Treating Hyperpigmentation in Darker Skin Tones

What are the causes of hyperpigmentation (increase in skin pigmentation)?

Hyperpigmentation may either be due to increased melanin deposition in the epidermis or dermis.

Epidermal pigmentary disorders respond well to treatment while dermal pigmentation may take a long time to lighten.

1. Melasma : Seen as brown patches on the face, it is more commonly seen in females. It occurs due to hormonal changes in the body. The pigmentation increases on sun sun exposure.
2. Peri-orbital melanosis : Also known as 'dark circles' may be heriditary, due to stress or eye strain
3. Freckles and Lentigenes : These are tiny black spots on the face and are genetic in origin.
4. Photomelanosis : This is increased pigmentation due to sun exposure. The pigmentation occurs on exposed skin, commonly on the face, neck and the back. The pigmentation may be patchy or as diffused darkening of the exposed skin.
5. Sun burn (tan) : A condition commonly encountered in fair skinned people due to excessive sun exposure.
6. Post inflammatory hyperpigmentation : It may be seen in the following cases:

• Seen after healing has occured, like in acne, eczemas, contact dermatitis etc.
• Drug induced pigmentation.
• Pigmentation due to cosmetics especially those containing fragrance.
• Macular Amyloidosis
• Systemic disease such as Addison disease, liver disease, pregnancy, pituitary tumours.

What are the latest peels used in dark skin with proven efficacy?
 
While Glycolic acid, TCA, Salicylic acid, Jessner’s, Baker Gordon’s peels are being used since a long time, newer combination peels are now commonly being used for hyperpigmentation as well as for anti-aging skin treatments.

1. Nomelan Fenol : It is a Solution containing phenol, trichloroacetic acid, retinoic acid, phytic acid and a mixture of hydroxy acids (glycolic, ascorbic, salicylic, and mandelic). It is used to treat Acne, Post Inflammatory Hyperpigmentation & Facial Melanosis. A peel is repeated every 3 weeks & a total of 3-5 sessions are done to achieve good cosmetic results. The depth of the solution will depend on the applied layers. For dark skins (phototype IV-VI) one should not apply more than 2 layers at a single peel session. The end result is a renewed and bright complexion with homogeneous skin color and texture.
2. Arginine & Lactic acid combination peel : It is used to treat peri-orbital melanosis. Arginine is an Amino Acid derived from Brown sugar. It stimulates protein synthesis & has an anti-inflammatory action with moisturizing effect. It is a large molecule, hence there is no irritation even in thin skin areas such as under eyes. It is safe in patients with sensitive skin. Lactic Acid is derived from fermented milk. It helps maintain skin pH and is also useful in adjusting the pH of formulations. It moisturizes skin as is the skin’s own natural moisturizer.
   6-8 sessions repeated at biweekly intervals causes a significant reduction of dark circles.
3. Retinol peel : A combination of  10% ascorbyl 2-glucoside, 15% lactic acid, 4% retinol & 1 % retinaldehyde available as Retises CT peel is used for photoaging, uneven skin tone, fine lines, open pores & stretch marks. It removes dead cells, causes cell renewal, stimulates collagen synthesis & increases natural moisturizing factors of the skin.