Hyperpigmentation : Causes, Types, Treatment and Symptoms

Hyperpigmentation is a common skin condition where excess melanin causes dark patches or spots on the skin. These spots, which can be brown, black, gray, red, or pink, do not cause pain or itching. Although it is mostly a cosmetic concern, you should consult a doctor if you experience symptoms like discomfort or swelling.

Most Common Hyperpigmentation Symptoms:

• Appearance of dark patches or spots on the skin.
• Color changes (brown, black, grey, red, or pink) may appear based on the underlying causes.
• Various sizes of patches appear on the sun-exposed areas.
• Changes in the skin texture, like skin thickening, leathery, or roughness.
• Varicose veins or webs of spider veins.
• Flat appearance
• Dark marks at the site of the original injury
• Hyperpigmentation in association with hormonal changes
• Result of chronic scratching

Common, Uncommon or Underlying Causes of Hyperpigmentation

Hyperpigmentation can be caused by a variety of factors, the majority of which are benign and related to environmental exposures or local skin changes; however, persistent or extensive darkening may indicate an underlying medical condition and should be evaluated by a healthcare provider.

Here are some reasons for Hyperpigmentation:

• Aging
• Eczema
• Sun exposure
• Certain medications
• Oral contraceptive use
• Pregnancy or hormonal therapies
• Neoplastic causes like melanoma
• Skin injuries, cuts, burns, or rashes
• Hemochromatosis: An iron overloading disorder causing skin darkening
• Acanthosis nigricans: Insulin resistance or obesity, causing dark velvety plaque
• Adisson’s disease: Focal dark patches all over the body due to hormonal changes
• Genetic pigmentary disorders: rare inherited syndromes, freckles, and cafe-au-lait spots
• Phytophotodermatitis: Plant compounds cause a chemical reaction alongwith sun exposure
• Primary biliary cholangitis is an autoimmune disease that is an internal medical condition

When to Seek a Specialist for Your Hyperpigmentation?

If you notice any concerning signs or symptoms with your hyperpigmentation, you should consult a specialist or dermatologist to ensure a fast diagnosis and appropriate treatment.

• When accompanied by pain, swelling, itching, bleeding, or ulceration could indicate inflammation or skin cancer.
• Skin posts that rapidly change in shape, size, or color, especially when they have thickened borders or black, darkened patches.
• Skin discolouration appearing or spreading rapidly without a clear cause
• Hyperpigmentation occurs with hormonal changes, loss of appetite, or fatigue.
• When the over-the-counter medication or previous treatments fail.

Don’t wait for signs to grow severe. Consult our Dermatologist today

Diagnostic Approach for Hyperpigmentation

A specialist-approved diagnostic strategy for hyperpigmentation employs several important procedures to precisely determine the kind, severity, and underlying cause of pigmentation changes, ensuring effective care and avoiding significant underlying disorders.

• Detailed history and overall skin examination.
• Visual assessment via type evaluation, distribution, color, and pattern recognition.
• Dermatoscopy: To distinguish between benign and malignant, or benign and atypical
• Wood’s lamp examination: Uses UV lights to identify the pigmentation in the epidermal or dermal layer
• Objective scoring system: Using Melasma Area and Severity Index (MASI) or Hyperpigmentation Area and Severity Index (HASI)
• Specialized instruments: Dermatologically trusted colorimetry and spectrophotometry measure melanin content and track changes.
• Digital image analysis to measure distribution

Types of Hyperpigmentation

There are eight types of hyperpigmentation, with occasional overlap and other unusual presentations (such as those caused by metabolic or genetic problems), each with distinct sites and triggers that guide diagnosis and treatment.

Some common types of Hyperpigmentation include:

• Age spots (solar lentigines)
• Melasma: Large dark patches on face, forehead, or stomach
• Post-inflammatory hyperpigmentation: Dark spots after an injury, rash, acne, and/ burns.
• Freckles (ephelides): Small tan-brown spots present mostly on the sun-exposed skin
• Maturational hyperpigmentation: Gradual darkening on the side of the face
• Periorbital hyperpigmentation: Dark circles around the eyes
• Acanthosis nigricans: Dark velvety plaques present anywhere on the armpits, groin, and skin folds.
• Lichenification: Thick leathery patches caused by rubbing or scratching
• Cafe-au-lait macules: Tan-brown patches seen anywhere on the trunk.

How to Treat Hyperpigmentation Symptoms?

Specialist-approved hyperpigmentation treatments target excess melanin with topical, procedural, and advanced options; while mild cases often respond to topical therapy and lifestyle changes, persistent or severe symptoms necessitate advanced procedures under specialist supervision for best results.

For underlying causes, treatments & rehabilitative strategies include:

• Topical therapies: Hydroquinone, kojic acid, vitamin C, glycolic acid, and retinoids.
• Combination creams for melasma or PiH.
• Chemical peels: Come in strong concentrations to exfoliate and remove the top layer of pigmented skin.
• Laser therapy: Various types, such as ruby lasers, pulsed lasers, erbium: YAG laser, target the pigment cells
• Microdermabrasion or dermabrasion: Manually exfoliates superficial skin layers
• Cryotherapy: Freezes localized pigmented lesions
• Certain medications
• Microneedling: Induces skin repair
• Platelet-rich plasma (PRP)
• Apply daily broad-spectrum sunscreen to avoid the recurrence of pigmentation
• Avoid triggering factors
• Consistent skin care routine: Gently cleansing and moisturizing improves outcomes and tolerance.

What if Hyperpigmentation is Left Untreated?

Although untreated hyperpigmentation rarely causes pain or serious health problems, its significant cosmetic and psychological impact needs early detection and adequate treatment to avoid progression and improve quality of life.

Some possible complications of an untreated Hyperpigmentation include:

• Worsens over time, becoming more pronounced and extensive due to continuous exposure to triggers like UV radiation or inflammation
• If the condition persists for several months due to a darker skin tone
• Psychological or emotional distress leading to reduced self-esteem, anxiety, and social discomfort
• May mask or delay the diagnosis of the underlying condition, such as hormonal imbalances or systemic changes.
• Prolonged ignorance or unsupervised treatment could lead to an uneven skin tone or worsening pigmentation.

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