If you are an individual of Asian, Hispanic/Latino, African, Native American, Pacific Island descent, and any combination of ethnic descent, you may have experienced the difficulties of getting rid of hyperpigmentation. According to Dr. Erica C. Davis, hyperpigmentation effects skin of color with greater severity and frequency.
Certain methods of removing hyperpigmentation has a high chance of causing more harm to the skin, especially for skin of color. It is important to understand the best treatment options for skin of color to avoid negative side effects such as post inflammatory hyperpigmentation and other complications and minimize expenses. Unfortunately, most skincare professionals are not adequately trained to manage hyperpigmentation on skin of color. It is a special area of study in dermatology that is beginning to gain awareness with the existence of the Skin of Color Society.
Hyperpigmentation such as sun spots, age spots, acne marks, and melasma is a condition of excess pigment in the skin, which results in a darken, mottled appearance. We will review the types of hyperpigmentation, then the most advanced treatment options available today to correct it. In dermatology, different terms are used to refer to hyperpigmentation resulting from specific causes. The following list of known types:
Freckles: Freckles are a type of hyperpigmentation that is due to genetics and sun exposure.
Age Spots/Sun Spots/Brown Spots: These spots are small round brown patches due to sun damage caused by UV rays. The DNA of these skin cells become damaged where melanocytes permanently increase production of melanin. The melanin pigments surface in the skin and become visible.
Melasma: Melasma are dark brown and sometimes gray patches, appearing most often on the forehead, upper lip, or cheeks on the face. The exact cause of melasma is not known but the medical community believes it that shifts in estrogen, sun exposure, and exposure to external environmental pollution are the leading causes. According to research from Dr. Martin N. Zaiac, Chairman, Department of Dermatology Herbert Wertheim College of Medicine, “Unfortunately, no therapy for melasma achieves particularly good or lasting results. Standard treatment uses hydroquinone cream. Tretinoin cream and a topical steroid can be added for increased efficacy. Other medications and procedures, such as laser treatment, have been used with varying results. In cases where exogenous hormones are believed to be the culprit, melasma may or may not improve after cessation.”
Post-inflammatory hyperpigmentation (PIH): PIH is a result of skin trauma where the skin produces more melanin to protect itself. Skin issues that often result in PIH include acne, eczema (atopic dermatitis), allergic reactions, infection, insect bites, lichen planus, bug bites, pseudofolliculitis barbae, psoriasis, and reactions to abrasive skin treatments like laser. PIH can be at the epidermal (top layer of skin) or dermal (deeper layer of skin) and appears tan, dark brown, and purple.
Hydroquinone – How safe is it?
Many dermatologists in the United States consider hydroquinone to be the most effective method of removing hyperpigmentation. It works by inhibiting the production of tyrosinase, an enzyme required to make melanin. Profession topical treatments using hydroquinone require at least 3 months or more to visible see results. However, hydroquinone has many negative side effects and safety concerns that in most other countries, it is banned from use. Studies of hydroquinone has shown that it is carcinogenic in rats. In humans, continued usage of hydroquinone has resulted in “rebound” hyperpigmentation where the skin becomes inflamed, thickened, and even more pigmented and in extreme cases, ochronosis, a permanent dark gray and blue darkening of the skin. Skin of color has a higher risk of PIH and ochronosis when using hydroquinone.
Glycolic Acid Chemical Peel
Many beauty spas will offer glycolic acid as a treatment for hyperpigmentation and discoloration, but they can cause excessive redness, swelling, and irritation in some people. Glycolic acid is safe for skin of color because it simply accelerates exfoliation by removing the dead skin layer. Because if just removes dead skin, glycolic acid does not address the cause of hyperpigmentation so expect the dark spots to return.
High concentration glycolic acid peels require special consideration so make sure to consult a dermatologist. If you want to try this at home, you can get the lowest concentrations (up to 5%) at the beauty store, but you will need a prescription for higher concentrations. A good tip for home application is to mix part of glycolic acid with part of aloe vera gel. This will really help reduce your risk of skin irritation. Glycolic acid leaves your skin very sensitive to the sun, so wear sunscreen every day.
Microneedling
Microneedling is a dermaroller procedure that uses small needles to prick the skin. The purpose of treatment is to generate new collagen to result in smoother and firmer skin. Of all the medical treatments, microneedling is well-tolerated by skin of color. Microneedling has been shown to improve the overall skin texture minimizing pores and reducing acne scars. However, microneedling does not reduce melanin production so hyperpigmentation will return. It is typically performed in a dermatologist’s office or a medical spa. The downside of microneedling is the cost and frequency of treatment required to achieve results. Most treatment plan requires six to eight treatments and is usually priced from $100 to $700 per session.
Natural Topical Alternative
Fading hyperpigmentation in skin of color is extremely challenging due to the high risk of PIH and rebound. Aggressive treatment plans using hydroquinone, chemical peels, and lasers all can produce some results but are all temporary solutions. To manage the hyperpigmentation, any form of treatment must be continuous and unfortunately, these treatment options are either too harsh for the skin and too expensive for long-term use. A good alternative is to use an all-natural topical cream that reduces melanin production. A cult favorite of natural estheticians is LeCerre’s Rapid Brightening Serum. The serum was formulated specifically to address skin of color using five natural active ingredients that have been clinically shown to be effective tyrosinase inhibitors, thereby reducing your skin’s ability to make more melanin. The serum is light and non-toxic where those who are pregnant or nursing can use the serum, unlike hydroquinone. This serum is a great alternative as it is inexpensive and can be used continuously without negative side effects.
