Tuesday, May 17, 2022

Hyperpigmentation on Black Skin: Causes and Best Treatments

  • Hyperpigmentation refers to patches or spots of skin that are darker than the surrounding area
  • This condition can affect any skin tone but is most problematic among people of color
  • The most common cause is skin injury which causes postinflammatory hyperpigmentation
  • Safe and effective treatments include skin lightening creams, light chemical peels and corticosteroids

Hyperpigmentation is a common skin condition, and one that can affect any skin type or tone. It is characterized by dark spots or patches that develop on the skin, and can result due to  several causes. Hyperpigmentation on Black skin is of particular concern, as symptoms are typically more severe than lighter skin tones and can last longer.

Solutions to counteract dark patches include over-the-counter (OTC) and prescription topicals as well as professional treatments.  

What Causes Hyperpigmentation on Black Skin? 

The Fitzpatrick skin type classification is a well-known tool that classifies skin type into six groups according to the amount of pigment present in skin to determine the risk of sunburn and cancer. Black skin is categorized as type VI and is at low risk of sunburn due to the high levels of melanin which provides a protective function. 

There are two kinds of melanin present in skin, eumelanin and pheomelanin. Of the six groups,  Black skin has the highest amount of eumelanin, a darker pigment, and the lowest amount of pheomelanin, which is lighter in color. This increased pigmentation is what makes darker skin tones most vulnerable to hyperpigmentation. 

This skin type has a low propensity to burn as well as a very low incidence of cancer as a result of sun exposure. This is due to the role melanin plays in protecting the skin by absorbing and scattering energy from UV light. 

Hyperpigmentation occurs when the skin overproduces melanocytes, melanin-producing cells that give skin its color. This increase in melanocyte activity has been shown to be stimulated by several inflammatory mediators that are released when inflammation occurs. This is true for all skin colors. 

However, Black skin is more susceptible to postinflammatory hyperpigmentation (PIH) than lighter skin tones due to the greater levels of melanin. PIH is the body’s response to inflammation which causes melanin to form clusters of dark spots and patches on the skin.

Hyperpigmentation can be caused by any injury such as a cut, scrape or mosquito bite; and skin conditions such as acne, eczema, sun exposure and hormones.

Common causes of hyperpigmentation on Black skin

Three primary causes of hyperpigmentation on Black skin are PIH, melasma, and to a lesser extent, unprotected sun exposure.

Of all the presenting complaints to dermatologists, PIH has been shown to be one of the most common among darker-skinned individuals. 

PIH develops when the skin regenerates after an injury which triggers melanin production. Noticeably darker spots or marks will remain where the initial wound or injury occurred. This is commonly seen with acne and eczema.  

Melasma is a pigmentation skin disorder that predominantly affects women of color of reproductive age. While the exact cause is not clear, it is known to be triggered by sun exposure or fluctuations in hormones. Hyperpigmentation appears as freckle-like dark spots.   

While high levels of melanin protects Black skin from sunburn, long-term exposure to the sun’s damaging rays can cause solar lentigines or sunspots to develop.

Best Treatments to Get Rid of Hyperpigmentation  

When looking at treatment options, it is important to opt for one that will not exacerbate hyperpigmentation, as Black skin is vulnerable to any type of trauma.  

The best treatments are those that offer a low risk of inflammation such as skin lightening creams, retinoids, and light glycolic and salicylic acid peels. 

Typically, it is the combination of treatments that offer the best results such as hydroquinone or  azelaic acid and microdermabrasion. Length of treatment will depend on the cause and severity, as well as individual response. With that being said, it can take from 3–12 months to see significant improvements. 

Products to Treat Hyperpigmentation

There are a number of OTC products such as brightening serums and creams that, with consistent use, can fade dark spots. Either can also be used as spot treatments to target individual spots rather than the entire face.

Prescription-strength options are another choice for those whose skin can tolerate them. They can provide faster results, and if you are under a dermatologist’s care, you would be well served as they can recommend combination therapy for greater efficacy.     

The most effective and safe options for lightening hyperpigmentation on Black skin include corticosteroids, hydroquinone, retinoids and niacinamide to increase skin cell turnover, even skin tone and inhibit melanin formation.

Corticosteroids are topical creams that are typically used once initial treatment is concluded to suppress inflammation in order to prevent PIH and subsequent recurring development of hyperpigmentation.  

In one clinical trial, researchers found the incidence of PIH decreased by 40% after a topical corticosteroid was applied 2 days before and after ND:YAG laser treatment.

Hydroquinone is considered a mainstay treatment for hyperpigmentation and PIH as it provides strong results. It is a tyrosinase inhibitor that effectively inhibits new melanin formation. However, there is controversy surrounding this skin-bleaching agent as it can cause white patches as well as worsen existing pigmentation, in addition to some serious side effects. 

With this in mind, it is important to consult with your care provider before using hydroquinone and to follow all instructions carefully.

Niacinamide is a derivative of B3 and is a proven treatment to reduce hyperpigmentation; it has anti-inflammatory and antioxidant properties and promotes skin cell turnover. It can effectively lighten skin by inhibiting melanosome transfer to induce skin lightening.

In one clinical study niacinamide was shown to significantly decrease hyperpigmentation and increase skin lightness.

Retinoids can reduce hyperpigmentation by blocking tyrosinase activity, dispersing dark fragmentation and stimulating skin cell turnover. It can be effectively used alone or combined with hydroquinone for greater results, as it enables better absorption of topical medicated products.

Professional Treatments

Professional treatments can be used as a single treatment or paired with a topical medication to target hyperpigmentation in different ways. Often, corticosteroids are included in the skin-lightening regimen to minimize irritation caused by topical skin-lightening products. 

Peels

Light chemical peels using glycolic or salicylic acid are safe and effective for Black skin. They work by removing the top layer of skin to eliminate dark skin cells, allowing fresh undamaged cells to take their place. 

Glycolic acid peels have been shown to be the most effective and safe peel for this skin type as well as azelaic acid. Both acids can be combined to attain greater results. 

In one study, azelaic and glycolic acid creams were compared to hydroquinone in a 24-week clinical trial of dark-skinned individuals. Results showed this combination was just as effective as hydroquinone in treating hyperpigmentation, making it a suitable choice for skin of color.

Microdermabrasion 

Microdermabrasion is a type of exfoliation, but at a deeper level. This treatment removes the outer layer of skin to reduce the appearance of hyperpigmentation. As it does not penetrate deeper into the lower layers of skin it can only provide small improvements. However, as a gentle exfoliant, it is a safe treatment and will not prompt inflammation and further hyperpigmentation.

Microneedling 

Microneedling involves superficial piercing of the skin with tiny needles which create small wounds. As they heal, collagen and elastin production are stimulated which evens skin tone. In one study, researchers found that microneedling was a safe and effective treatment for hyperpigmentation and showed significant improvements at week 4. 

Microneedling is an effective, noninvasive treatment that is ideal for Black skin because it rarely causes further hyperpigmentation unlike other more aggressive resurfacing procedures.

Natural Treatments 

Natural treatments cannot compete with the results of professional in-office treatments but can provide some mild improvements when used consistently:

  • Aloe vera contains aloesin and aloin, two components known to lighten skin
  • Ellagic acid can lighten skin by blocking melanin production
  • Green tea extract can reduce inflammation and fade dark spots 
  • Licorice extract has glabridin, a chemical that has skin lightening properties and also prevents tyrosinase production, an enzyme that darkens the skin after sun exposure
  • Soy extract has demonstrated strong depigmenting activity as well as the ability to prevent sun-induced pigmentation
  • Vitamin C is also a tyrosinase inhibitor, and can lighten dark patches and neutralize free radicals to prevent dark spots from forming

Treatments to Avoid

Certain treatments are considered too harsh for Black skin and can cause inflammation and further hyperpigmentation. Such treatments include:

As with any treatment, it is important to discuss the pros and cons with your care provider to ensure you receive the best treatment and avoid any unnecessary side effects. 

Takeaway

Hyperpigmentation can occur in any skin tone, but people of color are more prone to this skin condition due to the greater levels of melanin in their skin. Dark skin is more prone to developing postinflammatory hyperpigmentation and melasma. 

The best treatments are those that are least likely to cause inflammation and are safe and effective. These include OTC creams such as hydroquinone, corticosteroids and retinol.  

Professional treatments include light chemical peels, microdermabrasion and microneedling. Most often several treatments are combined for greater results or as maintenance treatment once the initial treatment is completed.

Sources

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