Uneven Skin Tone: Hyperpigmentation vs Hypopigmentation
Skin discoloration is one of the most common issues faced by our patients. Most pigmentation issues can be classified as either hyperpigmentation (darkening of the skin) or hypopigmentation (lightening of the skin) in nature. While both conditions can affect individuals with any skin tone, hyperpigmentation is more notable with persons of lighter skin tones while hypopigmentation is most visible in patients with darker skin tones. Either form of discoloration can result in an uneven skin tone due to the change in contrast compared to unaffected portions of the skin.
In this post we’ll discuss the differences between hyperpigmentation and hypopigmentation, along with preventive measures and treatment options for both conditions.
What is Hyperpigmentation of the Skin?
Hyperpigmentation occurs when melanin production increases in certain areas of the skin. The areas of the skin that experience increased melanin become darker in color (the degree of which depends upon the severity of melanin increase). The result is typically small patches of darkened skin (dark spots). However, hyperpigmentation can also occur on a wider scale and effect large areas of the skin.
What Causes Hyperpigmentation?
The most common causes of hyperpigmentation include:
Sun Exposure
Overexposure to the sun damages the skin which can lead to permanent hyperpigmentation. Melasma can also be triggered by too much sun exposure.
Hormonal Changes
Hormonal changes can lead to skin hyperpigmentation. Melasma, for example, is frequently associated with pregnancy. Addison’s disease, a deficiency in certain hormones, is also associated with hyperpigmentation.
Inflammation
Post-inflammatory hyperpigmentation, PIH, is darkening of the skin that occurs after injury, burns, or scarring from acne or psoriasis.
Medication
Hyperpigmentation is a known side effect of some over-the-counter and prescription drugs, such as NSAIDs.
Where Can Hyperpigmentation Occur?
Hyperpigmentation is most visible on the face, but commonly occurs where skin is exposed to the sun, such as the back of the hands, shoulders or chest.
Melasma, a type of hyperpigmentation driven by hormonal changes, most frequently appears on the face, although it can occur in any area prone to sun exposure.
Who Is Most Susceptible to Hyperpigmentation?
Any of the following put you at risk for developing hyperpigmentation:
- Advanced age
- Frequent sun exposure
- Limited sunscreen use
- Pregnancy or hormonal changes
- Addison’s disease or certain hormonal deficiencies
- Skin injury and scarring
- Acne or other skin-damaging conditions
Can Hyperpigmentation Be Prevented?
Hyperpigmentation is best prevented by avoiding excessive sun exposure and using sunscreen daily. Even when influenced by hormones, hyperpigmentation is worse where sun exposure occurs.
Hyperpigmentation Treatment Options
It’s best to treat hyperpigmentation when you first begin to notice it. While treating, prevent further damage by following a daily sun protection regimen. Treatment for hyperpigmentation includes the following:
Time
Some hormone-related cases may resolve on their own. Medication-induced hyperpigmentation, for example, often clears on its own when use of the medication is discontinued.
Chemical Peels
Chemical peels can reduce hyperpigmentation by removing the upper-most layer of skin, where excess melanin is stored.
Laser Therapy
Laser therapy and Intense Pulsed Light Therapy target and break down melanin in the skin, reducing hyperpigmentation.
What Is Hypopigmentation?
Hypopigmentation is a decrease in skin melanin. This leads to small or large areas where the skin is lighter than the rest of the body.
What Causes Hypopigmentation?
Common causes of hypopigmentation include the following:
Fungal Infection
Tinea Versicolor is one type of fungal skin infection that can lead to skin lightening.
Trauma
Burns, blisters, rashes or infections may cause skin lightening, either temporarily or permanently.
Auto-Immune Disease
Vitiligo is an auto-immune disease in which melanin-producing cells are damaged, causing light patches of skin on the face or body.
Where Can Hypopigmentation Occur?
Hypopigmentation can occur on the face or anywhere on the body. It’s sometimes more apparent on areas of the skin exposed to the sun, since darkening of surrounding skin increases contrast.
Who is Most Susceptible to Developing Hypopigmentation?
Any of the following put you at risk for developing hypopigmentation:
- Trauma or injury to the skin
- Fungal infection
- Auto-immune disease
Can You Prevent Hypopigmentation?
Not all forms of hypopigmentation can be prevented, but daily use of sunscreen is the best means for reducing its appearance. Sun protection prevents lighter skin from getting burned, and prevents surrounding skin from darkening, which reduces contrast.
Hypopigmentation Treatment Options
Hypopigmentation is treated differently depending on the cause.
Anti-Fungal Medication
Tinea Versicolor is treated with antifungal medications, which eventually reduce skin color changes.
Laser Therapy
Vitiligo and other forms of hypopigmentation may be treatable with low frequency laser therapy or light therapies such as IPL.
If changes to your skin color are worrying you, consult with your dermatologist to eliminate an underlying hormonal condition or infection. Your doctor can then recommend the best course of action to address both the cause and current condition.
Lela Lankerani D.O. received her undergraduate degree in Biology at Washington University where she graduated cum laude. Dr. Lankerani has published articles in several scientific journals and has presented at national scholarly meetings including the American Academy of Dermatology and American Osteopathic Academy of Dermatology.