How to get rid of stubborn hyperpigmentation

What is hyperpigmentation?

Pigmentation, hyperpigmentation, hyperpigmentation, and post-inflammatory hyperpigmentation can often be difficult to define. Skin Expert and Author of Black Skin: The Definitive Guide, Dija Ayodele, outlines in her book, “hyperpigmentation itself is not a skin condition. It is the outward symptom of a skin condition, e.g., acne or an injury. Skin discolouration (also known as hyperpigmentation) is always triggered by something else.” Further explaining, “when the skin is injured or inflamed in any way, extra melanin is produced. This is what causes the increase of colour. Skin conditions such as breakouts, acne, eczema are all inflammations of the skin that trigger the melanin cells to overproduce melanin. Physical injury to the skin also results in hyperpigmentation, so cuts, wounds, or grazes are also triggers,” she adds.

How does hyperpigmentation affect black skin?

“Hyperpigmentation occurs due to the overproduction of melanin," says Aesthetician Alicia Lartey. "People with darker skin tones usually range from 4-6 on the Fitzpatrick scale (a numerical classification scale that outlines all human skin colour). Already having an increased presence of melanin means that for those with black skin, when an injury occurs, there is a greater chance of a pigmentation deposit.”

How can I treat Hyperpigmentation?

While hyperpigmentation is recognised as darker patches surfacing on the skin, hypopigmentation is “defined as the loss of pigmentation on the skin that displays itself in lighter patches” explains Lartey. Hypopigmentation can be caused by skin conditions such as vitiligo, psoriasis, eczema, contact dermatitis, or skin damage such as blisters or burns (the latter is likely to be temporary). To treat it, topical steroids and creams are often recommended. However, it is best to seek the advice of your medical practitioner for a tailored and bespoke treatment plan.

“Depending on the degree and cause of hyperpigmentation, treatments range from active skincare ingredients to chemical peels to lasers. Once you have tackled hyperpigmentation, you must take steps to prevent it from recurring; one of the steps would be to use SPF daily. Sunscreen will also protect the areas of hyperpigmentation from darkening,” Dr Hamilton says.

Aesthetician & Founder of Moji Skin Clinic, Moji Olanipekun adds, “​​prevention is better than finding a cure, so avoiding triggers such as reducing trauma to the skin and using adequate protection forms will help decrease the likelihood of hyperpigmentation”.

Hyperpigmentation acne occurs when a dark spot appears after a spot disappears,: explains Dr Lauren Hamilton, Consultant Dermatologist at GetHarley. "For those with black skin, this can develop into a hyperpigmentation scar. “For those with more or severe hyperpigmentation, particularly because of acne, then a topical or oral retinoid should be effective. They slow the desquamation process, therefore inhibiting microcomedones that are the precursor lesions of acne.”

What is post-inflammatory hyperpigmentation & how can it be improved?

“The most common skin complaint that I see in dark skin is Post-Inflammatory Hyperpigmentation (PIH). This is when dark patches occur following injury or irritation to the skin. Examples include acne that has healed or from shaving. Whilst it is temporary, it can take longer to fade in darker skin. Darker skin is more susceptible to PIH due to the stimulation of melanin production following tissue injury.” shares Dr Hamilton.

How do you treat hormonal hyperpigmentation?

Otherwise known as melasma, hormonal hyperpigmentation often occurs due to the fluctuating hormones in the body with triggers such as pregnancy (chloasma), birth control and hormone medication being factors (as well as UV rays) that can contribute to the patchy discolouration on the skin. “Melasma is a challenge to treat and sadly no cure, but it can be managed so that its appearance on the skin is improved”, Ayodele further explains in Black Skin.

What in-clinic prescriptions are recommended to improve hyperpigmentation?

Dr Sophie Shotter, Consultant Doctor for GetHarley recommends in-clinic prescriptions such as "Hydroquinone, an active skin lightening ingredient, which is available via a prescription at 4%. This works well in combination with prescription retinoids, which will help clear the pigment quickly. I’m also a big fan of an ingredient called Cysteamine, which has only recently been formulated into a cream, but clinical studies have found it to be as effective as hydroquinone. It’s very simple to slot into a regime and is used once daily for 16 weeks”.

Chemical peels and lasers can improve discolouration around the mouth. According to Dr Shotter, the innovation in these services makes them great options for improving hyperpigmentation. “Chemical peels use blends of ingredients which will work to exfoliate and clear the melanin deposited within the skin causing uneven skin tone. Peels vary vastly - citric acid is an excellent base for treating pigmentation problems, but many will use an acid base and then add in other ingredients to target the pigmentation like Kojic Acid or Tranexamic Acid.” she explains.

Similarly with laser treatments, not traditionally catered to melanin skin, specific lasers such as the NdYag has been developed to treat darker skin and hyperpigmentation. “The wavelengths which are best for targeting melanin are 532nm, 694nm, 755nm and 1064nm. This is important when choosing a laser - NDYag can be used at 1064nm and 532nm, a Ruby laser is 694nm and an Alexandrite is 755nm” Dr Shotter says. What is important is that you go to a practitioner who is experienced in the use of lasers and who is experienced in working with skin of colour.

At-home recommended ingredients also include kojic acid and alpha-arbutin because they help suppress dark spots. “Kojic Acid & Alpha Arbutin which are what we call tyrosinase inhibitors which help to suppress the overproduction of melanin”. Olanipekun adds.

It’s a common misconception that hyperpigmentation is a problem only for the face. To help, try introducing active ingredients such as vitamin c, into your routine. “It’s brightening effects are a good first step to improving the appearance of uneven skin tone and dark spot”, Dr Hamilton says. But be careful not to introduce too many acids at once; this can do more harm than good - do consult a skin expert first.

“Choosing a treatment for hyperpigmentation depends on how deep your hyperpigmentation is. We typically see pigmentation sitting in the skin’s epidermis (upper layer) or the dermis (lower layer of the skin),” explains Lartey. “You can tell where the pigmentation sits in the skin by observing the hue of the pigment. If the pigmentation is in the epidermis, it usually has a brownish hue, but the hue is generally grey or purple if the pigmentation sits in the dermis. All over-the-counter non-prescription products can treat pigmentation in the epidermis. If your pigmentation sits in the dermis, you may need professional or prescriptive treatment.”

SHOP: The best products to treat hyperpigmentation, as recommended by the experts

Depending on the degree of hyperpigmentation, a combination of prescription and non-prescription ingredients may be recommended by experts. “Hydroquinone has always been the gold standard and is available on prescription at a 4% concentration. This works well in combination with prescription retinoids, which will help clear the pigment quickly. I’m also a big fan of an ingredient called Cysteamine - this is as effective as hydroquinone on clinical studies but was only recently formulated into a useable cream. It’s very simple to slot into a regime. It is used once daily for 16 weeks.” She concludes that “other great ingredients are Vitamin C, Arbutin, Kojic Acid and Tranexamic Acid”.

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