How Skin Hyperpigmentation Occur and the Treatment Options.
Post inflammatory hyperpigmentation (PIH) disorders of the skin can result from an overproduction or accumulation of melanin. In this article, we thought it would be interesting to touch base on how skin pigmentation occurs to gain a better understanding of hyperpigmentation treatment.
How Post Inflammatory Hyperpigmentation Occur
PIH can arise in any skin type, however, the frequency and severity of PIH tend to occur more commonly in patients with darker skin colour.
PIH can arise due to
- Injury or inflammation to the skin such as acne, resulting in overproduction of melanin or an irregular dispersion of pigment,
- Excess UV exposure such as sun tanning. This causes the melanocytes to fire more frequently than normal; and therefore produce more melanin, ultimately giving rise to a darker skin tone (Figure 1), and
- Certain medications such as birth control pills.
For the synthesis of melanin to be successful, this requires several things:
- The enzyme Tyrosinase to convert dihyroxyphenylalanine (DOPA) to melanin,
- Inflammatory mediators and reactive oxygen species which are released during inflammation,
- Production of melanocytes (melanin-producing cells) and the gene which controls the expression of melanosomes (the powerhouse within melanocytes where melanin is being produced).
A simple analogy to explain what a melanocyte is - melanocytes are all the rooms in the house. Within these rooms is where melanosomes reside to make the melanin. As such, depigmenting agents can target one or more steps listed above to treat post inflammatory hyperpigmentation.
The mainstay treatment for PIH can be any of the products below in addition to photoprotection such as a sunscreen.
Treatment Options for PIH
The mainstay treatment for PIH remains Hydroquinone. Hydroquinone inhibits Tyrosinase activity and also inhibit the production of melanocytes.
Hydroquinone monotherapy can be effective in treating PIH, but more recently HQ has been formulated with other agents, such as retinoids, antioxidants, glycolic acid, sunscreens, and corticosteroids, to increase efficacy.
Hydroquinone is an effective skin lightening ingredient but they have been known to cause ochronosis in those with darker skin during long term use and at higher concentrations. For this reason, we do recommend specialist advice if you are considering long term use.
A good option containing containing Hydroquinone is John Plunkett Superfade.
Retinoids exert multiple biological effects that result in skin lightening including the modulation of cell proliferation, differentiation, and cohesiveness; induction of apoptosis; and expression of anti-inflammatory properties.
It is effective in treating PIH, however, up to 50% of patients have reported retinoid dermatitis.
Third-generation retinoids, adapalene and tazarotene, are synthetic topical agents that are also effective in the treatment of PIH.
Isotretinoin is a naturally occurring, first-generation retinoid that is available in both oral and topical formulations.
Retinoids are not recommended during pregnancy and a prescription is required.
Actiwhite™ PW LS 9860
Formulated as a synergistic blend of pea extract and sucrose dilaurate. It is a gentle and effective alternative for patients who have reactions Hydroquinone.
- Inhibits the expression of gene PMEL-17 which is responsible for the maturation of melanosomes
- Deactivates tyrosinase activity
A good option containing Actiwhite is Luminous Silk Brightening Serum by ellé derm.
Arbutin inhibits the activity of Tyrosinase to suppress melanogenesis (Fig 2). It acts specifically by regulating the conversion of L-tyrosine into L-dopa, and subsequent conversion of L-dopa to L-dopaquinone.
Blocks the production of Tyrosine which then prevents melanin from forming. Skinceuticals makes a great product with Kojic Acid and Tranexamic Acid.
Inhibits the activity of Tyrosinase
Skinceuticals C, E and Ferulic Acid Serum
Glycolic Acid & Lactic Acid
Glycolic Acid and Lactic Acid work as an exfoliant to remove the top layers of dead skin cells. They do this by reducing cellular cohesion between corneocytes. They can be used to treat pigmentation but can take a long time to work. We would recommend using this as a maintenance therapy.
At a higher concentration, Glycolic Acid and Lactic Acid have been shown to produce increased amounts of mucopolysaccharides and collagen and increased skin thickness.
Helen is also contactable via: https://www.linkedin.com/in/ellederm/