Spotlight on hyperpigmentation – All spots are not created equal
Hyperpigmentation is one of the issues that many of my clients are concerned with. Despite being most frequently associated with age and sun spots, hyperpigmentation encompasses a very wide variety of condition from birthmarks to acne scarring.
There are many different forms of hyperpigmentation. Even though all of them involves the over-production of skin pigment, their causes are not always the same. Let’s start by looking at why hyperpigmentation occurs.
How we get our skin colour
We all have colour in our skin that exist in varying intensities from fair to dark. Our natural skin pigment is called melanin, which acts as a natural sunscreen, protecting us from UV radiation. This is why fair-skinned individuals are more prone to sunburns, as they have less melanin protecting them from the sun. Melanin is produced in pigment-producing cells called melanocytes that live in the bottom (basal) layer of our epidermis, just before the dermis. The melanin then gets transferred to the neighbouring skin cells (keratinocytes).
Causes of hyperpigmentation
Hyperpigmentation occurs when melanocytes produce excess melanin in response to various triggers. These triggers include
- UV exposure (most common)
- Hormonal changes – pregnancy, contraceptive pill
- Skin trauma – physical damage, acne, aggressive chemical peels, laser treatments
- Genetics – present from birth or developed later in life (includes melanocytosis where melanocytes are present in dermis instead of basal layer of epidermis)
Types of hyperpigmentation
The cause(s) of hyperpigmentation determines the type of hyperpigmentation that is formed. In this article, we won’t be covering congenital cases (present from birth) like birthmarks or moles.
Below describes the five most common types of hyperpigmentation that people are concerned about. These descriptions are not intended for self-diagnosis; please see your dermatologist for an accurate diagnosis.
Ephelides (freckles)
Appearance: Small, flat brown marks; usually present from tens to hundreds
Cause: Genetic (common in fair skins), exacerbated by sun exposure
Location: Upper epidermal layers
Solar lentigines (sun/age spots)
Appearance: Small, flat or slightly raised with clearly defined edge; from tan-yellow to dark brown
Cause: Sun exposure
Location: Upper epidermal layers
Melasma/Chloasma (mask of pregnancy)
Appearance: Patchy areas of light to dark brown pigmentation on sun exposed areas (forehead, cheeks, upper lips)
Cause: Multiple factors including genetics, sun exposure and hormonal changes. Most prominent in Asian, Hispanic and Middle Eastern female descendant.
Location: Can be in upper epidermal layers, lowest epidermal layer (near dermis) or a mix of both
Post inflammatory hyperpigmentation (acne scarring)
Appearance: Patches located at original damage site; light brown to black
Cause: Trauma, most commonly acne or over-aggressive skin treatments
Location: Dependent on site of damage; can be in upper epidermal layers, deeper epidermal layers (near dermis) or a mix of both
Acquired bilateral nevus of Ota-like macules (Hori’s naevus)
Appearance: Spots or patches prominently on both cheeks; often mistaken as freckles, solar lentigines or melasma
Cause: Genetic (form of melanocytosis); commonly appearing in 20s-30s in Asian female
Location: Dependent on site of damage; can be in upper epidermal layers, deeper epidermal layers (near dermis) or a mix of both
Identifying the different forms of hyperpigmentation helps us understand why they appear and subsequently the best approach to diminish them. The most common treatment is using skin care products with skin lightening actives. What are the most effective lightening actives? Check back soon to find out more!
