One of the most stubborn and frustrating skin problems for many people is hyperpigmentation – skin that is darker in certain areas. It is, in my opinion, the hardest problem to treat.
From my own personal experience with freckle-like dark spots, I understand the struggle. Mine positively refuse to go away (with topical products). It is a constant battle to keep them in check.
In my last blog post, I wrote about the effects of hormones on skin. One effect is an increase in pigmentation on the face and body during times when hormone levels change. It’s called melasma or pregnancy pigmentation – the topic of this post.
Pregnancy Pigmentation
If you are pregnant, or have been pregnant before, then you may have observed the appearance of dark patchy areas on your face and/or neck. Patches are areas, not small round spots like freckles.
Melasma patches are usually a uniform, tan or brown color. They have well-defined borders and are clearly visible from the surrounding skin (your normal skin color). They are also flat, not raised like a mole might be.
The pigmentation may form while you are pregnant (typically second or third trimester) or after you have given birth. The pigmentation forms slowly during pregnancy, and it fades slowly after pregnancy. It can take many months or even years for it to fade. Sometimes, the pigmentation is permanent. And it can re-appear with subsequent pregnancies.
Melasma
Melasma is the medical name for this condition. The dark patches typically appear on the central third of the face (cheeks), forehead, upper lip, and chin.
The pattern tends to be symmetrical – appearing in the same general area on both sides of the face, but not necessarily mirror images of each other.
The patches may also be irregular – positioned asymmetrically throughout the face. You may have only one single patch or you may have multiple areas of discoloration. Multiple patches can congregate in an area, looking like one large dark area (but it’s actually made up of several dark patches).
Melasma goes by other names – chloasma, mask of pregnancy, butterfly mask. “Butterfly” refers to the pattern of discoloration formed – where both cheeks and the bridge of the nose are pigmented (see photo to the right for an example). Butterly is a classic pattern for melasma, but you can still have melasma without this pattern.
Melasma occurs more often in darker skin tones, skin of color, and certain ethnicities, such as black, Hispanic, Asian, Mediterranean, Middle Eastern, and Indian skin. It is thought to have a genetic component. Unfortunately, the mechanisms of melasma are not well understood, and consequently, the treatment options are very limited (more on this below).
Melasma isn’t limited to women. Men can get it too (though much less frequently, about 10% of men).
Melasma may also occur after oral contraceptive use or when there are significant hormonal changes. Even hormonal fluctuations caused by stress can cause melasma.
What Makes Skin Pigment More
So what makes skin pigment more during certain times? While you may only care about what to do and not why, it’s important to understand this section. Much of your treatment success will depend on your understanding of what NOT to do.
#1 – SUN
The sun is a powerful activator of melanocytes, which are the cells in skin that are responsible for producing pigment.
The sun’s solar energy increases the number of melanocytes and their level of activity. This is why skin tans and burns when it is exposed to sun.
Melanin (pigment) is your skin’s defense mechanism against harmful UV radiation. It is the body’s way of coping with excess radiation. Melanin absorbs this heat energy to prevent it from damaging DNA and cellular organelles, both vital for normal functioning.
Any time you expose your skin to sun, the melanocytes in your skin become more active.
#2 – TRAUMA
Anything that triggers inflammation in your skin is a form of trauma. Trauma may be so minimal as to not be visible (such as everyday exposure to UV rays) or really obvious (when your skin is beet red, swollen, and in pain).
The inflammation process triggers pigment production, just like the sun makes your skin darker.
An acne scar is a good example. When you develop a dark spot after a pimple has healed, that darker color is due to inflammation, which has turned on the pigment-making switch. It’s known as Post-Inflammatory Hyperpigmentation (PIH). If your skin darkens after it has been cut or scraped, that’s also PIH at work.
#3 – HORMONES
During pregnancy, estrogen and progesterone levels surge. Both of these hormones are involved in stimulating the production of pigment too. I say “involved” because the mechanism isn’t well understood. Menopausal women undergoing hormone replacement therapy have elevated estrogen levels without exhibiting melasma or an increase in pigmentation.
In the case of melasma or pregnancy pigmentation, two things happen simultaneously that lead to dark patches:
1). Changing hormone levels (estrogen & progesterone) stimulate pigment production.
2). The sun exacerbates the situation by making already active melanocytes even more active.
Skin of Color
As I mentioned above, melasma tends to be more common in darker skin tones and skin of color. Why is that?
First, let’s define “skin of color” loosely. This term typically refers to olive, yellow, brown, and black skin tones.
You can also look at it another way – in terms of ethnicity/race, not the actual color you see. You may have fair or “white” colored skin, but if you are of Hispanic or multi-racial origin, your skin will exhibit risks for skin of color (more on this below). Color is deceiving.
For example, I am ethnically East Asian, and though somewhat fair (Fitzpatrick Skin Type 3) and the same complexion of some Caucasians, I most definitely consider myself to be in the skin of color group. My skin pigments and scars easily.
Certain skin problems are more prevalent in skin of color:
- pigmenting more (or losing pigment)
- scarring (e.g. acne scars, excess scar tissue)
- having more sensitivity or reactions to certain ingredients or cosmetic procedures.
Unfortunately, these risks are not addressed often enough. If you have skin of color, you may feel that much of the marketing, product development, and skin talk in this country (U.S.) caters to the majority Caucasian skin demographic.
So here, I just want to point out that if you have skin of color, you need to be aware of the following:
1). Your melanocytes (pigment-producing cells) are innately more active.
2). They are more sensitive to triggers, such as sun and trauma.
3). Your skin is more likely to scar after a trauma to skin, such as acne (the inflammatory process that causes acne is a form of “trauma”), a chemical peel that is too strong for you, a wound, a surgical procedure that involves cutting & suturing, dermabrasion or laser resurfacing.
There is nothing you can do about the innate biology of your skin. So you must be extra vigilant and proactive about protecting it from triggers and injury.
Treatments For Melasma
Treatments for melasma today are quite limited and hit or miss in their effectiveness.
Melasma pigmentation is extremely difficult to remove quickly.
In general, dark spots are hard to fade, much less eliminate altogether. Pigmentation has a tendency to keep coming back because skin has a ‘memory.’ Spots and lines/wrinkles will re-appear in the same places no matter how many times you exfoliate (except when you totally obliterate epidermal skin by a super strong medical peel or ablative laser).
Compared to dark spots that you might get from regular sun exposure, melasma is even more stubborn and resistant to treatment. So if you have it, you have to be patient as improvement will be slow and gradual.
Some people are lucky – discolorations fade fairly easily with good brightening treatments. Some people never see an improvement no matter what they apply. I fall into the latter category, and this has to do with where the pigment is located and what kind of pigment it is (a topic for another day).
