Most individuals will experience some form of hyper-pigmentation during their lifetime. Hyper-pigmentation can take on many forms, but it is essentially an overproduction and an abnormal distribution of pigmentation (melanin). Thankfully, there are many treatments on offer to reduce and/or remove such pigmentation. At my clinic in East Finchley, I have successfully been removing sun, age and liver spots with cryotherapy for several years.

This articles has been put together to give you an overview of the different types of hyper-pigmentation and to help you make the right choices when it comes to treating this condition.

Melasma (Chloasma):

Melasma is more common in women over the age of 30. This type of hyper-pigmentation looks like asymmetrical light brown patches usually found on the forehead, cheeks and around the mouth. Melasma can vary in size, but usually looks like large patches of darker pigmented skin. The sun will make this condition darker and it may fade in winter.

Hormone abnormalities can cause melasma, although the exact cause is not known. In particular, the sex hormones and the hormones produced by the adrenal gland affect the cells which produce the pigment in the skin. In pregnancy melasma can show up for the first time, called chloasma gravidarum or “the mask of pregnancy”.

There is no cure for melasma, but the condition can be controlled. If melasma first showed up in pregnancy, it will often disappear a few months after delivery. In other cases, avoiding triggers such as birth control pills and hormone therapy as well as using protection from the sun, may stop the condition from worsening. The appearance of melasama/chloasma can also, in most cases, be improved with skin lightening creams, chemical peels, micro needling and laser therapy.

References: https://www.britishskinfoundation.org.uk/melasma

Sun spots (Solar lentigines):

Sun spots take many years or even decades to appear. Years of overexposure to the sun’s ultraviolet light causes the melanin producing cells to become overactive, whereby they produce skin pigment in high concentrations or begin to clump together.

Sun spots are more notable and common in light skin. They are flat to the skin and can be of various sizes, shapes and shades of brown. They can usually be found on parts of the body which has had the most sun exposure, and are commonly found on the hands, chest and face.

Many different treatments are used to remove sunspots, some more successful than others. Home remedies may include Vitamin A creams and skin lightening creams. Home remedies can be effective in fading the sunspots, but patience is needed as it takes time before results are visible.

Professional treatments include IPL (intense pulsed light), which require several treatments until the sun spots have completely disappeared. Cryotherapy, on the other hand, will in most cases cause the sunspot to disappear after just one treatment, making it a cost effective and preferred treatment for this type of hyper pigmentation.

References: https://www.dermnetnz.org/topics/brown-spots-and-freckles/

Age spots and liver spots:

Age spots, also known as liver spots, vary in size and are light to medium brown. They are usually found on the face, shoulders and on the back of hands. They are flat to the surface of the skin and are very common in people over the age of 50. The sun as well as age is believed to play a role in the formation of this type of hyper-pigmentation.

Age spots are often confused with sun spots as they are so similar in appearance. As skin ages is becomes more common for an abnormal distribution of melanin and lipofuscin to appear in the skin. Whereas melanin is the natural pigment sound in the hair, skin and eyes, lipofuscin is a byproduct of the breakdown of blood cells. Lipofuscin is also known as the age pigment, and accumulates in the skin cells with age. The abnormal distribution of melanin and a build up of Lipofuscin causes age/liver spots to appear.

There are several treatments available for age/liver spots. Skin lightening creams are a common choice, however it requires discipline and takes time to show results. Effective and less time consuming treatments include cryotherapy, chemical peels, micro-dermabration and laser treatments.

References: Skoczyńska A, Budzisz E, Trznadel-Grodzka E, Rotsztejn H. Melanin and lipofuscin as hallmarks of skin aging. Postepy Dermatol Alergol. 2017;34(2):97-103.

https://www.aad.org/public/skin-hair-nails/anti-aging-skin-care/age-spots

https://arxiv.org/ftp/arxiv/papers/1505/1505.07012.pdf

Post-inflammatory hyper-pigmentation:

Post-inflammatory hyper-pigmentation can affect any age group. These dark patches are more common in darker skin and can show up anywhere on the body, and be any shape and size. This type of hyper-pigmentation is always the result of either trauma to or inflammation of the skin. It could show up following a burn, a cut, an acne breakout or after an eczema flare up. Factors such as sun exposure and scratching, picking and rubbing of the inflamed/injured skin is likely to make the condition worse.

Often post-inflammatory hyper-pigmentation will fade on it’s own, especially if the skin is properly nourished. However, prevention is easier than cure and regular use of sunscreen and gentle moisturiser for those at risk of this condition will help to reduce the likelihood of it developing. Prescription skincare is usually used as a treatment if it doesn’t resolve on it’s own.

References: http://bmctoday.net/practicaldermatologypeds/pdfs/Peds0611_PedSkincare.pdf

Freckles (ephelides):

The difference between freckles and other similar looking brown spots (sun spots ans age spots) is that freckles fade during the winter months while sun spots and age spots persists in the absence of ultraviolet (UV) light. Freckles are generally first seen in childhood in fair skinned individuals, being more prominent in summer. In winter they will fade or entirely disappear. With age freckles will become less noticeable. These brown spots are usually less than 3 mm in diameter.

The most effective treatment for freckles is good sun protection. Laser treatment has also been proven to be effective in some cases.

References: https://www.dermnetnz.org/topics/brown-spots-and-freckles/

Riehl Melanosis

Riehl Melanosis is a very rare form of hyper pigmentation which usually shows up on the face and neck of women. It is thought to be type of contact dermatitis, caused by fragrances, pigments or bactericide found in cosmetics. It has also been suggested that it is an immune reaction caused by internal as well as external factors.

Riehl Melanosis is difficult to treat, however vitamin C supplements, skin lightening creams and IPL (Intense pulsed light) and laser has been reported as effective treatments.

References: Riehl Melanosis Treated Successfully With Q-switch Nd:YAG Laser. Joanne E. Smucker BSa and Joslyn S. Kirby MDb. J Drugs Dermatol. 2014;13(3):356-358.

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