What is pigmentation (also called hyperpigmentation)?
Pigmentation, also known as hyperpigmentation, is a common skin condition where some areas of skin are darker than others and typically happens on areas of the body that are frequently exposed to the sun. It happens due to the uneven production of melanin by melanocytes in the skin.
Melanin is the pigment that gives skin (and also our hair and eyes) its colour and melanocytes are the cells in your skin that produce it.
Excessive melanin in some areas and less in others results in patches that look brown, black, grey or pink, depending on your race and ethnicity and people with darker skin tend to be more prone to pigmentation than those with lighter skin. Pigmentation is also at the heart of skin conditions like melasma and post-inflammatory hyperpigmentation. Pigmentation isn’t painful or physically uncomfortable, but tends to make people conscious of their appearance, so in this series of blog posts, I’m going to cover everything that you need to know about pigmentation and what you can do to fix it. Let’s dive right in.
What are the different types of hyperpigmentation?
When it comes to pigmentation, it’s important to differentiate between diffuse hyperpigmentation and localised hyperpigmentation.
Diffuse hyperpigmentation is pigmentation that tends to be widespread on different areas of the body, and localised hyperpigmentation is pigmentation that’s limited to one area of the body, as in the case of acne marks and melasma.
This is because diffuse hyperpigmentation tends to be associated with an underlying cause and only improves when the underlying cause is addressed. Its underlying causes include malignancy (i.e. cancer), autoimmune conditions, and the side effects of certain medications. Given the seriousness of these causes, I think it goes without saying that if you have diffuse hyperpigmentation you need to visit your doctor and look into what could be causing it.
In this blog, I’m going to focus on localised hyperpigmentation, its causes, and what you can do to address it. Here are the major causes of localised hyperpigmentation:
Age spots (also known as sun spots)
Age spots are small, darkened patches of skin that are caused by accumulated skin damage from sun exposure. Like all pigmentation, they also have to do with an uneven increase in the production of melanin and are most common in people over 40. They appear mainly on body parts that are frequently sun exposed such as the face, neck, décolletage, hands and arms. While usually harmless, age spots can sometimes become malignant (i.e. cancerous). If an age spot seems to change in shape, size or colour, becomes itchy, or starts to bleed, don’t wait, consult a dermatologist ASAP.
The prevalence of skin cancer in Pakistan
According to the Journal of the Pakistan Medical Association, over 800,000 new cases of skin cancer are diagnosed around the world every year and account for around 2100 deaths. Studies done in Pakistan show that skin cancer is one of the top three cancers in Northern Pakistan, which comprises North Punjab, North Balochistan, NWFP and FATA.
In NWFP, skin cancer is the most common cancer in men, where it accounts for 8.9% of all cancers, and is the second most common cancer in women, while in North Pakistan overall, skin cancer is the fourth leading cause of cancer in men (6.7% of all cancers) and the second leading cause of cancer in women (5.6% of all cancers). However, the incidence of skin cancer is likely higher than what has been estimated in these studies since it is often misdiagnosed or under-diagnosed.
As we travel towards the south of Pakistan, the incidence of skin cancer declines. There are likely three reasons for this:
Despite the lower incidence of skin cancer in darker skin types, dark skinned individuals still need to exercise caution since when they do get it, it tends to be a lot more deadly.
Melasma (also called chloasma)
Melasma is a form of pigmentation where larger patches of pigment develop mainly on the face. It can affect both men and women, but is more common in women and is thought to be triggered by hormonal changes since it occurs in 10-15% of pregnant women (and is also sometimes called the mask of pregnancy), and in 10-25% of those taking oral contraceptives.
Post-inflammatory hyperpigmentation (PIHP)
This happens after the skin has been subjected to injury or trauma in some form that leaves discolouration behind when it heals since melanocytes are known to also be stimulated by inflammation. Examples of PIHP include the marks left behind after acne, and in some cases, even by cosmetic procedures like dermabrasion, laser and chemical peels.
What causes pigmentation?
Pigmentation occurs when melanocytes begin to produce more melanin. Several factors can trigger an increase in melanin production but the single biggest factor is sun exposure. Since the primary role of melanin is to protect you from the sun, sun exposure stimulates melanin production leading, most immediately, to a tan. Excessive sun exposure over time makes the process go awry, leading to uneven pigmentation which is what we most commonly think about in association with the words pigmentation or hyperpigmentation. Once pigmentation has developed, sun exposure can also make it worse than it already is.
Other factors that can lead to pigmentation include genetics, as in the case of freckles, hormones, as in the case of melasma, and inflammation as in the case of the marks left behind after inflammatory skin conditions like acne, dermatitis, psoriasis and other injuries to the skin. Post-inflammatory hyperpigmentation occurs because inflammation can lead to up-regulation of melanin production in the skin.
Injury to the skin can counterintuitively, also be caused by aggressive or irritating skin products and treatments. These include abrasive scrubs, chemical exfoliants when incorrectly used, microneedling and even lasers when administered improperly without first patch testing the skin.
Pigmentation also becomes more common with age because of the way our skin changes over the years: the number of melanocytes decreases while the ones that remain become bigger in size and their distribution becomes more focussed resulting in age spots. As previously mentioned, pigmentation, especially in the form of melasma, can also be affected by hormones. Melasma affects mainly women and is thought to occur when the hormones oestrogen and progesterone stimulate the overproduction of melanin when the skin is exposed to the sun. Melasma can also be caused by hormone-based medicines like oral contraceptives.
Lastly, in some cases, hyperpigmentation can be a symptom of autoimmune and gastrointestinal disease, metabolic disorders and vitamin deficiencies and can also be triggered by non-hormonal oral medications including antibiotics and drugs used in chemotherapy, among others.
How can I prevent and treat hyperpigmentation?
Over the course of time, many options have become available to treat pigmentation. I’m going to cover the topical skincare ingredients and in-office procedures that are effective in the treatment of pigmentation in detail, in separate posts. What follows here, is an overview of how you can structure your everyday skincare routine to combat pigmentation if you have it. If you haven’t already read our blog on how to build a skincare routine from scratch, I would highly recommend you do that as well.
When it comes to pigmentation, before anything else, it’s essential to identify what’s causing it and also treat the cause. For example, if your pigmentation is being caused in the aftermath of acne and eczema, it’s essential that you first manage those conditions to prevent new pigmented patches from being created.
In addition to that, while sun protection is essential for everyone, it’s especially important if you’re prone to pigmentation since the sun is the single biggest cause of pigmentation and will invariably exacerbate it if you already have it. Look for a sunscreen that is broad spectrum and protects against both UVA and UVB radiation, and reapply it after sweating, swimming or other activities that could lead to it being washed off. If the sunscreen filters contained in the sunscreen aren’t photo-stable, also pay attention to reapplication every 2-3 hours throughout the day, while the sun is still out.
Lastly make sure you take regular photographs to monitor improvement since improvements do take some time and it’s often easy to assume that something isn’t working when in fact, it is. Here’s a skincare routine you could try if you’re prone to pigmentation.
Wash your face with our Hydrating Gentle Daily Cleanser.
Apply a few drops of our Serum Vitamin C, Niacinamide, Alpha Arbutin (launching soon).
Moisturise with our Carbamide Intensive Hydration Cream to lock moisture in.
Follow up with The Ultimate Sunscreen SPF 50 Ultra.
Wash your face with the Resurfacing Face Wash. Start by using this 2-3 times per week and slowly build up especially if your skin is sensitive, or you’re new to acids. On days that you don't use this, use our Hydrating Gentle Daily Cleanser.
Follow up with our Retin-oil Serum. Start by using the 0.2% 3 times a week if you’re new to retinoids, and slowly build up in terms of frequency and strength.
Moisturise with our Carbamide Intensive Hydration Cream.
Pro-tip: mix a few drops of our Sea Buckthorn Oil into your moisturiser at night for a powerful dose of vitamins and lipids that are excellent for your skin.
Still have questions? Drop us a message on WhatsApp (+92-302-222-8349) for a free skincare consultation and stay tuned to learn more about this stubborn condition and the ingredients that are effective against it. 🥰