The word ‘pigment’ simply refers to the natural coloring of your skin. For most people that means an even regular tone. Through illness, injury, or exposure to too much sunlight, the skin’s color can change and become much darker than surrounding areas. This is what we call hyperpigmentation.
So What Is Hyperpigmentation Really?
In the simplest terms it means too much skin color. The word hyper means a lot or too much of something, just like hyperactive means extremely active. So hyperpigmentation means too much pigment in your skin.
Melanin is the proper name for that skin pigment. And it’s too much of this melanin that creates dark spots on the skin. Freckles, melasma (‘pregnancy mask’), age spots, liver spots and sun spots are all types of this same skin discoloring condition. Collectively we call it hyperpigmentation.
In other words the condition as we see it are areas of skin where an excess amount of melanin has occurred. This causes skin patches that appear darker than the neighboring skin.
Areas of the skin that are most prone to hyperpigmentation are the hands, arms, and face.
What Causes Hyperpigmentation?
Evidence reveals that hyperpigmentation has a whole range of causes which include:
- Inflammatory hormones due to pregnancy or birth control pills that affect the sex steroids estrogen and progesterone, these can cause a specific type of hyperpigmentation known as melasma.
- Addison’s disease.
- Heredity, that is, your genetics as passed down from your parents and grandparents etc.
- Topical and oral antibiotics, retinoids, antiarrhythmics, and antimalarial drugs can stimulate phototoxic (i.e. sun sensitive) inflammation in the skin resulting leading to excess pigmentation.
- Sunlight exposure, assorted fabric dyes and plant derived irritants such as poison ivy, are considered external stimuli that activate melanocytes (the cells that produce melanin), known as inflammatory mediators. The condition can result in a patchy, irregular freckle like appearance on the skin’s surface known as lentigenes, normally referred to as liver or age spots.
- Non-steroidal anti-inflammatory drugs (more commonly known as NSAID’s).
- Chemotherapeutic drugs (used for treating cancer and autoimmune diseases).
- Cosmetic surgeries including resurfacing procedures, temperature, and chemical burns.
- Numerous types of dermatitis like eczema.
So it really can be anything from just bad luck with your genetics through to prescribed drugs or treatments you may be receiving.
So What Is Post-Inflammatory Hyperpigmentation?
When hyperpigmentation is due to skin inflammation resulting from acne or bungled skin treatments, it is known as ‘post-inflammatory hyperpigmentation’. Or the much shorter and more manageable ‘PIH’.
This more medical wording is used for discoloration of the skin following an injury. It is primarily found in darker skin and is also known as acquired melanosis. The condition affects both the face and the body. In fact, PIH is the skin’s natural response to inflammation.
PIH appears as flat areas on the skin also known as macules. The color varies from brown to black, pink to red, or brown depending on the individuals skin color and the extent of the discoloration.
The condition can happen to anyone; however, it is more common in individuals with darker skin tones when the color is more prone to intensity. It also tends to linger longer than in lighter skin tones.
Pigmentation is more intense when the cause is due to sun exposure and results in conditions like lichenoid dermatoses and phytophotodermatitis. In addition, there are medications that can darken PIH like clofazimine, anticancer drugs like bleomycin, tetracycline, busulfan, 5-fluorouracil, doxorubicin, and antimalarial drugs. Postinflammatory hyperpigmentation is also a result of damage to the dermis/epidermis due to the removal of melanin inside the skin cells or keratinocytes.
Post-inflammatory pigmentation will tend to darken and become more apparent when exposed to the sun. Therefore, a crucial part of managing this condition is use of a broad-spectrum sunscreen along with proper sun protection. In some instances, peeling treatments will decrease epidermal pigmentation. You can also use cosmetics like concealers that can help to minimize the appearance of PIH, or try treating it with skin lightening creams (more on that below).
The first thing to recognise is that acne hyperpigmentation and acne scars are very different things.
Hyperpigmentation (it’s actually PIH) is a reddish or brown mark on the skin that is typically less visible if you stretch out the area of skin. An acne scar on the other hand is a permanent mark where the skin’s collagen has been damaged. They are often indented (or little craters), but can also be raised areas.
The hyperpigmentation is caused by inflammation in your skin which is part of the healing process. Particularly when skin is broken due to pimples being squeezed, it can sometimes leave less than perfect texture and color. Tiny blood vessels can be broken that even once the area fully heals leave behind reddish marks. Redder marks are more common with light skinned people, whereas darker browner marks mostly affect Latino, Asian, African, and other ethnic skin tones.
Keeping Acne Hyperpigmentation at Bay
Probably, the worst thing you can do is to pick at acne lesions, as this can often result in lasting marks. I know it’s difficult to avoid. But if you’re suffering with acne the best thing you can do is minimize picking at the pustules.
Popping painful or unsightly pimples carefully with a clean pin, then very gently squeezing is probably fine. A lot of the skin damage is typically caused by squeezing far too hard with dirty fingernails. So using a clean tissue on top of your finger nails can both spread the pressure more evenly and avoid infecting the broken skin. The pimple should then be left alone afterwards. In addition, though it may seem a good idea to scrub acne marks away, coarse scrubbing will likely only cause more skin damage and make the problem worse.
The best means of preventing marks however is to remedy the acne itself. Preventing future outbreaks will of course prevent any risk of hyperpigmentation. Regardless of skin color, all acne is treated identically and usually responds well to the right topical treatment. When acne is chronic and pervasive with severe scarring, there are various treatments a dermatologist will recommend such as Accutane.
How To Get Rid Of Hyperpigmentation From Acne?
The good news however is that acne hyperpigmentation will tend to just disappear over time. The not so good news is that it can take quite a long time. This does depend on your skin type, so for some they will fade at a faster or slower rate.
Typically you’re looking at about 3 to 6 months for most people. So it’s not surprising that a lot of sufferers find more discomfort with these marks than the acne itself.
But there are things you can do to greatly speed this process up. The options are pretty much the same whatever the cause of the hyperpigmented skin. Read more about how to get rid of acne marks here.
Popular Treatments for Hyperpigmentation
Firstly, wearing a sunscreen can be a huge plus. Our skins naturally darken in the sun of course. So to help pigmentation to fade faster whatever else we do, staying out of the sun or using sunscreens can help a lot.
Skin lightening products are probably the most popular and least drastic approach. There are for example many different creams available which contain ingredients such as Vitamin C, Kojic acid, hydroquinone, and retinoids for lightening skin tone.
Gently exfoliating the skin before applying creams can increase effectiveness in two ways. Firstly by letting your skin absorb the product better. And by helping to remove darker dead skin cells more quickly. Harsh scrubbing is likely to do more harm than good though.
Here are some other options that have been shown to be effective in certain cases and may be worth considering:-
- IPL (Photofacial) – this treatment uses intensified pulsed rays and is commonly suggested by professionals to treat hyperpigmentation.
- Chemical Peels – also called a TCA peel or a deeper phenol peel. These can help to speed up the healing process while also clearing breakouts and boosting up collagen production. This treatment should only be carried out by an experienced clinician as scarring and irregularities can occur. Frequent follow-ups are usually necessary.
- Laser Peel – a number of laser resurfacing treatments are now also available, though they can be expensive. Costs can be anywhere from $800 up to many thousands. This depends on the size of the area to treat and number of treatments required.
- Concealers – cosmetic concealers or camouflage make-up may be sufficient if only a few small blemishes are visible.
Does Hyperpigmentation Go Away On It’s Own?
The answer totally depends on what type of hyperpigmentation you have, and the severity of it. PIH from acne for example will tend to fade away in around 3 to 6 months.
Many types of hyperpigmented spots will never fade however. So they may need some type of additional treatment if you want to reduce their appearance. This doesn’t have to mean severe treatment. There are now more natural solutions using ingredients like Vitamins A/C/E and glycolic acid. These will take a little time to reach their full effect but may be all you need.
A Final Note
Thankfully, hyperpigmentation is usually an innocuous skin condition. But if you are at all concerned about any unusual looking skin marks or moles, it is always best to have them examined by a dermatologist.