Different Types of Hyperpigmentation

I needed to understand hyperpigmentation to follow how red light therapy reduces it. I am sharing my research with you.

Takeaways:

There are several sub-types of hyperpigmentation, including:

• Melasma
• Post-Inflammatory Hyperpigmentation (PIH)
• Lentigines (Age Spots or Liver Spots)
• Freckles

Plus, there are many causes of extra melanin and many ways to combat dark spots. The causes of hyperpigmentation include:

• Genetic Predisposition
• Sun Exposure
• Other Ultraviolet Light Exposure
• Hormonal Changes
• Acne, Eczema, and Skin Injuries
• Medication Side Effects or Allergies

I was surprised when “freckles” appeared among the types of hyperpigmentation, but it makes sense. Anything that causes extra melanin (skin pigment) is hyperpigmentation.

Hyperpigmentation Types and Their Causes

Hyperpigmentation is the darkening of the skin in areas or patches due to excess melanin. Dark melanin is the pigment that gives skin, hair, and eyes color. Hyperpigmentation can occur anywhere on the body. However, it is most likely to occur in areas of frequent sun exposure, such as the face, neck, hands, and arms. There are several ways to get excess pigmentation and make it go away. Understanding the underlying causes will help direct your treatment approach.

Hyperpigmentation Types

The types of hyperpigmentation are all disorders of melanin. The difference is what triggers overproduction in certain spots. The types of hyperpigmentation are:

• Melasma
• Post-Inflammatory Hyperpigmentation (PIH)
• Lentigines (Age Spots or Liver Spots)
• Freckles

Melasma

Melasma is a common skin condition characterized by dark, patchy areas of pigmentation on the face. The spots usually appear on the cheeks, forehead, chin, and upper lip. Melasma is more common in women than men, especially because it is associated with oral contraceptive use and pregnancy.

Some men and women develop melasma even when not affected by hormonal medications and events. Melasma appears to have several causes. These include genetics, hormonal changes, sunlight exposure, ultraviolet light exposure, and certain medications. Anti-seizure drugs and cosmetics can also trigger melasma.

Melasma causes dark, irregular patches on the face that are tan, brown, or gray. Treatment options include medications and dermatological procedures. Hydroquinone, tretinoin, and corticosteroids can help lighten the skin and reduce the appearance of dark patches. Chemical peels, microdermabrasion, and laser therapy stimulate collagen production and rejuvenation of dark spots.

Post-Inflammatory Hyperpigmentation (PIH)

Post-inflammatory hyperpigmentation (PIH) is a common skin condition that occurs when the skin produces excess melanin in response to inflammation or injury. This can result in dark spots or patches of hyperpigmentation that are often darker than the surrounding skin.

Various factors, including acne, eczema, psoriasis, dermatitis, insect bites, or other skin injuries or irritation, can cause PIH. When the skin is inflamed or injured, it triggers the production of melanin, which can cause the skin to become darker in color.

Symptoms of PIH include the appearance of dark spots or patches of hyperpigmentation on the skin, which may be flat or slightly raised. These patches may be brown, black, or gray and may be more pronounced on skin areas exposed to the sun. PIH treatment options are the same as those for melasma.

Hydroquinone, tretinoin, and corticosteroids lighten the skin and reduce the appearance of dark patches. Chemical peels, microdermabrasion, and laser therapy cause collagen production and skin rejuvenation to lighten dark spots. The key to PIH is resolving the underlying inflammation. When that calms down, PIH is easier to attack and remove.

Lentigines (Age Spots/Liver Spots)

Lentigines, also known as age spots or liver spots, are small, flat, brown patches of skin. They usually appear on areas exposed to the sun, such as the hands, arms, face, and neck.

Age spots often occur in people over 50. The current thinking is that exposure to sun (and other ultraviolet light) increases age spots. They might be the result of glycation, which is when glucose impairs a protein molecule. They can also occur in younger people. Age spots are excess melanin.

Treatment options for lentigines include topical medications, such as hydroquinone, tretinoin, or azelaic acid, which can help to lighten the skin and reduce the appearance of age spots. Other treatments may include chemical peels, microdermabrasion, or laser therapy.

Freckles

Freckles are small, flat, brown spots on the skin, particularly on areas exposed to the sun, such as the face, arms, and shoulders. They are usually harmless and are more common in people with fair skin. The exact cause of freckles is not fully understood, but current thinking is that they are a melanin response to ultraviolet light exposure—excess melanin. Freckles may be more pronounced in the summer when the skin is exposed to more sunlight.

Topical medications, such as hydroquinone or tretinoin, lighten the skin to reduce the appearance of excess melanin. Other treatments may include chemical peels, microdermabrasion, or laser therapy. However, it is essential to note that freckles are generally harmless and do not require treatment for medical reasons.

The best way to prevent freckles is to protect the skin from the sun by wearing protective clothing, such as hats and long-sleeved shirts, and sunscreen with a high SPF. Avoid tanning beds and other sources of UV radiation, as these can increase the risk of developing freckles and other skin conditions.

What Causes Hyperpigmentation?

The sun’s ultraviolet light is just one cause of dark spots. There are several underlying causes of hyperpigmentation, including:

• Genetic Predisposition
• Sun Exposure
• Other Ultraviolet Light Exposure
• Hormonal Changes
• Acne, Eczema, and Skin Injuries
• Medications

Genetic Causes of Hyperpigmentation

Genetics can contribute to the development of hyperpigmentation.

Certain genes may make an individual more prone to developing hyperpigmentation. Individuals with darker skin tones have more melanin, inherited through genetics. More melanin can mean a tendency toward developing hyperpigmentation. Genetics can also trigger albinism, which affects the distribution of melanin. This can also present as dark spots.

Sun Exposure Causes Hyperpigmentation

Sun exposure can cause hyperpigmentation in people with lighter skin tones (less melanin).

Exposure triggers melanin production as a defense against ultraviolet radiation. The extra melanin can darken the skin over time. This hyperpigmentation usually occurs on the face, arms, and hands. Ultraviolet rays from the sun can damage skin cells, creating dark spots. Sun exposure can also exacerbate hyperpigmentation, making it appear more prominent or widespread.

Hormonal Changes Can Cause Hyperpigmentation

Hormonal changes can contribute to hyperpigmentation in several ways. Pregnant women can experience melasma and brown patches on the face, neck, and arms. Pregnancy increases estrogen and progesterone levels, which stimulate melanin production. Hormonal changes associated with the use of oral contraceptives or hormone replacement therapy can also contribute to the development of hyperpigmentation, particularly in individuals with a history of melasma. Hormonal changes associated with menopause or thyroid disorders can cause changes in skin pigmentation, leading to hyperpigmentation or hypopigmentation.

Acne, Eczema, and Skin Injuries Can Trigger Hyperpigmentation

Inflammation can contribute to hyperpigmentation in several ways. Acute inflammation is a natural and healthy response to injury and infection. The body responds to acne, eczema, and psoriasis with inflammation to fight off the disorder. That inflammation can trigger melanin to complement the healing process, leading to dark spots.

Additionally, inflammatory conditions such as lupus or certain autoimmune diseases can cause changes in skin pigmentation, leading to hyperpigmentation or hypopigmentation. Finally, inflammation resulting from skin injuries or trauma, such as cuts, burns, or surgeries, can also contribute to hyperpigmentation as the skin heals.

Medication Side Effects and Allergies Can Cause Hyperpigmentation

Certain medications can contribute to the development of hyperpigmentation. Dark spots can appear as a side effect or as an allergic reaction.

For example, some antibiotics, antimalarial drugs, and chemotherapy agents can cause hyperpigmentation as a side effect. Additionally, medications such as non-steroidal anti-inflammatory drugs (NSAIDs) or tetracycline antibiotics can cause hyperpigmentation as an allergic reaction, known as fixed drug eruption. The hyperpigmentation may appear as dark patches or spots on the skin and may be localized to the area where the medication was applied or systemic.

Conclusion

Hyperpigmentation has several underlying causes and sub-types that must be appropriately identified for effective treatment. Understanding the various triggers for excess melanin production is crucial in combating dark spots and uneven skin tone. While some causes, like genetics, are unavoidable, others, like sun exposure, hormonal changes, and certain medications, can be managed to prevent or reduce hyperpigmentation.