Uneven skin coloring, blotches, shadowy spots and prominent dark spots on the face, décolleté and hands, are even more of a concern than wrinkles, a magazine for the spa industry recently reported. It is borne out by the number of emails I get asking for help with hyperpigmentation. The truth is that hyperpigmentation is hard to treat safely and success requires patience. But it helps to know that there are many types of hyperpigmentation and that they respond to different types of treatment.
All skin pigmentation is due to melanin, which is made by a cell called melanocyte in the deepest layer of the epidermis. Melanocyte is very efficient at pumping out pigment, but it is much harder to switch off or slow down. It can also be triggered by a variety of stimuli including sun, stress, estrogen, trauma, pollution, and some medications. Another key player is tyrosinase, a copper-containing enzyme that catalyzes the production of melanin.
Here’s a run down that will help you do your own spot check and reach for the most appropriate solutions.
Caused by hormonal change, melasma is common during pregnancy or can be caused by birth control pills and hormone replacement therapy. One of the most challenging pigmentary conditions to treat, it affects more than five million Americans. According to Skin Inc, melasma should be considered “controllable but not treatable.”
These are what we refer to as dark spots, liver spots or age spots. Lentigines are pigmented areas with a clearly defined edge. They are not caused by the aging process, but are the result of careless sun exposure and, according to new research, by pollution. They are surprisingly common with estimates that 90 percent of light-skinned individuals over the age of 60 have them.
Post-inflammatory hyperpigmentation (PIH)
This is discoloration that follows an injury, such as burns, friction, blemishes and even professional exfoliation treatments like chemical peels. It is the skin’s natural response to inflammation — as the skin heals it can produce too much melanin (the protein that causes skin color). PIH is a common legacy of acne scarring. It can fade over time as the skin regenerates itself, a process that even in the relatively young can take months.
Treatments to fade hyperpigmentation
Always start with exfoliation, preferably with alpha hydroxyl acids (such as glycolic acid) to help fade existing pigmentation. Good products to start with are Dr. Dennis Gross Alpha Beta Daily Peels ($80 in the shop) and La Vie Celeste Exfoliating Gel Mask ($60 in the shop). If you prefer a serum with AHAs, I like Sciote Illume Brightening Serum ($95 in the shop) with five percent kojic acid, three percent glycolic acid and one percent salicylic acid.
Retinol is both friend and foe. Prescription retinoids may increase pigmentation secondary to irritation (a form of the PIH mentioned above). They can also make the skin more sun sensitive. I prefer gentler and buffered forms of retinol that can still be incredibly effective on tone and texture. For some choice products, see my most recent Five Best with retinol.
There are even some retinol alternatives coming on to the market. A recent discovery is Exo-T, derived from a marine bacteria found near Polynesian atolls. According to the manufacturer, it does a better job than alpha hydroxyl acids at stimulating cell turnover. It is one of the key actives in Skin 2 Skin Photoaging Repair Cream ($69 in the shop).
Azelaic acid, a naturally occurring fatty acid, is an up and coming ingredient proven to be beneficial in the treatment of hyperpigmentation, especially PIH from acne lesions. In one study, it demonstrated results similar to 4 percent hydroquinone, but without its side effects. It is in Dr. Dennis Gross Ferulic Acid & Retinol Brightening Solution ($88 in the shop), which also has AHAs and retinol.
TEGO PEP-4 is a tetrapeptide that diminishes dark spots and brightens the skin. Additionally it is able to reduce acne lesions and to alleviate melasma on ethnic skin. You’ll find it in Your Best Face Restore ($130 in the shop).
Ingredients to prevent hyperpigmentation
Given that it takes tyronsinase and melanocyte to make melanin, the most helpful preventatives are the ones that inhibit their action. These include:
This is marketed under the name B-White and it is said to inhibit tyrosinase activity, inhibit melanin synthesis and decrease the proteins involved in the pigmentation process. You can find it in Skin 2 Skin Photoaging Repair Cream ($69 in the shop).
Niacinamide (or vitamin B3) prevents the transfer of melanosomes to keratinocytes, minimizing color deposits. Inflammatory mediators also are inhibited, reducing pigmentation associated with PIH. There’s a hefty dose of it in Stemulation Hi-Impact ($185 in the shop)
This antioxidant scavenges free radicals, inhibits oxidation and tyronsinase synthesis and activity. Go for high concentrations of active C like in Skinfinite Advanced C20 ($65 in the shop).