Spot On: Hyperpigmentation Facts

The summer sun may bring out the best in dalmationus, but it can also bring out hyperpigmentation spots on our skin. Hyperpigmentation is a long word for brown, irregular patches that make skin tone uneven. It can be hormone-mediated due to pregnancy or birth control pills. Or it can be related to inflammation caused by sun exposure, heat or trauma. I see it frequently in my office, and it can affect men and women of all ethnic backgrounds. Those with more natural melanin in their skin have more issues with hyperpigmentation.

Melanin is pigment produced by cells called melanocytes in the lower layers of the skin. The color of your skin, hair and eyes is the result of melanin. Problems result when the melanocytes are overstimulated and produce extra melanin or the cells themselves over-proliferate and cause hyperpigmented skin areas. This is rarely a case for major medical worry, except in conjunction with other illnesses. Yet its presence really bothers patients. I hear that people are asked if their faces are dirty. And of course the children in our lives point out all of our imperfections and spots.

Hyperpigmentation is associated with a number of diseases or conditions, such as these:

Addison’s disease

Cushing’s disease

Acanthosis nigrans (related to insulin resistance)

Hemachromatois (excessive iron stores)

Celiac disease

Smoker’s melanosis

Melasma (related to pregnancy hormones and birth control pills can be resistant to treatment)

Post inflammatory hyperpigmentation (PIH) occurs following skin injury from acne lesions and cysts, psoriasis, burns, friction and even certain professional skin care treatments like upper lip waxing, peels and lasers. A bra strap, collar or underwire can cause this. A warm laptop can turn the tops of your upper legs brown, so use a lap desk! It starts to fade when the offending item is removed, or the injury heals. The process may take weeks to months, and topical or laser treatments can be helpful.

Lentigoes is the fancy word for freckles, sunspots and liver spots. They become more prevalent with age, but this is related to UV exposure over time, not the aging process itself. A large pigmented spot should be checked out for lentigo maligna, which is a potential melanoma precursor. When in doubt about any pigmented lesion or spot, get it checked, even if you’ve had it for a long time. Melanoma can arise from a pre-existing mole.

Treatments include:

Topical creams that contain ingredients such as kojic acid, alpha hydroxy acids, azelaic acids, ascorbic acid, retinol and licorice extracts can be found in over-the-counter product lines.  Higher concentration hydroquinone and retinoid products require a prescription.

Skin peels can be helpful to minimize pigment related to sun damage, but requires an experienced provider and careful follow-up.

IPL (Photofacial) is a patient favorite. It is like a broad band laser that particularly focuses on melanin. Treatment takes about 20 to 30 minutes and usually a series of treatments are done. The melanin is released from the cell and comes to the surface over 5-7 days. Skin looks a bit peppered during this time, but when the process is complete, the skin tone and texture is improved.

Sunscreen proves that your best defense is a good offense. Be proactive and use a broad spectrum physical block with a sun protection rating of at least 30. Look for zinc and titanium under the ingredients.

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