What is melanin?

Melanin (pigment) is the substance that gives the skin color. It is made in special skin cells. The amount of melanin in your skin determines your skin tone. Melanin absorbs the harmful Ultraviolet rays from the sun to protect the skin and causes an overproduction of melanin. Pigmentation spots are caused by an overproduction of melanin. Most pigmentation disorders create patches or dark spots.

What is hyperpigmentation?

Hyperpigmentation is patchy discoloration or marks made by deposits of excess melanin, that results from sun damage, acne, a pimple, a rash, trauma, scrapes and some medications. When hyperpigmentation develops after a skin injury or inflammation like acne, trauma and pimples, it is called post-inflammatory hyperpigmentation. Extensive and uneven skin tone is often caused by medication. Sun exposure will worsen existing hyperpigmentation. Hyperpigmentation is typically harmless but can affect your appearance and confidence. Hypopigmentation is the formation of white spots on skin exposed to the sun, usually the back, arms and chest. They are caused by low levels of melanin.

• Melasma is a skin disorder that creates irregular dark patches on the skin, usually on the face. It is triggered by hormonal changes from pregnancy, contraceptives and hormone replacement therapy; and darkens with sun exposure. Melasma may occur on the face called the “mask of pregnancy” and darkened skin on the abdomen and other areas.
• Sunspots and age spots (also called lentiges or liver spots) are flat brown spots caused by exposure to the ultraviolet light from the sun. UV light causes the melanin producing cells to multiply. Sunspots are the result of a buildup of melanin. As we age, and repeatedly sun exposure sunspots appear, usually after age of 50. However, people who spend a lot of time in the sun and those with a history of sun burns and tanning beds increase the risk of developing sunspots.  Sunspots are harmless, but when sunspots get larger, or change color, it is time to see your dermatologist.
• Seborrheic keratoses are round, raised and dark spots that look like they are stuck on the skin. They tend to run in families. They are not cancerous and commonly affect older people.

What are the treatments for hyperpigmentation?

• Skin lightening creams contain Hydroquinone that bleach and fade dark spots. They work by reducing the production of melanin. There are over- the- counter skin bleaching agents, but prescription bleaches contain twice as much active ingredient.
• Retinoids are a class of topical medications that come from Vitamin A and are prescribed to treat mild to moderate acne. They also work to unclog blocked pores and kill the bacteria that cause acne. Retinoids are also used to treat and prevent photo-aging, and pigmentation disorders including post-inflammatory hyperpigmentation, melasma, and age and sunspots. Low dose retinols can be found over- the- counter. Prescription doses available include retinol, tretinoin, adapalene, and tazarotene.
• Chemical peels are used for skin resurfacing which removes the top layers of dead skin cells to reduce the appearance of dark spots. The skin grows back blemish free. They are used to treat hyperpigmentation, as well as scars and wrinkles. Light chemical peels treat superficial pigmentation problems to improve skin tone and texture. Medium chemical peels remove the top layer of skin and go into the dermis to treat uneven skin tone, scars and wrinkles. Because a chemical peel can burn the skin, it is important to seek professional treatment.
• Laser skin resurfacing use laser light energy to diminish hyperpigmentation. The laser energy breaks up melanin deposits under the skin. Fractional laser resurfacing works by creating a controlled injury. As the injury heals, the hyperpigmentation is removed, and the new skin is blemish free. Newer lasers work faster to remove hyperpigmentation and can also remove scars and birthmarks.
• Ruby laser uses laser energy to specifically target melanin and is an effective treatment for sun spots in certain skin types.
• Microdermabrasion is exfoliation of hyperpigmented skin with the use of tiny sand particles. It is best for mild hyperpigmentation.
• Microneedling is the use a medical grade dermal roller that creates tiny injuries to stimulate collagen production and is often combined with topical treatments that are infused into the skin to treat hyperpigmentation.

Depending on your particular concerns and goals, a course of treatment may be required to eliminate hyperpigmentation. Dr. Ritu Saini is a board-certified, fellowship-trained dermatologist in New York who specializes in Mohs micrographic surgery, cosmetic dermatology, and laser surgery. Contact Dr. Saini to schedule a consultation and learn about all your options to treat your pigmentation problems.