Hyperpigmentation

Melanin is the pigment that give the skin its color. It is produced by cells called melanocytes. In response to certain triggers, these cells can become overactive and create more pigment than usual. This results in spots, patches, or widespread discoloration that may vary in shade from light brown to deep gray or black.

There are several forms of hyperpigmentation, including:

• Post-inflammatory hyperpigmentation (PIH): This develops after the skin has been injured or inflamed. Common causes include acne, eczema, psoriasis, or physical trauma such as cuts or burns.
• Melasma: A chronic condition that presents as larger, blotchy patches, typically on the cheeks, forehead, nose, and upper lip. It is more common in women and is often linked to hormonal changes, such as those occurring during pregnancy or from the use of oral contraceptives.
• Sunspots (also known as solar lentigines or liver spots): These are flat, round, and typically small areas of increased pigmentation caused by prolonged sun exposure. They are more common in older adults but can affect people of any age who spend a lot of time in the sun.
• Freckles: These small, flat, brown marks are genetically determined and can become darker with sun exposure. While generally harmless, they are another example of how melanin overproduction can manifest.

Hyperpigmentation can result from a variety of internal and external triggers. The most common causes include:

• Sun exposure: Ultraviolet (UV) rays from the sun stimulate melanin production. Over time, this can result in cumulative pigmentation changes, particularly on sun-exposed areas like the face, arms, and hands.
• Hormonal changes: Hormonal fluctuations, particularly those involving estrogen and progesterone, can stimulate melanin production. This is a major contributing factor in melasma, which often arises during pregnancy (referred to as the “mask of pregnancy”) or from hormonal contraceptives.
• Inflammation or injury to the skin: Inflammatory skin conditions like acne, eczema, or psoriasis, as well as trauma such as burns, cuts, or cosmetic procedures, can trigger a localized overproduction of melanin.
• Medications: Certain medications, including chemotherapy drugs, anti-malarial medications, and some antibiotics, may cause hyperpigmentation as a side effect.
• Underlying medical conditions: Rarely, hyperpigmentation may be associated with systemic diseases.

Diagnosis of hyperpigmentation involves a comprehensive skin examination, medical history, and evaluation of potential triggers. During a consultation, Dr. Neely Khan begins by assessing the distribution, pattern, and depth of the discoloration. She may ask questions about the sun exposure habits, skincare routine, past skin injuries or conditions, medications, and hormonal history.

In some cases, a specialized light known as a Wood’s lamp may be used to determine how deep the pigment resides in the skin. This helps guide treatment decisions. In rare or uncertain cases, a skin biopsy may be performed to rule out other conditions or confirm the diagnosis.