecting them with the dark pigment that then leads to hyperpigmentation.
Composition of Melanin: The basic component of melanin is an amino acid (protein) called tyrosine. When tyrosine is acted upon by an enzyme called tyrosinase, it starts the process of creating melanin. So the villain in this entire scenario is tyrosinase. But for its activity, we would not have hyperpigmentation. However, by the same token, you would not have any skin color. We have two components to skin color. One is “constitutive” or pertaining to your genetic constitution and the other is “facultative” which is induced by the sun, tanning, hormone impacting medications, recreational drugs and over exposure to heat (such as high temperatures even in a shady area or working in close proximity to a cooking range). These are all triggers that activate the enzyme tyrosinase, causing it to go into overdrive and create excess melanin. Not much can be done about your genetic framework but you can take precautions to lessen the degree of hyperpigmentation caused by external factors.
Treatment: Chemical Peels are perhaps the best treatment modality for hyperpigmentation because they exfoliate pigment carrying, dead skin cells. However, practitioners (aestheticians etc) need to work on the side of caution, especially with darker skin. This is because melanin stimulation is based on hormones and heat. When a chemical acid is placed on the skin, it is perceived as a burn or heat trauma by the skin and, more melanin is created which makes the hyperpigmentation even darker. Low strength peels at a gradual pace, should be emphasized in such cases. Peels need to be customized to suit skin color and ethnicity! Microneedling is another tool and involves very minute titanium needles creating micropunctures in the skin in conjunction with some skin lightening agents. The results are phenomenal, if performed correctly. Lasers are not a favorite because those people who get hyperpigmentation are generally already prone to tanned skin and laser heat further stimulates melanocytes, creating more melanin.
Home Care: The gold standard of treating hyperpigmentation (remember you cannot use any strong chemical based products whilst pregnant or lactating) is a combination of Retin A (Retinoic Acid) combined with 4% Hq (hydroquinone). Why? Retinoic Acid is a DNA regulator and will regulate the formation of melanin. If it is too high, it will send chemical messages to the melanocytes to reduce their activity and simultaneously, exfoliates older cells along with those that are hyperpigmented, which are ultimately sloughed off. Hydroquinone is a tyrosinase inhibitor. In other words, it does not allow the enzyme tyrosinase to create an over abundance of melanin. It is not recommended to use hq indefinitely. It can create cytotoxicity (cell toxicity). Six months on and six months off, is the rule of thumb. The other ingredients that can be highly useful to prevent hyperpigmentation are Vitamin C, Kojic Acid, Mandelic Acid, Glycolic and Lactic Acids, Licorice, Arbutin, Green Tea Extracts and the Daisy flower to name a few botanicals for home care.
Can severe hyperpigmentation be treated safely and completely? My honest answer is NO if it is dermal hyperpigmentation (deeper skin)! Improvement, yes, but not a resolution! Superficial hyperpigmentation is easier to treat. Mandatory precautions include never forgetting to wear an SPF 30 at the least and obviously a lifestyle change is warranted which precludes many outdoor activities.