We all dream of having even, flawless skin but this is not always possible due to blotchy spots (aka hyperpigmentation) that occasionally seem to appear out of nowhere.
Hyperpigmentation is annoying and unfortunately can take at least 2 months to see results even with the correct hyperpigmentation treatment.
What causes hyperpigmentation?
Hyperpigmentation occurs due to an overproduction of melanin (the pigment that gives our skin colour) in certain areas on our face (it can also occur on the body, although this is rare). Excessive sun exposure, acne and heat can cause inflammation to the skin, thus trigger our body to produce excess melanin. Post-inflammatory hyperpigmentation is extremely common in acne sufferers and is even more evident in those with tan to darker skin type.
Melasma is a type of hyperpigmentation and primarily affects the cheeks, forehead, chin and lips. This is mostly caused by changes to hormone levels and is commonly seen in pregnant women.
How to Treat Hyperpigmentation
Let's talk prevention first! The #1 product is a sunscreen with a minimum SPF30+. Sunscreen not only prevents future blotchy patches from occurring; it also acts as an anti-ageing and you're not undoing all the hard work you have put in the treat the pigmentation.
Hyperpigmentation treatment can range from hyperpigmentation creams, serums, chemical peels and laser therapy. Some standout ingredients that have good clinical evidence for their skin lightening effects include Retinoids, Hydroquinone, Kojic Acid, Alpha Hydroxy Acids, Niacinamide, Licorice Root Extract, Soy (Pea Extract) and Vitamin C.
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 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 hyperpigmentation, 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 post-inflammatory hyperpigmentation.
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.
Niacinamide has shown to be effective in the treatment of hyperpigmentation by reducing the transfer of melanin to the upper skin layers. When compared to Hydroquinone in a double-blind study, post-treatment biopsy showed Niacinamide 4% was as effective as Hydroquinone 4%, although results were seen at 8 weeks and 4 weeks respectively.
However, Niacinamide was better tolerated and produced milder adverse effects compared to Hydroquinone.
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.
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.
Kojic Acid blocks the production of Tyrosine which then prevents melanin from forming. Skinceuticals makes a great product with Kojic Acid and Tranexamic Acid.
L-Ascorbic Acid (Vitamin C)
Inhibits the activity of Tyrosinase
Skinceuticals C, E and Ferulic Acid Serum
Glycolic Acid & Lactic Acid
Glycolic Acid and Lactic Acid (AHAs) work as an exfoliant to remove the top layers of dead skin cells. They do this by reducing cellular cohesion between corneocytes. Over the counter topical AHAs can be used to treat hyperpigmentation but can take a long time to work, therefore we would recommend using this as maintenance therapy if you have severe hyperpigmentation.
Higher concentrations of Glycolic Acid (40-60%) is commonly used by dermatologists and aestheticians as chemical peels for hyperpigmentation.
At higher concentrations, Glycolic Acid has also been shown to increase collagen production.
Author: Helen Huynh
Pharmacist and editor for ellé derm.
1. Sarka, R et al (2013) "Cosmeceuticals for Hyperpigmentation: What is available?." Journal of Cutaneous and Aesthetic Surgery. Jan-Mar; 6(1): 4–11. doi: 10.4103/0974-2077.110089
2. Navarette-Solis, J (2011) "A Double Blind, Randomised Clinical Trial of Niacinamide 4% vs Hydroquinone 4% in the Treatment of Melasma." Journal of Dermatology Research and Practice. doi: 10.1155/2011/379173