Hyperpigmentation ? what you need to know

What causes hyperpigmentation?

Hyperpigmentation may be caused by sun damage, inflammation, or other skin injuries, including those related to acne vulgaris. People with darker Asian, Mediterranean, or African skin tones are also more prone to hyperpigmentation, especially if they have excess sun exposure.

Many forms of hyperpigmentation are caused by an excess production of melanin. Hyperpigmentation can be diffuse or focal, affecting such areas as the face and the back of the hands. Melanin is produced by melanocytes at the lower layer of the epidermis. Melanin is a class of pigment responsible for producing color in the body in places such as the eyes, skin, and hair. As the body ages, melanocyte distribution becomes less diffuse and its regulation less controlled by the body. UV light stimulates melanocyte activity, and where concentrations of the cells are denser than surrounding areas, hyperpigmentation is effected. Can also be caused by using skin lightening lotions.

Hyperpigmentation is associated with a number of diseases or conditions, including but not limited to the following:

• Addison's disease and other sources of adrenal insufficiency, in which hormones that stimulate melanin synthesis, such as melanocyte-stimulating hormone (MSH), are frequently elevated.

• Cushing's disease or other excessive adrenocorticotropic hormone (ACTH) production, because MSH production is a byproduct of ACTH synthesis from proopiomelanocortin(POMC).

• Acanthosis nigricans – hyperpigmentation of intertriginous areas associated with insulin resistance.

• Melasma, also known as chloasma – patchy hyperpigmentation often found in pregnant women.

• Linea nigra – a hyperpigmented line found on the abdomen during pregnancy.

• Peutz-Jeghers syndrome – an autosomal dominant disorder characterized by hyperpigmented macules on the lips and oral mucosa and gastrointestinal polyps.

• Exposure to certain chemicals such as salicylic acid, bleomycin, and cisplatin.

• Smoker's melanosis

• Celiac disease

• Cronkite-Canada syndrome

• Porphyria

• Tinea fungal infections such as ringworm

• Haemochromatosis - a common but debilitating genetic disorder characterized by the chronic accumulation of iron in the body.

• Mercury poisoning - particularly cases of cutaneous exposure resulting from the topical application of mercurial ointments or skin-whitening creams.

• Aromatase deficiency

• Nelson's syndrome

Hyperpigmentation can sometimes be induced by dermatological laser procedures.

Types 

Hyperpigmentation may either be due to increased melanin deposition in the epidermis or dermis.

Melasma: Melasma is uneven production of pigmentation on the face, which presents as dark brown/ black skin patches. Sun exposure is the primary cause while additional factors may include certain medications or health issues, hormonal imbalances caused by Pregnancy/ menopause or use of oral contraceptives. 

Peri-orbital melanosis: Also known as dark circles, this may be hereditary or caused due to stress or eye strain. 

Freckles: Freckles are most visible on people who have a light complexion. Having freckles is genetic but sun damage can cause excessive and uneven freckles. 

Photo-melanosis: This is increased pigmentation due to sun exposure on exposed skin, commonly on the face, neck. back and arms. The pigmentation may be patchy or diffused. Sun burn: A condition commonly encountered in fair skinned people due to excessive sun exposure. 

Is there anything you can do to prevent it?

One of the best ways to avoid pigmentation is to fastidiously apply a sunscreen with a minimum SPF of 30+, which will block both UVA and UVB light. The sunscreen needs to be applied every three to four hours if you're outdoors.

Topical creams containing hydroxy quinone, tretinoin, topical steroids, alpha hydroxy acid creams, azelic acid or kojic acid should be used at nightime together with sunblock during the day. Oral use of antioxidants also help in reducing pigmentation.

If creams do not work, chemical peels, microdermabrasion or fractional lasers are further treatment options. These procedures require multiple sessions at intervals of one to four weeks. 

Home remedies

• Peel an avocado, mash it up and apply the juice on pigmented skin.
• Massage cocoa butter on affected skin twice a day for about two to three weeks.
• Mix a few drops of lime juice with honey and leave it on for 10 minutes.
• Applying the juice of raw potatoes is another simple remedy to treat pigmentation.