An expert guide to hyperpigmentation

The skin is the largest organ of the human body and one of the most important – and it’s also quite complicated. Skin serves as a shield, safeguarding us from external aggressors such as bacteria, chemicals, and temperature. But despite being incredibly tough, it’s also flexible and sensitive to damage and change – particularly pigment changes, which cause patches of skin to become darker.

“Skin hyperpigmentation can occur in people of different skin colour, skin type and skin texture,” says Dr Ariel Haus, the founder of Dr Haus Dermatology. Hyperpigmentation is a darkening of the skin from its regular colour. This can occur either as spots or patches, or as diffuse hyperpigmentation, where there is generalised darkening of the skin tone. “A suntan is an example of generalised hyperpigmentation. However, the same mechanism that produces a healthy-looking change of colour as a response to sun exposure is also involved in producing unwanted localised hyperpigmentation such as blemishes, freckles and other skin imperfections.”

Every time you venture outdoors without sun protection, the body produces more melanin to defend itself against UV rays. Over time, this can result in changes to the skin’s appearance. Burns, bruises, acne and other trauma to the skin can also increase melanin production. “In the case of hyperpigmentation, melanin production goes into overdrive and is deposited irregularly in the skin, giving the appearance of brown patches or dark spots,” says Dr Haus. “This excess melanin production can be triggered by existing sun damage, acne or other skin scarring, or inflammation carried over from a past flare-up of eczema or psoriasis – also known as post-inflammatory hyperpigmentation.”

For the treatment of hyperpigmentation, one of the baseline recommendations made by most dermatologists would be daily application of a broad-spectrum sunscreen, factor 30 or higher. Many hyperpigmentation cases respond well to topical creams or oral medications, with ingredients like azelaic acid, vitamin C and retinoids. Lasers and light sources can often offer a more potent approach to addressing uneven skin tone and abnormal hyperpigmentation, including café-au-lait macules. But while most hyperpigmentation issues can be quickly and effectively resolved, the one exception has previously been melasma, Dr Haus says.

“Melasma is a particular category of hyperpigmentation linked to hormonal fluctuation. It typically presents on the forehead, nose, cheeks, chin and upper lip, causing brown or greyish patches of pigmentation. It affects mainly women, especially during pregnancy. It is also more commonly seen in darker skin types. Due to the refractory and recurrent nature of melasma, patients often seek alternative treatment strategies such as laser and light therapy, which uses targeted beams of light to reduce hyperpigmentation. But while laser therapy can be effective, there is sometimes an increased risk of post-inflammatory hyper- or hypopigmentation.”

The latest addition to Dr Haus Dermatology’s range of non-surgical technologies, the Smart PICO Laser system, is able to minimise the appearance of hyperpigmentation caused by melasma, while mitigating the risk of post-inflammatory conditions. Dr Haus says: “As one of the more advanced aesthetic laser systems on the market, the technology can deliver exceptional results for reducing fine lines and wrinkles as well as amplifying our ability to treat recalcitrant conditions such as melasma and PIH in darker skin types, all while minimising undesirable side effects and downtime. The SmartPICO laser system offers a solution by employing targeted pulses that effectively reach the precise layers of skin tissue, promoting the natural generation of collagen. After undergoing this treatment, the skin is radiant and smooth after as little as one session.”