Hyperpigmentation is a common, usually harmless condition in which patches of skin become darker in color than the normal surrounding skin. This darkening occurs when an excess of melanin, the brown pigment that produces normal skin color, forms deposits in the skin. Hyperpigmentation can affect the skin color of people of any race.
Hyperpigmentation may be caused by sun damage, inflammation, or other skin injuries, including those related to acne vulgaris. People with darker Asian, East Indian, Mediterranean or African skin tones are also more prone to hyperpigmentation especially if they have excess sun exposure.
Hyper pigmentation macule often is the remnant of an inflamed acne lesion. PIH macules can follow relatively minor pimples and papules, in addition to more serious lesions. However, the more inflamed a breakout, the larger and darker the PIH macule tends to be. Picking or popping a pimple increases the chance of developing postinflammatory hyperpigmentation.
Sun exposure often reverses the results of therapy, compromising the lengthy treatment process. Consequently, the first line of therapy for hyperpigmentation is a broad-spectrum sunscreen used in conjunction with a phenolic agent such as a hydroquinone, or with a nonphenolic agent such as tretinoin, azelaic acid, or kojic acid. There are hundreds of sunscreen formulations with different UV absorbing chemicals in various concentrations.
Overall darkening of the skin may be due to pigmented chemicals in the skin.Silver, gold, and iron each have a characteristic color when visible in the skin. Several drugs and body chemicals, like bilirubin, can end up as depositsin the skin and discolor it.
Hyperpigmentation is caused by an increase in melanin, the substance in the body that is responsible for color (pigment). Certain conditions, such as pregnancy or Addison's disease (decreased function of the adrenal gland), might cause a greater production of melanin and hyperpigmentation. Exposure to sunlight is a major cause of hyperpigmentation, and will darken already hyperpigmented areas.
Melanin, a brown pigment manufactured by certain cells in the skin called melanocytes, is responsible for skin color. Melanin production is stimulated by a pituitary hormone called melanocyte stimulating hormone (MSH). Other pigments appear in the skin much less often.
hyperpigmentation and skin-lightening creams are sold over-the-counter that claim they will help these spots to fade more quickly. Most of them use a 2% hydroquinone solution, something that will not alter your natural skin tone. However, you should treat the entire skin area with the product and it will lighten a tan. If the 2% solution is not working for you, you can ask your dermatologist about getting a treatment with a stronger concentration.
The sudden onset of a single unraised, spot of even color tone (pink) is not the usual esthetic hyper-pigmentation we run across. More likely, that is a pre-cancerous atrophic keratosis which has become visible. The visible evidence is not alarming IF this is accompanied by a therapeutic regime, which may in fact have "lighted up" the spot.
Azelex does work for PIH, but it's a secondary agent, IMO. I usually go with HQ first, but use kojic acid or Azelex if they have issues with the HQ. I get a 6% HQ cream compounded locally for stubborn cases.
Skin sensitive to sunlight must be protected by shade or sunscreens with an SPF of 15 or greater. Skin cancers must be, and unsightly benign lesions may be, surgically removed. Laser surgery is an effective removal technique for many localized lesions. Because it spreads so rapidly, melanoma should be immediately removed, as well as some of the surrounding tissue to prevent ragwort.
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