Skin Condition Series, Hyperpigmentation

The meaning of pigmentation is colouring. The colour of your skin is affected by disorders of skin pigmentation. The colour of your skin is due to the presence of a pigment referred to as melanin. Melanin is produced by special skin cells referred to as melanocytes. If these cells become damaged or unhealthy, the production of melanin is affected. If too much melanin is produced by the melanocytes then your skin colour becomes darker than normal, a condition referred to as hyper-pigmentation of skin. Similarly, if too little melanin is produced by the melanocytes, then your skin colour becomes lighter than normal, a condition referred to as hypo-pigmentation of skin.

What is Hyper-pigmentation?

Hyper-pigmentation is characterized by production of too much melanin (the brown pigment responsible for the colour of the skin) by the body resulting in darkening of skin. It is a commonly occurring, usually harmless skin condition in which skin patches become darker in colour in comparison to the surrounding normal skin.

What are the symptoms of hyper-pigmentation?

The symptoms of hyper-pigmentation are single or multiple areas of darker coloured skin than the surrounding normal coloured skin. Hyper-pigmentation can be focal affecting areas such as back of the hands or face or diffuse.

The skin colour of individuals of any race can be affected by hyper-pigmentation. Individuals who have darker skin tones have a greater risk to develop hyper-pigmentation, particularly with excessive exposure to the sun. The elderly are more prone to develop hyper-pigmentation because as the body ages the distribution of melanocytes become less diffuse. The body also loses its ability to control the regulation of melanocytes.

What are the causes of hyper-pigmentation?

“Liver” or age spots: It is a common type of hyper-pigmentation. They result due to damage by sun’s rays and are also referred to as solar lentigines by doctors. They are small, darkened areas, which are usually present on the face or hands or other areas that are exposed to sun frequently.

Chloasma or Melasma spots: These spots are similar to age spots in appearance, apart from being larger. They occur most often due to result of changes in hormones and are common during pregnancy (often referred to as the “mask of pregnancy”) and in females who take birth control pills.

Freckles: They are small brown spots that may occur on any place on the body, the most common areas being the arms and the face. Freckles are inherited or genetic.

Acne: Hyper-pigmentation may occur on the skin after the acne lesions have healed, also referred to as post-inflammatory hyper-pigmentation.

Injuries to the skin including surgeries: Dark spots may also occur on the skin due to a skin injury or after certain surgeries.

Hyper-pigmentation of skin is associated with numerous diseases some of which are:

• Addison’s disease and other types of adrenal insufficiency, which is characterized by elevation of the hormones stimulating synthesis of melanin such as melanocyte-stimulating hormone (MSH)
• Cushing’s disease or other causes of excessive production of adrenocorticotropic hormone (ACTH)
• Acanthosis nigricans, in which hyper-pigmentation is present in the intertriginous areas of the body (area where two areas of the skin touch or rub each other) in association with insulin resistance
• Linea nigra, which is a hyper-pigmented line formed on the abdomen in a female during pregnancy
• Peutz-Jeghers syndrome, which is a genetic disorder characterized by presence of hyper-pigmented macules on the oral mucosa and lips in association with gastrointestinal polyps
• Exposure to some chemicals including bleomycin, salicylic acid, and cisplatin
• Smoker’s melanosis
• Porphyria-Porphyria is a term used for a group of disorders, which occur as a result of build up of natural chemicals that manufacture porphyrin in your body. Porphyrins are important for the optimal functioning of the haemoglobin. Skin symptoms occur in cutaneous form of porphyrias. These symptoms occur due to oversensitivity to sunlight and may cause change in colour of the skin from healing blisters.
• Fungal infections due to tinea such as ring worm
• Haemochromatosis-A disease characterized by excessive absorption of iron in the body, which is then stored in different organs such as the heart, liver and pancreas. Deposit of iron in cells of the skin can make the skin appear gray or bronze in colour.
• Grave’s disease-It is a disorder of the immune system resulting in excessive production of thyroid hormones. One of its symptoms is development of red, thick skin usually on the tops of the feet or shins, also referred to as Graves’ dermopathy.
• Due to tinea cruris
• Mercury poisoning due to topical application of skin whitening creams or mercurial ointments
• Nelson’s syndrome-It is a rare disorder, which occurs in some patients suffering from Cushing’s disease as a result of removal of both adrenal glands. One of the key symptoms of Nelson’s syndrome is development of dark skin pigmentation along with symptoms of headaches, pituitary failure and visual loss.
• Various drugs such as antiarrhythmics, some antibiotics and antimalarial drugs
• Incontinentia Pigmenti-An inherited disorder of pigmentation of skin that is accompanied by abnormalities of skeletal system, teeth, central nervous system and the eyes. The pigmentation is present on the extremities and the trunk, is blue, slate-grey or brown and is distributed in wavy lines or irregular marbled way.

Supplements to help with hyper-pigmentation

Copper: Copper is a metal that is found in trace amounts in the body but it is still considered to be an essential nutrient. Natural foods that contain copper include shellfish, oysters, nuts, lamb, split peas and liver. It is found useful for improvement in pigmentation of hair and skin. In one study, it is noted that hyper-pigmentation of skin is treated by topically applying an effective amount of a composition comprising a peptide copper complex to the affected area.

Vitamin A: Vitamin A is a type of fat soluble vitamin that is predominantly stored in the liver. Retinol is the pre-formed type of Vitamin A found only in animal sources, whereas carotenoids are only found in the plant sources. Food sources of Vitamin A are butter, oily fish, cod liver oils, egg yolks, whole milk, peppers, dark leafy vegetables, sweet potato, kale, broccoli, carrots and parsley. According to a study published in the journal Seminars in Cutaneous Medicine and Surgery, retinoids have been efficacious in treating hyper-pigmentation in darker racial ethnic groups.

Vitamin C: Also referred to as Ascorbic acid, vitamin C is a water soluble vitamin. It is naturally found in many plant based food products such as mango, kale, carrots, strawberries, raspberries and cabbage. It has many vital roles to play in the human body. It is a potent antioxidant, which helps to destroy free radicals, reduce oxidative stress and maintain integrity of cells. It also helps to regenerate Vitamin E, which is another potent antioxidant. According to a study published in the Journal Dermatologic Surgery, a significant amount of scientific research supports the usage of cosmeceuticals that contain vitamin C. Benefits of vitamin C are lightening hyper-pigmentation, promoting synthesis of collagen and improving a variety of inflammatory dermatoses.

Vitamin E: Vitamin E is a type of fat soluble vitamin. There are 8 forms of Vitamin E: four tocopherols and four tocotrienols. Vitamin E is a potent antioxidant. It reduces oxidative stress by destroying free radicals, thereby, reducing cellular damage. According to a study published in the journal Dermatologic Surgery, experimental evidence suggests that oral and topical use of vitamin E has photoprotective, anticarcinogenic, and skin-barrier stabilizing properties. Another study published in the journal Dermatologic therapy states that vitamins C and E inhibit the acute ultraviolet damage of sunburn, erythema and tanning along with chronic UV photoaging and skin cancer. It further adds that both are highly effective depigmenting agents.

Co-Q10: Co-Q10 also referred to as Ubiquinone is present in most of the human cells. It is a fat soluble compound that is produced from the amino acid Tyrosine. Coenzyme Q10 has antioxidant properties, which means that it helps in destroying oxidizing free radicals that damage cells. According to a study published in the journal International Journal of Cosmetic Science, CoQ10 may have potential depigmentation effects.

Bilberry: The Bilberry is a small purple/blue berry that is obtained from the Bilberry plant or Vaccinium Myrtillus. It is a shrub that has its origin in Northern and Central Europe, America and Northern Asia. The Bilberry plant produces both white flowers and fruit. It is a close relative of blueberry and both of them are a rich source of anthocyanins, which are potent anti-oxidizing agents. Bilberries may treat damage due to sun and pigmentation. They are regarded as a natural version of hydroquinone, which is used for skin whitening but not usually recommended as it has adverse effects on the skin.

The meaning of pigmentation is colouring. The colour of the skin is affected by disorders of skin pigmentation. Hyper-pigmentation of the skin occurs as a result of excess melanin production by the melanocytes. There are various causes of hyper-pigmentation of skin. Various supplements such as Bilberry, CoQ10, copper, Vitamin, A, C and E are available that you can take to relieve the symptoms of hyper-pigmentation of skin.

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