Hyperpigmentation: Causes, Symptoms, Remedies, and more!

Introduction

Human skin color varies greatly across the globe, from the very pale complexion of Celtic skin to the very dark skin complexion found in countries like Sub-Saharan Africa. There are several conditions of the pigmentary system over this spectrum of skin tones, resulting in problems ranging from hypopigmentation (patches of skin that are lighter than your actual skin tone) to hyperpigmentation (Patches of skin that are darker in color than the surrounding skin).

Variations in skin disease, presentation, and treatment are caused by structural and functional changes in the skin, and also due to the influence of cultural practices. Skin hyperpigmentation occurs when melanin, a pigment that is responsible for pigmentation is overproduced in certain areas on the skin. To care for persons who are affected by facial hyperpigmentation, it is important to have a complete understanding of the causes of the conditions and their treatment strategies.

What causes hyperpigmentation?

Hyperpigmentation may be caused due to several factors like:

Exogenous factors (having an external cause or origin)
Endogenous factors (having an internal source or origin)
Nutritional factors

Exogenous factors:

These are due to factors like sun damage (these spots are also known as solar lentigines). It is also caused due to injury to the skin like acne, cuts, or burns, which is sometimes referred to as post-inflammatory hyperpigmentation.

Endogenous factors:

These are due to adrenal disorders like Addison’s disease- A condition in which the body doesn’t produce much of a hormone called cortisone.
Genetics (for example, a family with freckles).
Hormonal changes during pregnancy or puberty.
Medications like oral contraceptives (birth control pills) and medicines that result in sensitivity to light.
Thyroid disorders.

It is also caused due to other conditions like diabetes, acanthosis nigrans (a skin condition that results in dark pigmentation in body folds and creases), Acromegaly (hormonal disorder due to excess secretion of pituitary hormone), carcinoid (slow-growing cancer that arises in many places in the body), Nelson syndrome (A disorder marked by abnormal hormonal production, pituitary gland enlargement, and development of massive and invasive growths called adenomas), Cushing’s syndrome (production of too much cortisol over time), pheochromocytoma (a non-cancerous tumor that grows in the adrenal gland), and hyperthyroidism (excess production of thyroid hormone).

Nutritional factors:

This is due to deficiency of certain vitamins like folic acid, vitamin B12, Tryptophan deficiency, niacin deficiency, vitamin A deficiency, and kwashiorkor (a type of malnutrition due to protein deficiency in the diet).

Symptoms of Hyperpigmentation

Different types of hyperpigmentation and their symptoms include:

Sun damage: One of the common forms of hyperpigmentation includes age or liver spots. They are caused due to sun damage and are called solar lentigines by doctors. These are small, darkened patches that are commonly observed on the hands, face, and also other sun-exposed areas.
Melasma: These appear similar to age spots but are larger areas of darkened skin that occur due to hormonal changes. Pregnancy, for example, can produce an increase in melanin production, resulting in a "mask of pregnancy" on the face as well as darkened skin on the abdomen and other regions. Women who are on birth control pills might also end up with hyperpigmentation as their bodies undergo hormonal changes comparable to those experienced during pregnancy. If the pigment bothers you, you should stop using birth control pills.
Skin injury: Skin disorders like acne can result in dark spots after the condition heals. Injuries to the skin such as some surgeries can also lead to dark spots.
Freckles: Freckles are small, brown spots that can develop anywhere in the body. These spots are however common on the face and arms. Freckles, age spots, and other skin dark skin patches can get darker when exposed to the sun. This occurs as melanin absorbs the energy of the sun's harmful UV rays to protect the skin from overexposure to the sun.

Home Remedies for Hyperpigmentation

Home remedies for hyperpigmentation improve the appearance of dark skin patches that occur due to the condition. Some remedies include:

Aloe vera gel: This gel contains skin-lightening properties. It can be taken in combination with other ingredients like tea tree oil for a greater effect on the skin.

Green tea: It contains a compound called catechins that protect the skin from free radicals. This type of antioxidant can prevent harmful molecules from damaging your skin cells and causing inflammation, which can result in dark spots on the surface.

Apple cider vinegar: It has natural lightening compounds. The presence of acetic acid helps reduce pigmentation and fade dark patches on your skin. It also contains antibacterial properties that help prevent further breakout and make your hyperpigmented areas less evident.

Coconut oil and turmeric: Coconut oil and turmeric can be combined and used to manage hyperpigmentation naturally. Coconut oil is high in antioxidants, which help to fight free radicals in the skin while also moisturizing it and preventing additional damage. Turmeric is a natural antioxidant that can help with hyperpigmentation when combined with coconut oil.

Pomegranate extract: This extract helps manage hyperpigmentation as it contains ellagic acid. Ellagic acid is an antioxidant that fights against free radicals in the skin. Pomegranates contain antioxidants that help delay cell damage and promote cell regeneration. Pomegranate extract helps to prevent hyperpigmentation by protecting the skin from sunlight and skin irritation.

When to Seek Medical help

You should consult your dermatologist when you notice symptoms like:

Red skin
Itchy skin
Painful skin
Skin that is hot while touching
Bleeding or pus discharge from the area.

Conclusion

Sometimes, the skin produces extra melanin which can produce spots or patches that appear dark than the surrounding skin. Hyperpigmentation is a common skin condition that can however make one self-conscious. Making necessary lifestyle changes and treatments might help. One of the best ways to prevent and decrease hyperpigmentation is by avoiding sun damage.

Daily application of a broad-spectrum sunscreen (one that blocks both ultraviolet rays, UVA and UVB) might help prevent hyperpigmentation. Wearing protective clothes and hats also can help prevent this condition.

Frequently asked questions

1. What is hyperpigmentation?

Hyperpigmentation is a common condition that results in some areas of the skin being darker than other areas. The word 'hyper' means more and 'pigment' means color.

2. What are the over-the-counter creams and ointments which can be used for hyperpigmentation?

Topical creams and ointments that are prescribed by doctors for managing hyperpigmentation are corticosteroids, azelaic acid, tretinoin, salicylic acid, tretinoin, vitamin C or B3, glycolic acid, hydroquinone, and skin bleach.

3. What are the other treatment options for hyperpigmentation?

Other treatment options for hyperpigmentation include pigmented lesion laser, cryotherapy, chemical peels, and laser skin resurfacing.

4. What are the different hyperpigmentation disorders?

Different hyperpigmentation disorders include post-inflammatory hyperpigmentation, melasma, solar lentigines, ephelides, café au lait macules, etc.

5. How are pigmentation disorders diagnosed?

Pigmentation disorders are diagnosed by obtaining a proper medical history, physical examination, skin examination, biopsy, and blood tests to check hormones, vitamins, iron, and thyroid function.

References

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2. N.A Vashi, R.V Kundu. Facial pigmentation: causes and treatment. British journal of dermatology. 169(3): 41-56 Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.12536

3. Prity Rathee, Sunil Kumar, Dinesh Kumar, Beena Kumari, Savita S. Yadav; Skin hyperpigmentation and its treatment with herbs: an alternative method. Future journal of pharmaceutical sciences. 2021 Jul 132 Available from: https://fjps.springeropen.com/articles/10.1186/s43094-021-00284-6#citeas

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5. American osteopathic college of dermatology. Hyperpigmentation. [Internet] Available from: https://www.aocd.org/page/Hyperpigmentation

6. Nation. 5 simple home remedies for hyperpigmentation. [Internet] Available from: https://nation.africa/kenya/health/women-s-health/5-simple-home-remedies-for-hyperpigmentation-3644234

7. Cleveland Clinic. Hyperpigmentation. [Internet] Available from: https://my.clevelandclinic.org/health/diseases/21885-hyperpigmentation#living-with

8. American academy of family physicians. Pigmentation disorders: diagnosis and management. [Internet] Available from: https://www.aafp.org/afp/2017/1215/p797.html