Picture the scene: you’re washing your face one morning when suddenly you notice a new dark mark on your face. Perhaps it’s where you had a spot pop up recently…maybe you spent a long day in the sun at the weekend or perhaps its been hiding in the depths of your skin for years, waiting to reappear. There are lots of factors to consider before you even think about treating dark spots – also known as ‘hyperpigmentation’.
What is hyperpigmentation?
Along with adult acne and rosacea, hyperpigmentation is a common skin complaint among both men and women in the UK and one that we treat every day at Kate Kerr London.
Hyperpigmentation occurs when a patch of skin produces excess melanin or distributes melanin unevenly. Melanin is a pigment that gives skin its colour and is produced by skin cells called melanocytes. These melanocytes have lots of little fingers that deposit pigment into the surrounding cells to provide a little sun umbrella that protects the skin cells from inflammation, whether that be from trauma or UV exposure. These melanocytes are found in the basal layer (the innermost layer of the epidermis). When they behave erratically due to genetics or because they have become damaged, melanin production is accelerated. This excess melanin is then distributed unevenly into the surrounding cells, which shows up as uneven skin tone and blotchiness, or hyperpigmentation, as those cells reach the skin’s surface.
In order to successfully treat hyperpigmentation, first we must understand the root cause and the depth of the pigment. We need to not only block the activation of the over-excitable melanocytes, but also ensure that if they are activated, the melanin is distributed evenly around all of the surrounding cells, ensuring a beautiful even colour on the skin’s surface. We also need to try to purge the existing pigment.
Types of hyperpigmentation
All hyperpigmentation isn’t treated equally; several conditions or factors can alter the production of melanin in your body. Below, find out more about the different types of hyperpigmentation and how they can be treated.
Melasma
Melasma causes patches that are brown or grey in color and are often quite large in appearance. Unlike other forms of hyperpigmentation, which appear as random spots or freckles, melasma often (but not always) appears in symmetrical patterns, most commonly down the centre of the face, on the forehead, cheeks, upper lip, nose and chin. It can also appear on other body parts such as the neck and arms. It occurs deep within the skin and the melanocytes can even deposit pigment down into the dermis, making it much more challenging to treat.
What causes it?
Despite being one of the most common forms of hyperpigmentation, the exact cause of melasma is currently unknown. It is thought to be caused by melanocytes (those pigment-producing cells) that have become sensitised or abnormal. Hormonal changes could have a big role to play as it can often develop during pregnancy, as a result of hormonal therapies or when taking hormonal contraceptives. Burn injuries, IPL (that’s intense pulsed light) and excess sun exposure can also trigger melasma.
How to treat it
Melasma is highly sensitive to sunlight, so can often reoccur after treatment, even with diligent sun protection. There isn’t necessarily a ‘forever fix’ when it comes to treating the condition, but it can be managed if you’re extremely strict when it comes to your skincare regime and are diligent when it comes to sun protection; in fact, keeping the skin tone even can be a long-term commitment. Whilst we can’t change your genetics and the way in which your melanocytes are programmed, we can help to control them by helping to control their activation and ensure they are functioning well when activated.
When it comes to treating melasma, we recommend a comprehensive skincare regime made up of powerful antioxidants, tyrosinase-inhibiting ingredients (tyrosinase is an enzyme within the melanocytes that catalyses the production of melanin), retinol and SPF. An antioxidant serum use in the morning helps to protect the skin from sun damage, while a retinol stabilises the melanocytes and prevents them from behaving erratically as a result of distributing pigment unevenly.
Often, we need to refer our clients to a dermatologist to treat melasma, particularly if the melasma is within the skin’s dermis (the deeper layer of the skin) or if we aren’t able to purge all of the existing pigment. This type of hyperpigmentation usually requires treatment with prescription creams such as hydroquinone and tretinoin. When referring our clients to a dermatologist for this kind of treatment, we continue to offer support through the process alongside regular facials. On occasion, it is appropriate to also offer gentle peels. We are very careful not to cause trauma with advanced treatments until the skin is stabilised in order to prevent further pigmentation.
When it comes to effectively managing your symptoms, sun protection is key. Exposing your skin to the sun for even five minutes can cause melasma to reoccur and undo all of your hard work. You’ll need to wear a high factor SPF every day, even if you’re staying indoors and re-apply every two hours when out in the sun. If you’re outside in the sun, be sure to wear a wide-brimmed hat and sunglasses and try to seek shade or avoid the sun during the time of day when it’s strongest (typically between 10am and 4pm).
Sunspots
Sun spots, also called liver spots or solar lentigos, are flat brown spots that sit on the surface of the skin and develop on areas exposed to the sun, such as the face, neck, chest, arms and the back of the hands. They can often look like large freckles and are more likely to appear after the age of 40, though some people develop them earlier. As well as the appearance of localised dark spots, you might also notice that they create a subtle change in the texture of the skin. It’s a good idea to get any changes to your skin checked with a doctor or dermatologist to rule out melanoma.
What causes it?
As the name suggests, sunspots are often caused by exposure to the sun, but can also develop over time, as we age. UV rays stimulate the melanocytes to increase melanin production – the more time we spend exposed to UV light, the more melanin will be released. Essentially, your skin remembers every hour of sun exposure you’ve ever had and the effects are cumulative. This often shows up as hyperpigmentation and premature ageing in our adult yers.
How to treat it
Unfortunately, the sun damage itself is irreparable, but we can minimise and protect the skin from further deterioration through a targeted skincare regime made of serums containing transexamic acid, niacinamide, retinol and bakuchiol – these help to lighten the pigmentation – alongside Vitamin C and SPF. At Kate Kerr London, we often refer our clients for cryotherapy treatments or medical lasers that are specifically designed to treat solar lentigos. Meanwhile, we can improve the skin texture, diffuse the pigmentation around the lesions and prevent further sunspots with regular bespoke facials and an anti-pigmentation focused skincare regimen. For some clients, IPL and Nano Fractional Radio Frequency can be helpful.
As with melasma, sun protection is key in order to prevent further hyperpigmentation. Be vigilant with your sunscreen application, using a broad spectrum, high factor SPF every day – even if you’re staying indoors – and re-apply every two hours. Follow the usual sun safety advice when you head outside: think wide-brimmed hat, sunglasses and seek shade as much as possible between 10am-4pm.
Post-inflammatory hyperpigmentation
Post-inflammatory hyperpigmentation (PIH) is very common, and is often the result of acne, trauma, eczema or a rash. When that inflammation goes away, the skin develops more melanin. Marks can then pop up anywhere on your skin a few days after the injury, and are typically small, localised and a darker brown compared to your normal skin colour.
What causes it?
A result of injury or inflammation to the skin, a common cause of post-inflammatory hyperpigmentation is acne. Red, angry spots stimulate the melanocytes to produce more melanin, which creates these red or brown stained areas on the skin. A larger blemish results in more melanin being released, while picking at blemishes increases inflammation and therefore pigmentation. These red-pinkish marks are known as post-inflammatory erythema (PIE); a type of skin reaction caused by injured or inflamed blood capillaries.
How to treat it
In order to successfully treat the hyperpigmentation, we have to treat the cause first. Our approach is to encourage pigmentation to fade over time with a brightening skincare regime designed to renew the skin, stabilise the melanocytes and purge existing pigmentation. We also recommend a Brightening or Restoration & Rejuvenation facial once per skin cycle (every 4-6 weeks), combined with a course of Advanced Skin Peels to lighten dark spots and even out skin tone, soften and smooth out the skin’s texture and to improve the appearance of hyperpigmentation and dullness. Any pigmentation will become darker or worse with sun exposure, so as always, sun protection is just as important as correction. Be sure to use a broad-spectrum, high factor SPF every day – even if you’re staying indoors – and re-apply every two hours. The usual sun protection rules apply, and as someone with hyperpigmentation, it’s a good idea to be extra vigilant. Wear a wide-brimmed hat, sunglasses and try to seek shade when the sun is at its strongest between 10am-4pm.
What about darker skin tones?
One common misconception is that, because darker skin tones are better protected from the sun due to higher levels of melanin in the skin, sun protection isn’t required. On the contrary, more melanin means the skin is more prone to post-inflammatory pigmentation and hormonal pigmentation and textural changes. Sun exposure makes existing post-inflammatory pigmentation and melasma worse, and can also create hyperpigmentation that didn’t already exist (known as non-specific hyperpigmentation), so using SPF daily and avoiding direct sun post-skin treatments is essential. With darker skin tones, sun damage will often manifest in different ways, such as with enlarged pores or the skin becoming oilier.
Many women of colour typically notice body hyperpigmentation on their inner thighs, bottom, armpits and neck – high-friction areas that are often subject to inflammation from rubbing and chafing. The underarms are also prone to pigmentation due to hair removal methods like shaving.
How to prevent hyperpigmentation
Aside from wearing SPF, the biggest thing you can do to protect your skin from hyperpigmentation of all kinds is to use an antioxidant serum in the day, and a retinol in the evening, along with a tyrosinase-inhibiting serum applied morning and night. The retinol helps to stabilise the melanocytes, while the antioxidant and tyrosinase-inhibiting serums prevent the melanocytes from being activated, whilst ensuring that any pigment is deposited evenly if they are.
Wearing a high factor SPF, which provides UVA, UVB and visible light protection every day is also key. With all pigmentation treatment it is incredibly important to be vigilant with application. Months of investment in skincare and treatments can be undone by a small amount of unprotected time in the sun.
You need to apply your SPF every day, even if it’s cloudy outside and even if you’re staying inside! Don’t think of it as “sunscreen” – it’s a radiation screen, designed to protect you from all forms of light, from UV rays to High Energy Visible (HEV) light. HEV is the light that’s emitted from our laptop and mobile screens – it causes just as much damage to the skin, including pigmentation. And you aren’t safe from UV rays indoors either – if there is daylight in your home, then UVA is bouncing around.
It’s a good idea to get into the habit of performing your skincare regime first thing in the morning and applying your SPF – then remove it at the end of the day once you’re finished spending time on any devices. If you’re heading outdoors and it’s sunny, wear a wide-brimmed hat, sunglasses and clothing that helps to block the sunlight. It’s also a good idea to seek shade or avoid the sun between 10am and 4pm. Remember, you also need to re-apply that SPF every two hours when you’re outside.
If you suffer with post-inflammatory pigmentation as a result of acne, don’t pick at the blemishes as this increases inflammation and hyperpigmentation. Avoid spritzing your perfume or aftershave directly onto the skin as this can actually cause pigmentation on the sides of the neck.
Finally, never have an advanced treatment that can cause trauma without stabilising and restoring the skin’s health first to prevent post-inflammatory pigmentation. We never recommend Advanced Aesthetic Treatments to treat hyperpigmentation unless we have clients on a skincare regime that is focusing on prevention and control. Lasers, lights and peels will remove the pigmentation, but they won’t treat its cause, so it will keep coming back. A targeted skincare regime will not only improve your hyperpigmentation concerns, but will also give you optimum skin health overall.
Effectively treating your hyperpigmentation requires commitment and compliance, but at Kate Kerr London, we see very positive results. A study has shown that pigmented skin is often deemed to appear ‘older’ than skin with lines and wrinkles, because our eyes are drawn to the contrast in colour. Evening out skin tone is one of the most rewarding results we see when treating our clients’ skin – the glow that we can achieve for them is phenomenal and they are often blown away by their before and after photos.
Seek out personalised advice
Above all, always seek out personalised advice when you can. Many of the skincare ingredients used to treat hyperpigmentation, when used at the effective concentration, have the potential to irritate the skin, so professional supervision and support is paramount.
Treating hyperpigmentation is a complicated process – it’s important to get advice via a consultation on what type of pigmentation issues you have. If you try to self-diagnose, you can often cause further problems for your skin. If you would like support with treating your skin, book a consultation and we’ll create a tailored plan.
