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Hyperpigmentation

  • rolandabell
  • Sep 22, 2024
  • 6 min read

Updated: Jun 23


Hyperpigmentation

Pigmentary disorders are among the top 5 dermatologic diagnoses in people of color with many of these conditions manifesting as hypo- or hyperpigmented patches of skin. Hyperpigmentation occurs when an event such as inflammation or injury triggers the skin to produce excess melanin. The discoloration of the skin varies based on skin tone, appearing as either purple, gray, pink, brown, tan, or black. Hyperpigmentation can result from a variety of conditions including skin inflammation, sun exposure, melasma, or medical conditions such as Lupus or diabetes (Dlova, Akintilo, & Taylor, 2019; Cleveland Clinic, 2021; Fisher, 2024).



Post Inflammatory Hyperpigmentation

           

Acne: This condition is due to an overproduction of sebum, bacterial infection, or when pores become clogged with oil and dead skin cells. Subsequently, the skin glands become inflamed resulting in either whiteheads, blackheads, or pimples. Hyperpigmentation occurs when dark spots appear after an acne outbreak. These dark spots may go away on their own or with the use of prescribed and over-the-counter treatments; however, this process may take longer in people with darker skin tones.


In a study conducted by Al-QuarQaz et al (2021), they reported several factors that may exacerbate acne related hyperpigmentation including injury/trauma to the skin, irritation, and dryness. Popping pimples injures the skin tissue which causes inflammation that leads to hyperpigmentation. In addition, medications can be irritating (e.g. incorrect amount of salicylic acid) or drying (e.g. benzoyl peroxide) also causing inflammation that may lead to hyperpigmentation. Moreover, the acne healing process also can result in irritation and dryness. When the acne begins to heal, the surrounding skin dries out. As the body begins to shed this dry skin, it may cause itchiness. Therefore, in addition to cleansers, also include noncomedogenic moisturizers as part of your skin care regimen to maintain skin health without clogging the pores (American Academy of Dermatology Association, 2022; Cleveland Clinic, 2023; Snyder, 2018; WebMD, 2019).

 

Eczema: Like acne, eczema is an inflammatory process that may stimulate the production of melanin. Symptoms of this condition include itchiness, excessively dry skin, rashes, or small, rough bumps. The inflammation and constant scratching of eczema patches not only results in skin discoloration, but also in changes to the texture of the skin. The skin becomes thicker and can be itchy even when the individual is not experiencing a flare up (American Academy of Dermatology Association, 2023).

 

Waxing and Shaving: The irritation and inflammation associated with hair removal can cause post inflammatory hyperpigmentation. When one shaves or waxes, this can irritate the hair follicle. This irritation can trigger an increase in melanin production which results in dark spots on the affected area. Shaving techniques that cause skin irritation or injury include dry shaving, using a dull or old razor, and shaving against the direction of the hair growth.


Factors that may lead to hyperpigmentation in waxed skin include inadequate skincare, ingredients in the wax, as well as, the temperature of the wax. Prior to waxing, discontinue use of products that contain retinol a week before the procedure. Retinol makes the skin more sensitive and using this ingredient prior to waxing can cause the removal of both hair and skin which may result in scarring. Recently waxed skin should not be exposed to sunlight as the the skin is most sensitive to UV rays after this procedure. Avoid using products that contain ingredients that irritate the skin. Prior to performing the waxing, do a patch test to ensure that the skin does not react adversely to the chosen product. After waxing, sooth your skin. Apply cold packs if you are experiencing pain, avoid taking hot baths or showers, and wear loose clothing right after waxing to avoid the irritation that may occur from the skin rubbing against the fabric. Check the temperature before application to ensure that the wax is not hot enough to burn the skin (American Academy of Dermatology Association, 2024; Cleveland Clinic, 2023).

 

Melasma

 

Melasma is a pigmentary disorder that appears as brown/gray patches or freckles on the cheeks, forehead, nose, and lips. Melasma is prevalent in women of Latin, African, Asian, and Middle Eastern descent (Skin of Color Society, 2024). The onset of this condition typically occurs during a woman’s reproductive years and is especially common among pregnant women. The most prominent factor contributing to the manifestation of melasma is hormonal imbalance, particularly of the hormones estrogen and progesterone. Conditions that may create a hormonal imbalance include thyroid disorders, birth control, pregnancy, antiseizure medications, and medications to adjust hormone levels during menopause. Increased hormone levels signal the body to produce more melanin which results in the dark patches or freckle like spots characteristic of melasma (Cleveland Clinic, 2020).




Medical conditions

           

Lupus: Lupus are a class of conditions that cause inflammation throughout the body. This chronic autoimmune disorder occurs when the body’s immune system attacks its own tissues and organs. Some forms of lupus impact the skin only (e.g. discoid lupus erythematosus) and some forms affect joints and multiple organs (e.g. systemic lupus erythematosus (SLE)). When lupus affects the skin, it is referred to as cutaneous lupus. Lupus can appear as a widespread rash on the back, a butterfly rash across the face, or hyperpigmented skin on other parts of the body that look like a sunburn. Lupus related hyperpigmentation can be the result of photosensitivity, of the antimalarial drugs used to treat the disease, or from the healing of skin lesions (Johns Hopkins, 2024; AAD, 2022).

           

 Diabetes: Ancanthosis Nigricans (AN) can be a cutaneous warning sign of diabetes. This condition causes dark, velvet-looking bands of hyperpigmented skin. AN is caused by high insulin levels. When the body cannot use insulin properly, it builds up in the blood stream. Excess insulin stimulates skin cells to reproduce too quickly, causing them to produce more melanin which darkens the skin. The excess insulin causes the body to build up a tolerance to it, making the hormone less effective in regulating sugar levels. Insulin resistance is a risk factor for type 2 Diabetes (American Academy of Dermatology Association, 2024; American Diabetes Association, 2024; Cleveland Clinic, 2021).  

 

  

Summary

Hyperpigmentation can be caused by a variety of factors including inflammation or hormonal imbalance. These processes stimulate the over-production of melanin. Inflammatory processes include lupus, eczema and acne. The hyperpigmentation can worsen with scratching and injury to the skin (e.g. pimple popping). Shaving and waxing can cause irritation by the friction that comes from the skin rubbing against fabric or a razor, using ingredients that induce adverse reactions, or inadequate skin care. Hormonal imbalances also contribute to hyperpigmentation. Conditions that elevate estrogen, progesterone, or insulin can cause dark spots. If you are experiencing hyperpigmentation, visit a medical professional to determine the cause, especially if you have tried several over-the-counter treatments and they have not resolved the discoloration.



References

Al-Qarqaz, F., Bodoor, K., Baba, A., Al-Yousef, A., Muhaidat, J., & Alshiyab, D. (2021). Post-acne hyperpigmentation: Evaluation of risk factors and the use of artificial neural network as a predictive classifier. Dermatology reports, 13(3), 8223. https://doi.org/10.4081/dr.2021.8223



American Academy of Dermatology Association (2024). Acanthosis nigricans: Overview. https://www.aad.org/public/diseases/a-z/acanthosis-nigricans-overview


American Academy of Dermatology Association (2023 October 10). Eczema types: Atopic dermatitis overview. https://www.aad.org/public/diseases/eczema/types/atopic-dermatitis


American Academy of Dermatology Association (2022 September 23). Lupus and Your Skin: Diagnosis and Treatment. https://www.aad.org/public/diseases/a-z/lupus-treatment



American Diabetes Association (2024). Understanding Insulin Resistance. https://diabetes.org/health-wellness/insulin-resistance


Cleveland Clinic (2021, October 7). Hyperpigmentation. https://my.clevelandclinic.org/health/diseases/21885-hyperpigmentation


Cleveland Clinic (2023, February 17). Tips for a Smooth Shave Every Time. https://health.clevelandclinic.org/want-a-smooth-safe-shave-every-time-try-these-10-tips


Cleveland Clinic (2023, January 4). Acne. https://my.clevelandclinic.org/health/diseases/12233-acne


Cleveland Clinic (2020, July 27). Melasma. https://my.clevelandclinic.org/health/diseases/21454-melasma


Cleveland Clinic (2021 August 21). Diabetes Rash & Other Skin Conditions. https://my.clevelandclinic.org/health/articles/12176-diabetes-skin-conditions

 

Dlova, N. C., Akintilo, L. O., & Taylor, S. C. (2019). Prevalence of pigmentary disorders: A cross-sectional study in public hospitals in Durban, South Africa. International journal of women's dermatology, 5(5), 345–348. https://doi.org/10.1016/j.ijwd.2019.07.002


Fisher, J. (2024, March 11). Demystifying hyperpigmentation: Causes, types, and effective treatments. https://www.health.harvard.edu/diseases-and-conditions/demystifying-hyperpigmentation-causes-types-and-effective-treatments




Snyder, A (2018, September 26). Managing Itchy Acne. https://www.healthline.com/health/itchy-acne


WebMD (2019, January 17). Don't Make These Acne Treatment Mistakes. https://www.webmd.com/skin-problems-and-treatments/acne/features/acne-treatment-mistakes


 
 
 

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