Hyperpigmentation is a complex process in the skin. Dermatologists are well-versed in all types of pigments in the skin, including birthmarks, melasma, scars, sun spots, moles, and hyperpigmentation caused by inflammation.
Hyperpigmentation of the face can be broken down into two main categories. The first is sunspots and sun damage that we accumulate throughout our lives in the form of freckles, brown spots, melasma, and overall dyschromia (blotchiness).
The second cause of hyperpigmentation in the face is post-inflammatory hyperpigmentation. This occurs due to an inflammatory process in the face, whether a laser procedure, a traumatic wound, or something that injured the skin and left it with a hyperpigmented area.
Post-inflammatory hyperpigmentation is common in those with olive-toned skin or Fitzpatrick types III and above. When the skin is inflamed for whatever reason (i.e., a laser or trauma), patients who have olive-toned skin and pigment in their hair, eyes, and skin tend to deposit melanin in areas of trauma. Once the redness and pink areas go away and resolve, what’s left behind is brown, tan pigment. This pigmentation resolves slowly with time, especially if you avoid the sun. However, it can be permanent if the inflammation is extreme.
Post-inflammatory hyperpigmentation can be treated first by avoiding sun exposure and wearing sunscreen every day. An SPF of 30 or higher and a physical blocker such as zinc or titanium are recommended over chemical blockers.
Also, dermatologists understand that the pigmentation cycle in the skin can be inhibited and reversed with several known key ingredients. Some of the most common ingredients are vitamin C, hydroquinone, retinol, glycolic acids, or other alpha hydroxy acids. Using these daily can improve all types of pigmentation in the skin.
In addition, procedures can improve post-inflammatory hyperpigmentation. However, this can be tricky because if you cause additional inflammation, one could achieve more hyperpigmentation. Gentle and short-pulsed lasers like the Spectra laser or Pico lasers are acoustic energy lasers that do not deliver intense thermal energy to the tissue, thereby eradicating pigment by not heating it, which can lead to more pigmentation.
The first type of hyperpigmentation, in the form of sunspots, melasma, and overall blotchiness, can also be treated with prescription-level topicals. Once again, sunscreen is the most important intervention. The addition of daily vitamin C, retinol, hydroquinone, and alpha hydroxy acids improves sun damage overall.
There are a host of lasers that target dyschromia or sun damage in the skin. Lasers that are light and require several treatments, like IPL, the LaseMD, or Clear + Brilliant are great options. Erasing pigmentation can be mild or aggressive, depending on your skin type. Severe sun damage and hyperpigmentation can be improved with deeper, more aggressive lasers like Fraxel® or a CO2 resurfacing procedure. These are more aggressive than the lighter procedures mentioned above and require the hands and expertise of a trained provider that won’t use an inappropriate laser on vulnerable skin. Laser energy must be used cautiously in patients with darker skin types because worsening post-inflammatory hyperpigmentation can ensue.
The first step to fixing any type of hyperpigmentation is sunscreen and prescription-grade pharmaceutical topicals such as vitamin C, retinol, hydroquinone, and alpha hydroxy acids. The second intervention would include lasers and procedures. The last intervention to mention is the use of oral tranexamic acid. This is a safe medication used in obstetrics and gynecology for decades. However, it has been used in dermatology for the last decade for melasma and other pigmentation disorders. This medication has a few side effects, but you must be screened for medical conditions that could be contraindicated. Hyperpigmentation is one of the most common things dermatologists see. Make sure that you get a thorough evaluation by an expert before treating your hyperpigmentation.
If you’d like to address your hyperpigmentation, we encourage you to schedule a private consultation at ZENA Medical in Newport Beach, California today. Our dermatologists, nurse practitioners, and aesthetics professionals will make sure your outcome is optimal and safe. Call us at (949) 200-8222 or fill out our convenient contact form on Zenamedical.com. We look forward to meeting you!
