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Skin color is determined by the amount of melanin pigment in the skin, which is produced by melanocyte cells. Therefore, the more the melanin content in the skin, the deeper the color.
The skin generally has an even skin tone, but at times, some areas of the skin may appear darker due to various reasons, including increased melanin production or increased number of melanocytes. (1) This condition of darkly colored patches in the skin is known as hyperpigmentation. It is commonly called age spots, sunspots, or melasma.
You may develop hyperpigmentation due to different factors such as UV exposure, (2) hormonal imbalance, (1) smoking, tobacco consumption, (3) allergies, injury, certain cancer treatments, increased iron concentration, and even excessive alcohol consumption. (4)
Clinical Procedures for Hyperpigmentation
Several dermatological procedures can help fade hyperpigmentation marks on the skin.
Consult your dermatologist on the proper treatment method for you. The doctor may examine your skin and ask about your medical history to determine the cause of your hyperpigmentation.
Your dermatologist may then suggest any of the following treatments based on your condition and skin type.
1. Laser treatment
Laser treatment may be expensive, but they are the most effective in treating hyperpigmentation. The lasers work by photodamaging the melanocyte cells and consequently destroying them. This helps in reducing melanin content in the skin and thus in improving hyperpigmentation.
Different lasers can be used, such as Q-switched Nd:YAG laser, PDL laser, carbon dioxide laser, and Q-switched ruby laser, to treat the hyperpigmentation with minimum scarring. (5)
Alternatively, intense pulsed light (IPL) may be used. However, this laser is less focused and, therefore, can affect the surrounding skin.
Consult your dermatologist on a focused laser treatment to prevent burns and inflammatory response.
2. Chemical peeling
Chemical peeling refers to exfoliation of the skin using mild acids. This treatment works by removing the surface layer of the skin, where melanin is present, therefore fading dark spots.
Moreover, the procedure exposes new skin layers, stimulating the production of new skin cells and boosting collagen synthesis. The commonly used acids for chemical peels include lactic acid, glycolic acid, mandelic acid, salicylic acid, and acetic acid.
A recent addition to chemical peeling treatments is the use of yellow peel. It is a combination of phytic acid, azelaic acid, retinoic acid, and kojic acid that produces antipigmentation effects.
This solution helps improve hyperpigmentation by influencing the sensors and receptors at cellular levels. It also helps boost microcirculation to the area, thereby increasing oxygen and nutrient supply.
Moreover, the contents of yellow peel stimulate skin proliferation, control sebum production, and exhibit antioxidant and antibacterial effects.
Over-the-counter (OTC) chemical peels are also available for use. However, they are best used for mild exfoliation and may not be effective in the treatment of hyperpigmentation. (6)
3. Dermabrasion and microdermabrasion
Dermabrasion is another exfoliation treatment and refers to mild sanding of the skin surface using a rotating brush. This procedure may be repeated a few times for effective results.
However, it can cause redness, scabbing, and swelling in the skin. In some cases, the skin may take several months to heal completely.
Microdermabrasion is another form of dermabrasion that employs the use of diamond- or crystal-tipped brushes for the exfoliation of surface skin cells. This method is commonly used to treat mild hyperpigmentation. (7)
Cryosurgery is a surgical procedure that involves freezing the affected tissue to extremely low temperatures using liquid CO2, liquid nitrogen (NO2), or ice and salt. The process destroys melanocyte cells and thus reduces hyperpigmentation. (8)
5. Other treatments
For malignant hyperpigmentation, excision or Mohs micrographic surgery may be required.
Topical Hyperpigmentation Treatments
Besides clinical procedures, you can use serums, creams, lotions, and ointments to reduce hyperpigmentation. These creams are available in both OTC and prescription strength.
1. Prescription-strength creams
Your dermatologist may prescribe creams containing glycolic acid, retinoid, deoxyarbutin, kojic acid, or hydroquinone. These compounds slow melanin production, enabling the dark spots to fade gradually.
2. Prescription-strength bleach
You can also use prescription-strength bleaches to help lighten your skin. These contain twice the hydroquinone as OTC bleaches.
Note: Hydroquinone can be carcinogenic at high concentrations. (9) Make sure that hydroquinone concentration in your bleach is within 3%–4%.
3. Cortisone and tretinoin
In severe cases of hyperpigmentation, your doctor may recommend creams containing cortisone and tretinoin. These creams show results in 3–6 months and may irritate sensitive skin.
4. OTC creams
Non-prescription-strength creams, when applied regularly, can give you an even skin tone in a few months. Select creams that contain the following compounds: (10)
- Glycolic acid or kojic acid
- Vitamin E
- Extracts of soy, rose, grapefruit seed, licorice, orchid, aloe vera, marine algae, green tea, coffeeberry, umbelliferone, and mulberry
- Cinnamic acid
- N-acetyl glucosamine
Caution: The compounds present in different prescription and OTC creams can increase sensitivity to the sun. (11) Moreover, some creams may cause heavy metal poisoning if they contain toxic metals such as mercury and, therefore, should be used with caution. (12)
Home Remedies to Reduce Hyperpigmentation
Since hyperpigmentation is generally caused by increased melanin production, it can be treated with agents that block this biochemical process.
Many natural ingredients block the activity of the enzyme tyrosinase, which is responsible for converting premature melanin to active melanin. Lowering the melanin production allows the previously present melanin to decrease gradually, thus fading dark spots over time.
Here are some home remedies that can improve hyperpigmentation and are safe to use.
Caution: Make sure to conduct a patch test before using these ingredients to check for any allergy or sensitivity reaction.
1. Use alpha-hydroxy acids
Indian gooseberry and dairy products such as yogurt and milk contain alpha-hydroxy acids, similar to those used for chemical peeling. These ingredients can be used to mildly exfoliate the skin. (13)
How to use:
- Mix any of the ingredients with 1 tbsp of rose water and 1 tsp of lemon juice to form a mask.
- Add some oatmeal or sandalwood powder if the mask is too thin.
- Apply the mask to your face and wash it off after 15–20 minutes.
2. Apply lemon or lime juice
Lemon juice is a natural bleaching agent that can lighten dark spots. (14)
How to use:
- Mix 1–2 tbsp of lemon juice with water. You can also add vitamin E oil to it for added benefits. (15)
- Apply the mixture to the dark spots.
- Rinse the area after 15 minutes.
Note: Lemon juice can make your skin sensitive to solar damage. Therefore, avoid sun exposure and apply sunscreen after trying the remedy.
3. Treat with aloe vera gel
The active compound of aloe vera gel, known as aloin, is shown to have skin-lightening effects. (16)
How to use:
- Cut open a fresh aloe vera leaf and extract the gel. Apply it to the affected skin, and wash it off after 20 minutes.
- You can also add 1 tsp of lemon juice to 2 tbsp of aloe vera gel and use it as a mask.
Caution: Do not ingest the gel as it can have side effects.
4. Apply turmeric
Turmeric is another natural ingredient that can treat hyperpigmentation by blocking the activity of tyrosinase. (17)
How to use:
- Mix 2 tsp of turmeric powder with milk to form a paste. You can also add lemon juice to the paste.
- Apply the paste to the affected areas.
- Wash the paste off after 20 minutes using lukewarm water.
5. Use honey-based masks
It is shown that the application of organic and medical-grade honey can fade hyperpigmentation spots. (18)
How to use:
- Mix half a ripe avocado with 2 tsp of honey and 1 tsp of milk. Mash the paste to obtain a uniform consistency.
- Apply the paste to the affected areas.
- Wash the skin after the paste dries using lukewarm water.
6. Use skin-lightening oils
How to use:
- Dilute the essential oils with any carrier oil and use it to massage your skin.
- Add the essential oils to any skin-lightening mask.
7. Apply rose extracts
Masks made using rose extracts, especially alcohol based, (20) can give the skin an even tone. (21) You can buy alcohol-based rose extracts from drugstores. However, when preparing rose extracts at home, avoid using alcohol as it can cause skin dehydration.
How to use:
- Soak a few rose petals in milk. Grind after an hour to form a paste. Apply the paste to the affected skin for 15 minutes, and then wash it off.
- Add 2 tbsp of sandalwood powder to the rose extract to form a thick paste. Apply the mask to your face, and wash it off after 30 minutes with lukewarm water.
8. Dab some pomegranate juice
Pomegranate juice can also improve hyperpigmentation by acting on tyrosinase. (22)
How to use:
- Dab some pomegranate juice on the affected areas using a cotton ball.
- Let the pomegranate juice dry.
- Wash the area of application.
9. Try oral supplements
Hyperpigmentation can occur due to nutritional deficiencies, such as a lack of vitamin B12, especially in darker-skinned people. You can take supplements to prevent similar problems.
Make sure to consult your doctor regarding the use of any supplements as they can have side effects or can interfere with your medications.
When to See a Doctor
Hyperpigmentation is a common problem that can generally be improved with self-care, home remedies, and medical treatment.
It is suggested to keep a track of your recovery and note any significant changes in the spots. This is vital as, in rare cases, hyperpigmentation may indicate serious conditions such as cancer. Immediately consult your doctor if the spots are growing, changing in color, or itching.
Most-Asked Questions About Hyperpigmentation
Can photodynamic therapy be used for fading hyperpigmentation spots?
Photodynamic therapy (PDT) is generally used for treating certain premalignant skin diseases and skin cancer. It can also be used for skin rejuvenation and whitening.
Therefore, it is best to try other remedies that are more effective and safer than PTD.
Can potato, green tea, or apple cider vinegar lighten the skin?
The use of potatoes for skin lightening is a popular anecdotal remedy, which is thought to work due to the catecholase content of potatoes. However, no study backs this claim. Instead, it has been seen that the enzyme catecholase is involved in melanin synthesis. (28)
Green tea (epigallocatechin gallate) has been shown to help reduce melanin concentration in vitro. (29) However, no human trials have been performed to evaluate their efficacy. Therefore, simply placing green tea bags over the affected area may not show effective results.
Apple cider vinegar (ACV) is a remedy supported by anecdotal evidence. It is thought to work due to its acetic acid content, which is commonly used for chemical peels. However, the acid content of diluted ACV may not be effective.
Can hyperpigmentation spots be prevented?
Hyperpigmentation spots can develop due to a variety of reasons. In most cases, age spots or lentigines can be prevented by avoiding sun exposure, using sunscreen, avoiding tanning beds, limiting alcohol intake, smoking cessation, and consuming an antioxidant-rich diet.
However, in some cases, hyperpigmentation spots cannot be prevented, such as those associated with pregnancy.
Hyperpigmentation is a common skin problem with a wide range of causes, the most common being excessive sun exposure. Consult your doctor on the different clinical treatments suitable to your condition.
You can also try various home remedies and medicated creams to improve hyperpigmentation upon the approval of your doctor.