Hyperpigmentation Discoloration

Hyperpigmentation discoloration affects about 30% of the global population. For most, it deeply affects their social life and solutions are intensely thought after. 50% of affected populations have been seeking for treatment.

cysteamine melasma

Hyperpigmentation discolorations are complex concerns that affects the social life of many patients

Hyperpigmentation is the darkening of an area of skin caused by increased in melanin containt. The pigmentation is due to overproduction of melanin by the pigment cells, melanocytes, which is taken up by the keratinocytes (epidermal melanosis) and/or deposited in the dermis (dermal melanosis, melanophages). It is caused by a number of factures including hormonal changes, inflammation and other skin injuries, and will amplify after sun exposure. 

Hyperpigmentation is more accute in people that tan well or have naturally brown skin (Fitzpatrick skin types 3 and 4), but will also affect those who have fair skin (skin types 1 and 2) or black skin (skin types 5 or 6).

 

melasma melanin pigmented cells

Hyperpigmentation is due to the overproduction of melanin by the pigment cells

 

What are the different type of hyperpigmentation discolorations ?

Hyperpigmentation is associated with a number of skin conditions. Some of these conditions require medical support. Make sure that you visit a dermatologist that will help you with the diagnostic and treatment of your condition.

Type of Hyperpigmentation Discolorations Clinical features
Melasma Although it is also called the mask of pregnancy, many melasma patients develop this skin disease without any relation to pregnancy and the disease also affects men. Contraceptive pills, sun exposure and certain medications such as phenytoin can induce melasma. There is a genetic predisposition to melasma, with at least one-third of patients reporting other family members to be affected. However, in most cases, the cause of melasma is complex and remains unclear.
Post Inflamatory Hyperpigmentation PIH is due to a number of factors, that can be classified as: endogeneous, particularly: post-acne and post-eczema exogeneous, particularly: post-scaring, post-burn, post-surgery, post-laser, post-needling, post-peeling, etc.
Lentigo A lentigo is a small pigmented spot on the skin with a clearly defined edge, surrounded by normal-appearing skin of the face or the hand usually. A lentigo has an increased number of melanocytes. It is benign, however one might desire the removal or treatment of some of them for aesthetics purposes.
Freeckles Freckles are clusters of concentrated melaninized cells which are most easily visible on people with a fair complexion. Freckles do not have an increased number of the melanin-producing cells, or melanocytes, but instead have melanocytes that overproduce melanin granules (melanosomes) changing the coloration of the outer skin cells (keratinocytes).
Eye Contour Dark Circle Periorbital hyperpigmentation is a commonly encountered condition. It is caused by various exogenous and endogenous factors. The causative factors include genetic or heredity, excessive pigmentation, postinflammatory hyperpigmentation. Eye contour dark circles affect the person’s emotional well-being and influence quality of life.
Elbows & Finger Joints Darkening
Intimate Discoloration Male and female intimate areas are also affected by hyperpigmentation. Medical aesthetics offers many alternatives to improve intimate discoloration of the underarm, nipple, bikini line, or of the genital area, vagina and penis. Improving the appearance of th intimate area does play a role in the wellbeing and self-esteem of many.
Leaps Discoloration

Hyperpigmentation is also associated with a number of other diseases or conditions, which requires strict medical diagnostic, treatment and follow up by a dermatologists.

This includes: Acanthosis nigricans (hyperpigmentation of intertriginous areas) ; Addison's disease and other sources of adrenal insufficiency ;  Aromatase deficiency ; Coeliac disease ; Cronkite-Canada syndrome; Cushing's disease or other excessive adrenocorticotropic hormone (ACTH) production ; Grave's disease; Haemochromatosis ; Linea nigra ; Nelson's syndrome ; Peutz-Jeghers syndrome ; Porphyria ;  Tinea cruris ; Tinea fungal infections such as ringworm.

Exposure to certain chemicals such as salicylic acid, bleomycin, cisplatin leads to hyperpigmentation discoloration. This is particularly the case with mercury poisoning —particularly cases of cutaneous exposure resulting from the topical application of mercurial ointments or skin-whitening creams.

How hyperpigmentation discolorations are treated today?

    Hyperpigmentation discoloration can be very slow to respond to treatment, especially if it has been present for a long time. Treatment may result in irritant contact dermatitis in patients with sensitive skin, and this can result in (further) post-inflammatory pigmentation.

    Several depigmenting treatments have been developped. The most effective treatments have been based on topical products that contain hydroquinone. Hydroquinone, after being applied onto the skin, is absorbed by the melanocytes and is metabolized within the (hyper-functioning) melanocytes to produce a toxic radical (quinone) that causes the abnormal melanocyte to die. This causes the hyperpigmentation area to become normal in colour, as hydroquinone has little or no effect on the normally functioning melanocytes.

    Although hydroquinone is considered to be the most effective treatment for hyperpigmentation, its use has become more and more restricted in recent years due to reports on the cancer-producing effect of this agent. Hydroquinone has thus been banned in several countries including European countries and Japan.

    A substitute to hydroquinone?

    After the hydroquinone ban, several products have been developed and put on the market for the treatment of hyperpigmentation. These products contain depigmenting agents such as kojic acid, azelaic acid, arbutin, glabridin, and more recently developed molecules, such as 4-butyl resorcinol or 4-ethyl-phenyl resorcinol. However, experience has shown that the majority of these molecules and fractional laser treatments are far less effective than hydroquinone as hyperpigmentation treatments.

    This leaves health-authorities, clinicians and patients seeking for a true substitute.