What It’s Really Like To Treat Hyperpigmentation

To better understand the causes of hyperpigmentation and the professional and at-home treatment options that exist to treat it, The AEDITION speaks with board certified dermatologists and patients.
Patient Perspective
Written by India Bottomley
07.28.2020
What It’s Really Like To Treat HyperpigmentationNathan Dumlao/Unsplash

Pigmentation is somewhat of a buzzword in the skincare world. But it is also an umbrella term that refers to all types of dark spots. Causes of unwanted pigmentation are varied, with sun exposure, genetics, acne, and hormone levels all playing a role. When it comes to figuring out an effective solution for your skin types and concerns, you may be confronted with a minefield of conflicting advice. To better understand the causes of hyperpigmentation and the professional and at-home treatment options that exist, we spoke with board certified dermatologists and patients.

What Is Hyperpigmentation?

Simply put, hyperpigmentation is the appearance of darker areas of skin — usually small spots on the face, neck, décolletage, and hands — that can happen for a number of reasons. “There are many different types of hyperpigmentation, meaning increased pigmentation in the skin,” says Morgan Rabach, MD, a board certified dermatologist and co-founder of LM Medical in New York City. Pigmentation can occur as a result of:

  • Increased Melanin in the Skin: Melanocytes (i.e. pigment-producing cells) increase melanin and then release it into the skin.
  • Increased Pigment Cells: “Increased melanin is produced by melanocytes as the skin's own natural umbrella — meaning melanin protects skin cell nuclei (the cell's computer) from damage from sunlight, which is why we get tan,” Dr. Rabach explains.
  • Injury & Inflammation: “Unwanted pigmentation typically happens after an inflammatory event on the skin, such as acne lesions, or rashes such as eczema or psoriasis, or even wounds,” says Amy Spizuoco, DO, a board certified dermatologist and founder of True Dermatology in New York City.
  • Medications & Hormones: Melasma, for example, is an increased pigmentation on the forehead, cheeks and upper lip that is linked to hormonal changes.

Once you understand the root cause of your pigmentation, there are a number of at-home and in-office treatment options available.

Professional Treatments for Hyperpigmentation

Treating hyperpigmentation often requires a multi-modal approach that involves a combination of skincare and professional procedures. Depending on the type of pigmentation, in-office treatments range from chemical peels to laser treatments.

IPL lasers can be used to treat some types of pigmentation,” says Adriana Lombardi, MD, a board certified dermatologist and founder of Skin Cancer & Cosmetic Surgery Center of New Jersey. “Typically, patients will get results in three to five sessions. The depth of pigment deposition in the skin plays a large role in how many sessions are required and how the patient will respond.”

Chemical peels, which are available in superficial, medium, and deep potencies, can also be used to refine skin tone and texture. Additionally, Dr. Rabach says microneedling can be considered, too.

At-Home Treatments for Hyperpigmentation

When it comes to picking out skincare products to combat hyperpigmentation, there are certain ingredients you should be on the lookout for. All three dermatologists recommend alpha-hydroxy acids (AHAs), like glycolic acid. Vitamin C can be helpful, too, Dr. Lombardi says. And Dr. Rabach advises that kojic acid can also be an effective lightening agent. Available in both prescription and over-the-counter formulations, Dr. Spizuoco says retinol and retinoids are also often part of treatment plans for hyperpigmentation.

While all of these active ingredients are proven to help treat pigmentation concerns, it is important to use them under the care of a board certified dermatologist or skin expert. “Ingredients that cause inflammation or more irritation can exacerbate hyperpigmentation,” Dr. Lombardi cautions. “Always do a spot test prior to using a product all over your face. When using retinol, start with a tiny pea-sized amount and follow it with a moisturizer.”

Suncare Tips

If you often associate hyperpigmentation with sun damage, you’re onto something. While not all pigmentation is the result of sun exposure, UV rays can exacerbate the condition. As a result, sun protection is the most important component of any at-home skincare routine.

All three dermatologists recommend using mineral sunscreens. Since they physically block light, they prevent the production of melanin, Dr. Rabach explains. She suggests the SkinMedica Total Defense + Repair Broad Spectrum SPF 34 and EltaMD, the latter of which is also a favorite of Dr. Spizuoco. La Roche Posay Anthelios is another dermatologist fave, as is ISDIN Eryfotona. Dr. Lombardi likes the zinc-based sheer sunscreen because it is packed with antioxidants and is also available in tinted options. For protection from the inside out, Dr. Lombardi is a fan of supplementing a skincare routine with the ISDIN Sunisdin Soft Gel Capsules.

Patient Perspective

We spoke to three patients about their experience treating hyperpigmentation concerns with both in-office and at-home treatment protocols.

Jools, 32, New York City

Jools started to notice pigmentation during her late twenties and consulted a dermatologist to find a long term fix after she turned 30. After experimenting with a combination of in-office peels and a prescriptive skincare routine, she has seen great improvements in her complexion.

The AEDITION: What led you to visit a dermatologist about your pigmentation concerns?

Jools: I had started noticing some dark spots appearing on my face when I was around 25, but I thought it was a normal part of my skin starting to age. I guess it was, but then the areas became significant enough that I would avoid going anywhere without makeup on. I was getting them on the backs of my hands as well. Eventually, I consulted ‘Dr. Google’ and found out there was actually something that could be done about it, which led to me consulting a dermatologist that a friend of mine recommended.

The AEDITION: How did you find the process of settling into a new skincare routine?

Jools: There was some trial and error — often because I wanted to speed things up too much, so I would skip a step and go up two ‘notches’ on the retinol, when I was only supposed to go up by one increment at a time. Then I would deal with a few side effects for a couple of days afterward. After around two months, I’d learned my lesson and followed what my derm said to the letter. For people starting out, I would say to be transparent with your dermatologist. If you forget to do your skincare routine often, don’t pretend that you get round to it every day. Be honest, they’ll figure out a system that will work for your lifestyle. And if something doesn’t feel right for you, then send them an email and they will likely find another solution that could work instead. It’s definitely a question of trial and error for a little while, but it’s worth sticking with it.

The AEDITION: Are you satisfied with the results achieved with this combination of treatments?

Jools: I am. I didn't even know it was something that could be treated, so the fact that I’m able to go out with minimal makeup now feels like a real victory.

Dinah, 45, Long Beach, CA

Dinah has finished a course of five IPL treatments for hyperpigmentation and has been able to reverse some of the unwanted signs of aging that had been bothering her for the last few years.

The AEDITION: What led you to visit a dermatologist about your pigmentation concerns?

Dinah: I was working with my dermatologist on a few different age-related concerns, one of which was hyperpigmentation that had been getting worse for some time. My doctor suggested a laser treatment because it would be effective for my particular situation, so we started out on the basis of me needing somewhere between three and five sessions to get good results.

The AEDITION: How did the treatments go?

Dinah: It was a very straightforward treatment. I had been having a few different treatments, and this was definitely on the lower end of the ‘inconvenience’ scale. It’s not particularly uncomfortable, downtime is minimal, and it doesn’t take too long. I would recommend future patients ask any questions they have with regards to what to expect ahead of time because I found that helped me to calm my nerves.

The AEDITION: Are you satisfied with the results achieved with laser therapy?

Dinah: I am now. I must say, after the third session I was hoping for more visible results. But, in the end, we ended up going for the full five treatment course. By the end of that, I was pleased with the results. I think being clear with your dermatologist about how you feel about the results is important. It will help them to guide you towards the right next steps for you.

Sam, 47, Dallas, TX

Sam has a genetic predisposition to hyperpigmentation and has been working with a dermatologist for two years to address this and other skin concerns. With a mix of at-home skincare and in-office peels, he is working to both treat and prevent new age spots.

The AEDITION: What led you to visit a dermatologist about your pigmentation concerns?

Sam: I have a family history of hyperpigmentation, and I wanted to get the issue resolved before it made me self-conscious, as I try to age gracefully. It was something that I raised during a routine consultation with my dermatologist, who was able to integrate some good products for treating and preventing dark spots into my skincare regime.

The AEDITION: How have the results affected your self confidence?

Sam: I think anti-aging and preventative treatments have an incredible ability to give people back control over how they see themselves. For me, it’s definitely not about changing how people perceive me, but about me being able to look in the mirror and being able to be happy — or at least okay — with what I see looking back at me.

The AEDITION: Do you have advice for people who wish to treat pigmentation concerns?

Sam: My main piece of advice would be to write a list of questions ahead of time. Talk to your parents or siblings about any skin concerns they have that might be hereditary. I prioritized the questions that were medically important and then worked my way down the other aspects that concerned me about the appearance of my skin. I think it gave the doctor and me a good foundation to work from.

The Takeaway

Treating unwanted hyperpigmentation often calls for a combination of at-home skincare and in-office procedures, and patience is required to see results. Since pigmentation can be caused by a number of factors, it is important to consult with a board certified dermatologist to ensure you understand the root of the problem and all the possible solutions.

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INDIA BOTTOMLEYis a freelance writer for AEDIT.
tagsSkinSkincareExpert Opinion
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