Treating Hyperpigmentation In Skin Types 4-6

Skin of colour -

a) Common causes of hyperpigmentation in dark skin

Deep skin generally ages at a much slower rate, mainly due to the extra protection provided by melanin. A disadvantage of having more melanin is the greater ‘reactiveness’ of the skin. The slightest stimulus such as a scratch, rash or inflammation may trigger the production of excess melanin. Excess melanin appears on the skin as dark spots or patches on the skin. This is known as post-inflammatory hyperpigmentation.

Hyperpigmentation can also be present at birth. A common area includes the intimate area and inner thighs. This long-standing excess pigment differs from post-inflammatory hyperpigmentation in that the staining sits deeper within the skin and therefore more difficult to treat.

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b) What treatments are available for hyperpigmentation on the NHS?

There is very limited help on the NHS for hyperpigmentation. Ultimately, it boils down to why you have hyperpigmentation and the reason you want it removed. Unless you can prove a medical reason, treatment is extremely unlikely to be provided. Hyperpigmentation, particularly in deep skin is prolific. It is part of our natural body defence system with chances of reoccurrence being great.

A condition such as melasma may allow treatment on the NHS. It most likely would’ve been brought on through pregnancy, for example, a medical reason.

Hyperpigmentation as a result of stage 4/5 acne may also be eligible along with treatment of the acne itself. Hyperpigmentation as a result of Keratosis Pilaris is unlikely to be available. KP is chronic and has no cure. The same can be said for birthmarks or dark inner thighs that we’ve always had.

A quick look at the hyperpigmentation page on the NHS suggests private aesthetic treatments and over the counter cosmetics. Don’t feel discouraged. An advanced aesthetic practitioner can guide along with non-invasive and accessible treatments. A cosmetic doctor is able to offer more invasive treatments should they be required.

The best thing we can do is arm ourself with an effective skincare routine, maintenance & treatment plan. Identify the right formulas to suit individual skin needs. Gradually over time, results will be apparent.

If you’d like to look at the suggestions from the NHS the webpage. They’ve entitled the page skin lightening

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c) Self-treating hyperpigmentation through online pharmacies

Hyperpigmentation can be extremely upsetting. The remedy is often sought through self-care which can include prescription medication. Such drugs have become widely available online through pharmacies located in Asia. As such, the cost of these products can be extraordinarily cheap & tempting.

Legally available through a prescribing medical professional, many of these online pharmacies only ask for self-declaration of owning a prescription. They will often not ask for it to be produced.

Over the counter products may seem to have a weak or undesirable effect. It’s easy to become overwhelmed with the array of products on the market and the assumption is if it’s medical-only it is strong and will work.

Why does prescription medication exist?

Medical professionals have years of education and training. It’s their job to guide their patients. Not only will they know the correct medications we need but how to use it properly. Self-treating always carries the risk. The greatest advantage of prescription medication is guidance.

However, with enough research, can we successfully treat ourselves?

A common prescription drug is hydroquinone. A gold standard in skin bleaching as described by many medical professionals. Hydroquinone has been linked to cancer. Studies in rodents have shown some evidence that hydroquinone may act as a carcinogen or cancer-causing chemical. Although, cancer-causing properties have yet to be proven in humans hydroquinone is banned in the UK.

Hydroquinone is available over the counter in America at strengths of 2%. General safety measures of using hydroquinone involve cycling. Using the products for a few months at a time then substituting the following months with an alternative. Long-term use of hydroquinone has been linked to ochronosis, skin darkening and disfigurement.

Another common, probably most popular prescription drug for hyperpigmentation is Tretinoin (Retin A). Tretinoin is a derivative of vitamin A and is available over the counter and prescription strengths. It causes the cells of the skin to grow (divide) and die more rapidly.

Tretinoin increases cell turnover reduces the layers of cells in the skin with new cells replacing old thus promoting a brighter, youthful complexion. Risks associated with Tretinoin include sun sensitivity. Protection is paramount as significantly worsened hyperpigmentation is possible.

Self-treating with medication often accompanies feelings of desperation. Desperate feelings about ones’ physical appearance calls for medical advice. An aesthetic therapist can guide through skin regenerative treatments and general skincare maintenance but it would be irresponsible to treat a client with feelings of desperation.

Body dysmorphia is a distinct mental disorder in which a person is preoccupied with an imagined physical defect or a minor defect that others often cannot see.

Hyperpigmentation can be treated through pharmaceuticals and cosmeceuticals, which are not the same as over the counter. The first step in treating hyperpigmentation is exfoliation or skin priming as discussed later.

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d) Microneedling for treatment of hyperpigmentation in dark skin

“Dermapen is fast-becoming a popular choice in skin rejuvenation and is used to treat pigmentation, acne scars, stretch marks and fine lines and wrinkles, among other skin concerns. It’s become quite praised due to its low-risk and having a minimal downtime. As soon as you receive the treatment, your body responds by producing new collagen, elasticity and skin cells.”

“Interestingly, it was previously only used as medical treatments until a few years ago where beauty therapists started offering it as part of skin rejuvenation treatments.”


The process

  • The area is first cleansed so that it’s makeup and dirt-free.
  • Numbing cream may be applied to prevent any pain.
  • Following 15–20 minutes, a serum – suited for your specific skin type and skin condition can be applied, a process commonly known as Mesotherapy.
  • The treatment can be applied which is relatively quick but will depend on where the treatment is being performed.
  • The level of penetration depends on the results we’re looking for.
  • Needle depth ranges from 0.5mm up to 3mm with 3mm+ reserved for the body & stretch marks. To learn more about micro-needling see A guide to micro-needling for skin rejuvenation

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e) Chemical peels for treatment of hyperpigmentation in dark skin

Chemical peels use natural derivatives to break down the top layer, or layers of skin. This process diminishes the look of fine lines, wrinkles and uneven skin tone. Chemical peels are incredibly versatile and effective in the treatment of hyperpigmentation in deep skin. Typically used on the face chemical peels are equally effective on the body too. Acne on the back aka as bacne can see incredible results.

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f) Why mandelic acid is the perfect choice for hyperpigmentation in dark skin

More melanin means more melanocytes and therefore greater risk of skin injury-causing irritation which can trigger excess pigmentation. Consequently, deeper skin should be treated less aggressively than fairer skin. Mandelic acid is gentle and fits our requirements perfectly. It has a larger molecule allowing a slower absorption by the skin.

Glycolic acid has a small molecule which allows fast absorption by the skin. Glycolic acid is therefore classed an aggressive peel. It induces rapid turnover and is an optimal choice for lines & wrinkles in fairer skin. Too much irritation too quickly is bad news for skin types 4-6. This process can trigger an inflammatory response with greatly worsened hyperpigmentation the likely result.

Does the larger molecule of mandelic acid mean it’s weaker or less effective? Absolutely not. It simply means, it works slower and therefore safer.

Mandelic acid amongst its micro-exfoliating properties has the ability to lift the excess pigment from the surface of the skin. And unlike other acids, mandelic works in the deeper skin layers to inhibit melanin production. It is anti-bacterial, anti-fungal and anti-inflammatory. It clears dead skin cells, kills bacteria, reduces redness and inflammation, and helps to diminish the appearance of acne scars.

Mandelic acid has benefits for ageing skin as well. It accelerates cell renewal making skin appear lighter, brighter, firmer, and smoother. At the same time, mandelic acid promotes collagen production to increase skin’s elasticity and youthful appearance. And thanks to mandelic acid gentle action, it’s an option in the treatment of hyperpigmentation in the intimate and inner thigh area.

Besides traditional on-off chemical peel treatments, mandelic can be purchased in lower leave on form. Such cosmetic products work well in priming the skin and in between chemical peel treatments.

Mandelic Acid 10% + HA

Mandelic Acid 10% + HA offers superficial dermal peeling that is gentler than other alpha hydroxy acids. Mandelic acid to penetrates the skin more slowly which in turn makes it very gentle and suitable for all skin types. You don’t need a concentration of more than 10%, because then you would simply be achieving an indirect peeling strength that is more easily offered through lower percentages of glycolic acid.

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g) Laser treatment of hyperpigmentation in dark skin

Laser resurfacing is one of the top nonsurgical cosmetic treatments. Until recently, lasers were exclusively used on lighter skin tones. Today, there are devices that can safely treat varied skin tones. They work on the premise of faster pulses which generates less heat. This means they’re less likely to cause scarring on deeper skin.

Laser resurfacing can be used to zap away scars, blemishes, birthmarks, sun spots and more. Treatment is commonly performed with a Pico laser.. name brands include PicoSure, PicoWay and Pico Genesis.

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h) The importance of skin priming the skin in preparation for treatment

Skin priming is of utmost importance in skin types 4-6. Lack of or too much too quickly can be detrimental to achieving skin goals. Black skin can be extremely sensitive and is the most reactive of all skin types.

Skin priming allows the skin to prepare for exfoliative and regenerative treatments. This process will prevent the skin from experiencing ‘shock’ when such treatments are performed. Too much, too soon can cause irritation which leads to inflammation and subsequently hyperpigmentation. It’s possible to end up on a vicious cycle of uneven skin tone.

Skin priming is easy. 2-3 weeks before a regenerative treatment we shake up our skin kit to include a targeted cleanser, moisturiser, serum and exfoliator. An aesthetic therapist can aid in product selection to allow the best possible results from aesthetic treatments.

Treatment of hyperpigmentation is progressive. Skin priming should continue for the duration of any professional treatments to see the greatest result. We prep before and keep up the skin routine following each treatment which is usually performed every 4-6 weeks over a course of 3-6 treatments.

Skin priming is good practice for all skin type. It is especially important for deeper skins due to the higher reactivity of the skin. To get a better understanding of the products we should be using, take a look at a guide to cosmeceuticals and skincare products.

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i) Skincare products for the treatment of hyperpigmentation in dark skin

Mesoestetic De-pigmentation Skin Preparation Kit

Used for 2 weeks in preparation for a chemical peel treatment.

  • Optimises your results.
  • Ensures even penetration.
  • Reduces the risk of adverse reaction or PIH
  • Encourages cell turnover.
  • It will start to treat the problem.
  • Introduces the skin to quality result-lead ingredients.

Ultimate W+ whitening foam. Cleanses and purifies the skin in-depth, effectively removing make-up and eliminating dead cells and impurities. ACTIVE INGREDIENT: Glycolic & Lactic Acid, AHA’s to encourage skin regeneration and boost the skin’s natural barrier function. Aloe Vera has a powerful moisturising, soothing and whitening effect.

Brightening Peel Booster. Renewing and lightening gel for hyperpigmentation, uneven tone, imperfections and signs of photo-ageing. It reduces melanogenic activity. ACTIVE INGREDIENT: Glycolic Acid 10% AHA to stimulate cell renewal and significantly increase moisture in the dermis. Phytic Acid 2% De-pigmenting and anti-oxidant effects

Ultimate W+ essence. Intensive whitening and anti-oxidant serum. Prevents and reduces dark spots. ACTIVE INGREDIENT: the [meso] white complex® to inhibit melanin synthesis and Garden Cress, a strong phytonutrient that inhibits binding of a-MSH to its receptor, reducing the appearance of dark spots and providing whitening benefits.

Light Water Anti-Aging Veil SPF50+. Very high sun protection for normal and combination and dry skins. Combines physical and chemical UVA, UVB filters with biological HEV + IR filters. Antiaging Action

Sample skincare routine for pigmentation with The Ordinary

Skincare for AM

Alpha Arbutin 2% + HA – Apply AM & PM

Niacinamide 10% + Zinc 1%

Magnesium Ascorbyl Phosphate 10%

Skincare for PM

Azelaic Acid Suspension 10%

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