What causes hyperpigmentation? Drugs, deficiencies, diet, and more

Defining hyperpigmentation

There are many different types of hyperpigmentation, and in some cases it can be difficult to tell which forms are permanent or could become worse. At its most basic level, hyperpigmentation refers to patches of skin that are darker than the surrounding skin color. These patches can be red, light or dark brown, grayish, raised, or flat. Forms of hyperpigmentation include:

• Freckles
• Age spots
• Liver spots
• Sunspots (solar lentigines)
• Melasma (AKA chloasma)
• Post-Inflammatory Hyperpigmentation (more on this below)
• Acanthosis Nigricans (a form of hyperpigmentation that causes discoloration in body folds and creases)

These hyperpigmented spots and patches of darker skin get their color due to an overproduction of skin pigment or melanin.

What isn't hyperpigmentation? Birthmarks, lesions, vitiligo (hypopigmentation), sunburns, and other discolorations that do not involve the excess production of melanin.

The causes of hyperpigmentation can be hard to spot

In some cases, it's clear what caused the hyperpigmentation. Other times, it can be difficult to get to the sole root or multiple roots of the problem. Common causes of hyperpigmentation include:

Sun exposure: Sun exposure is one of the most common and easily identifiable causes of hyperpigmentation. Sometimes, after excess sun exposure, dark spots can appear seemingly overnight. More often, decades of ultraviolet light exposure slowly start to form dark patches on the skin. Melanin acts as your skin’s natural sunscreen and protects you from harmful sun rays. This is why people tan in the sun! However, we now know that sun exposure is extremely damaging for the health and appearance of the skin.

• Hormone imbalances: Hormonal changes can trigger melanocytes, the melanin-producing cells in the skin, to go into overdrive. There are many things that can trigger hormone changes including:
• Addison's Disease: A rare endocrine disorder that affects the hormone-producing adrenal glands.
• Medications: Ingredients found in certain prescription drugs can cause the skin to produce excess melanin, especially when triggered by sun exposure. Drugs containing heavy metals such as iron and some tetracyclines, antipsychotics, anticonvulsants, antimalarials, and NSAIDs can all lead to various colors and shapes of hyperpigmentation. You can speak with a doctor or dermatologist about the medications you're currently taking to see if their side effects may include hyperpigmentation.
• Pregnancy: Pregnancy-induced hyperpigmentation, AKA melasma, is also very common and often causes a tan or brown "mask" to form across the cheekbones and nose. This type of hyperpigmentation is often temporary and fades postpartum.
• Inflammation or Injury: PIH or Post-Inflammatory Hyperpigmentation commonly affects those with darker skin tones. PIH is a form of skin discoloration that remains after a wound heals. It is essentially a form of scarring that can occur from injuries, sunburn, acne, chemical peels, dermabrasion, laser therapy, and even some more aggressive forms of hyperpigmentation treatment that puncture the epidermis or aggravate the skin. Skin conditions like eczema and dermatitis can also lead to PIH.
• Nutrient Deficiencies: Some studies have suggested that hyperpigmentation can occur as a result of iron deficiency and/or vitamin B12 deficiency.

Why is hyperpigmentation more common among people of color?

Though hyperpigmentation appears in all skin types, people with darker skin tones are more susceptible to hyperpigmentation and especially PIH. This is because they naturally have higher concentrations of melanin within their skin. Thus, when the melanocytes become damaged through sun exposure and/or trauma, there is more melanin that "leaks" and causes dark spots to form. Since women are more likely to experience hormone fluctuations due to pregnancy, it places women of color at an even higher risk of developing hyperpigmentation. This influences how people of color should protect their skin and the treatment options that are available.

Ways to Prevent Manage Hyperpigmentation

For the safest, most effective hyperpigmentation treatment plan, you should meet with a dermatologist or doctor. They will be able to run through a list of possible causes and identify what issues underlie your hyperpigmentation.

Recommended for EVERYONE: Sun protection

No matter what skin tone or level of hyperpigmentation you're struggling with, the best method to avoid further damage is multiple forms of skin protection. In addition to using a moisturizing sunscreen with an SPF of at least 30, protective clothing and forms of "portable shade" like umbrellas and large sun hats are helpful. Managing hyperpigmentation is one thing, but protecting against skin cancer is another. Don't skip this step!

Best for light hyperpigmentation (dark and fair skin tones): OTC Lightening Creams

For "new" or light hyperpigmentation, over-the-counter lightening creams are best. Many of the common ingredients found in OTC lightening products include:

• Hydroquinone
• Licorice extract
• N-acetylglucosamine
• Vitamin B-3 (niacinamide)

Best for light hyperpigmentation on dark skin tones: OTC tyrosine inhibitors

Tyrosine is an enzyme needed for melanin and pigment production. Over the counter tyrosinase inhibitors can include facial acids or retinoids. OTC tyrosine inhibitors include:

• Kojic acid
• Lactic acid
• Azelaic acid
• Glycolic acid
• Ascorbic acid (vitamin C)
• Retinol creams
• Liquorice root extract

Best non-invasive preventative method: Collagen

Collagen is used in wound healing. Consuming collagen can increase the body's natural collagen production to strengthen and heal the skin. It's safe to consume and can be used by people with any skin type. However, topical collagen creams cannot penetrate the skin barrier and should not be used to treat hyperpigmentation. For a holistic and effective skincare routine, try a powdered collagen supplement.

Best for severe or stubborn hyperpigmentation on darker skin tones: Low-intensity laser treatments

When done incorrectly, laser treatments can further damage the skin and cause more hyperpigmentation. When done gently by a dermatologist that is trained in treating skin of color, it may be a viable solution for stubborn hyperpigmentation. Speak with your dermatologist about laser treatment options and your concern about PIH before you begin.

Best for severe or stubborn hyperpigmentation on fair skin tones: Microdermabrasion

Microdermabrasion works by penetrating the skin with tiny needles and creating micro-injuries. This then stimulates collagen to rush to the skin and reveal new, healthy skin cells. The results of microdermabrasion may even be improved or prolonged by taking a collagen supplement.

Ultimately, finding the best hyperpigmentation treatment and prevention plan can only be discovered by you and a licensed dermatologist. If you're just starting to explore your options, following strict sun protection and adding a collagen supplement, and potentially vitamin B12 or iron supplement, to your diet may be the best place to start!

Article References:

1. https://www.healthline.com/health/beauty-skin-care/hyperpigmentation-treatment#options-for-each-skin-tone
2. https://www.verywellhealth.com/post-inflammatory-hyperpigmentation-15606
3. https://www.webmd.com/skin-problems-and-treatments/hyperpigmentation-hypopigmentation