Skin Pigmentation Treatments

It is not uncommon for people to develop an uneven skin tone and complexion. What is known as hyperpigmentation happens for many reasons, ranging from genetics to spending a lot of time in the sun to having underlying medical conditions. Skin pigmentary changes can significantly affect a person’s emotional well-being and self-confidence.

There is a range of pigmentation treatments that can help. Topical creams or serums, which can be used at home and are fairly inexpensive, are an essential part of the process. Here are key ingredients that may be recommended by your physician:

• Hydroquinone, a skin-lightening agent, can help fade dark spots.
• Kojic and azelaic acids gradually reduce hyperpigmentation.
• Retin-A, a type of retinoid, aids in skin cell turnover, improving irregularities.
• Vitamin A, C, & E can brighten skin and even out tone by inhibiting melanin production.

All of these ingredients must be used as directed. Also, keep in mind that the daily application of broad-spectrum sunscreen is crucial in preventing further pigmentation issues due to UV exposure, ensuring the effectiveness of other products, and supporting overall skin health. Sun protection is one of your best defenses when it comes to maintaining a uniform skin tone.

There are also several in-office treatments that can be considered. These include chemical peels, micro-needling, intense pulsed light (IPL) therapy and laser treatments. (See below for more information.)

It’s important to note that if you have melasma, a skin condition that can be triggered by hormones, stress, or pregnancy, certain treatments will not be suitable for your skin and can make pigmentation issues worse. For people of color with hyperpigmentation, it’s crucial to approach treatment cautiously, as your skin is more susceptible to developing post-inflammatory hyperpigmentation or scarring from aggressive treatments.

Consulting a dermatologist is vital to determine the best treatment based on your specific pigmentation issue and skin type. Be sure to discuss the benefits, risks and potential outcomes of all your options.

There are several in-office treatments that your dermatologist or plastic surgeon can use to help with hyperpigmentation. Let’s take a closer look at some of the most common ones.

• Chemical peels are a popular option for treating various forms of hyperpigmentation and uneven skin tone. Superficial peels that use glycolic acid can help improve mild pigmentation issues by gently exfoliating the skin’s surface. For moderate hyperpigmentation conditions, such as sun damage or age spots, a Jessner’s peel or modified Jessner’s peel containing salicylic acid and lactic acid may be recommended.

Stubborn cases of melasma or more severe sun damage may require stronger trichloroacetic acid (TCA) peels to penetrate deeper into the skin. The specific peel formulation and depth should be carefully selected by your physician based on your skin type, condition, and desired outcome.

• Microneedling employs a device equipped with fine “micro” needles that make tiny punctures in the skin, creating nearly invisible channels. These channels activate the body’s natural healing processes and stimulate collagen production, helping to tighten pores, reduce hyperpigmentation, and enhance overall skin health. For optimal results, multiple sessions are advised.

The treatment can be augmented with additional treatments like platelet-rich plasma therapy (PRP), vitamin C serums, or exosomes, which are tiny vesicles packed with growth factors and proteins. Microneedling can also be combined with radiofrequency (RF) energy-based devices such as Sylfirm X and Morpheus 8 to help reduce hyperpigmentation and improve overall skin tone and texture. The addition of RF energy during the microneedling process provides an extra boost by heating the deeper layers of the skin. This heat energy can help break down existing pigment clusters and inhibit the production of excess melanin, which is responsible for hyperpigmentation.

• Intense pulsed light (IPL) therapy uses broad-spectrum light to target specific skin concerns. The exact method and sequence of light varies based on the device, but all IPL devices work by using broad-spectrum light to penetrate your skin and break down the pigmented cells or blood vessels, allowing for gradual improvements.

IPL is particularly effective for reducing the appearance of age spots and sun spots (solar lentigines) by breaking up the excess melanin in these flat, brown pigmented lesions. It can also significantly lighten freckles, both flat and raised, by disrupting the concentrated melanin within them. IPL is considered one of the best treatments for improving the patchy brown or grayish discoloration associated with melasma.

• Laser treatments like Q-switching or fractional lasering are commonly used for hyperpigmentation. These lasers aim to break up melanin clusters, reducing dark spots. Multiple sessions are often recommended.

Consulting a specialist is vital to determine the best treatment for you, whether you opt to treat the issue at home or with an in-office technique. Be sure to discuss the benefits, risks, and potential outcomes of various procedures with an experienced practitioner.

Before you go

Speak with your physician to identify the cause of your hyperpigmentation and a treatment plan to address it. Your doctor will often make recommendations based on your skin tone and the severity of the pigmentation.

Several weeks before more involved laser resurfacing and chemical peels, you may be instructed to begin using a retinoid cream, hydroquinone, or a serum to help prepare the skin and improve results. In the days leading up to the procedure, patients must stop using any products containing retinoids or harsh ingredients that could irritate the skin. A broad-spectrum sunscreen is also recommended for daily use to protect the skin from further sun damage before undergoing laser treatment.

Post-inflammatory hyperpigmentation (PIH) is a common side effect that can occur after certain skin treatments, such as laser resurfacing, chemical peels, or microneedling. It appears as dark patches or uneven skin tone, caused by an overproduction of melanin as the skin tries to heal and protect itself. To help prevent this issue, it’s crucial to use broad-spectrum sunscreen daily and avoid sun exposure as much as possible for several weeks prior to and after your treatment. Additionally, incorporating brightening ingredients like vitamin C, Kojic acid, or licorice extract into your skincare routine can help fade existing hyperpigmentation over time.

During the procedure

The majority of skin pigmentation procedures can be performed under local and topical anesthetics in your physician’s office. Many surgeons also incorporate laser resurfacing and chemical peels when they are performing facelifts, neck lifts, and blepharoplasty. Depending on the procedure, the process may last anywhere from 15 minutes to two hours. After laser resurfacing is complete, the treated area is usually covered with a healing ointment to protect it as it begins the healing process.

Skin Pigmentation Treatment aftercare 

The majority of skin pigmentation treatments require little to no downtime and you should be able to return immediately to your regular routine following in-office treatments. Other more in-depth procedures may require several days if the skin undergoes an extensive peeling process.

Following the procedure, you may experience redness or peeling as your skin is regenerating. Fading of hyperpigmentation can take weeks to months, and obtaining the best results may require the consistent use of topicals or multiple sessions of procedural treatments.