Understanding Hyperpigmentation: Causes, Types, and Advanced Treatment Options
Hyperpigmentation is a common skin concern that affects individuals of all skin types and tones. At Karwal Aesthetics, we understand the impact that uneven skin tone can have on confidence and quality of life. This comprehensive guide explores the science behind hyperpigmentation, its various forms, and the evidence-based treatments we offer to address this condition effectively.
What is Hyperpigmentation?
Hyperpigmentation refers to areas of skin that appear darker than the surrounding skin due to excess melanin production. Melanin is the pigment responsible for skin, hair, and eye color, produced by specialised cells called melanocytes. When these cells become hyperactive or increase in number, they produce more melanin, resulting in darker patches on the skin.
The Science Behind Hyperpigmentation
According to research published in the Journal of Clinical and Aesthetic Dermatology, melanin production is a complex process influenced by various factors including UV exposure, hormonal changes, inflammation, and genetic predisposition. When the skin experiences trauma or inflammation, it can trigger a response that increases melanin production as a protective mechanism.
Common Types of Hyperpigmentation
1. Melasma
Melasma presents as symmetrical brown or grayish patches, primarily on the face. Research in the International Journal of Women's Dermatology indicates that hormonal influences play a significant role, with melasma affecting up to 50-70% of pregnant women. It's also common in those taking hormonal contraceptives or hormone replacement therapy.
2. Post-Inflammatory Hyperpigmentation (PIH)
PIH occurs following skin injury or inflammation, such as acne, eczema, or psoriasis. Studies in the Journal of the American Academy of Dermatology show that PIH is particularly prevalent in individuals with darker skin tones (Fitzpatrick types IV-VI).
3. Solar Lentigines (Sun Spots)
These small, darkened patches result from chronic sun exposure. Research published in Photochemical & Photobiological Sciences confirms that cumulative UV exposure is the primary cause, with prevalence increasing with age.
4. Freckles (Ephelides)
Freckles are small, flat brown spots that appear on sun-exposed areas. Unlike other forms of hyperpigmentation, freckles have a strong genetic component, as documented in studies from the Journal of Investigative Dermatology.
Hyperpigmentation vs. Tear Trough Deformity: Understanding the Difference
It's crucial to distinguish between hyperpigmentation and tear trough deformity, as they require different treatment approaches:
Hyperpigmentation Under the Eyes
True hyperpigmentation under the eyes is characterised by:
Darkening of the skin due to excess melanin production
Consistent color changes regardless of lighting or angle
Responds to topical depigmenting agents and procedures targeting melanin
Tear Trough Deformity
In contrast, tear trough deformity is characterised by:
A depression or hollow between the lower eyelid and cheek
Shadowing effect that can appear as darkness under the eyes
Often accompanied by volume loss and thinning skin
Changes appearance with different lighting or head position
Requires volumising treatments such as dermal fillers
According to research in Plastic and Reconstructive Surgery, tear trough deformities result from anatomical changes including fat pad displacement, ligament laxity, and bone resorption. While they may appear as dark circles, they require structural correction rather than pigment-targeting treatments.
Evidence-Based Treatments at Karwal Aesthetics
Our approach to treating hyperpigmentation is based on current scientific evidence and clinical expertise. We offer a comprehensive range of treatments tailored to individual needs:
1. Medical-Grade Topical Treatments
Hydroquinone
Considered the gold standard for treating hyperpigmentation, hydroquinone works by inhibiting tyrosinase, the enzyme responsible for melanin production. A systematic review in the Journal of the American Academy of Dermatology confirms its efficacy in treating various forms of hyperpigmentation with concentrations between 2-4% showing significant results within 8-12 weeks.
Vitamin C (L-Ascorbic Acid)
Our 20% Vitamin C formulations provide powerful antioxidant protection while inhibiting melanin synthesis. Research in Dermatologic Surgery demonstrates that vitamin C not only reduces hyperpigmentation but also provides photoprotection and collagen-stimulating benefits. The high concentration (20%) we use ensures optimal penetration and efficacy.
Retinoids (Tretinoin and Retinol)
These vitamin A derivatives accelerate cell turnover and disperse melanin while inhibiting tyrosinase. Studies in the Journal of Cosmetic Dermatology show that retinoids enhance the penetration of other depigmenting agents, making them valuable in combination protocols. Tretinoin (prescription-strength) offers more potent results, while retinol provides a gentler option for sensitive skin.
2. Advanced Injectable Treatments
Sunekos
This innovative treatment combines hyaluronic acid with a specific amino acid complex that stimulates fibroblasts to produce new collagen and elastin. Research published in Clinical, Cosmetic and Investigational Dermatology shows that Sunekos improves skin quality and can address issues like fine lines and uneven skin tone. While not directly targeting melanin, its skin regeneration properties help create a more uniform complexion.
3. Combination Approaches
Research in the Journal of Drugs in Dermatology supports combination therapy as the most effective approach for treating stubborn hyperpigmentation. At Karwal Aesthetics, we often combine:
Hydroquinone with retinoids for enhanced penetration and efficacy
Vitamin C for daytime antioxidant protection with retinoids for nighttime repair
Topical treatments with in-clinic procedures for comprehensive results
Treatment Protocol for Tear Trough Deformity
For true tear trough deformities, we utilise:
Dermal fillers to restore volume and correct anatomical depression
Specialised injection techniques to avoid complications in this delicate area
A conservative approach to ensure natural-looking results
According to research in the Aesthetic Surgery Journal, hyaluronic acid fillers provide temporary but effective correction of tear trough deformities with high patient satisfaction rates when performed by experienced practitioners.
Customised Treatment Plans at Karwal Aesthetics
Our approach begins with a thorough assessment to determine:
The specific type of hyperpigmentation
Contributing factors unique to each patient
Whether the under-eye darkness is true hyperpigmentation or a tear trough deformity
Skin type and sensitivity considerations
Previous treatments and responses
Based on this evaluation, we develop personalised treatment protocols that may include a combination of topical agents, in-clinic procedures, and maintenance regimens.
The Critical Role of Sun Protection
Research in the Journal of the American Academy of Dermatology emphasises that without consistent sun protection, even the most effective hyperpigmentation treatments will have limited success. UV exposure stimulates melanocytes and can quickly reverse treatment results. We recommend:
Daily application of broad-spectrum SPF 30-50
Physical sun protection (hats, sunglasses)
Reapplication every 2 hours when outdoors
Year-round sun protection, regardless of weather conditions
Conclusion
Hyperpigmentation requires a multifaceted approach based on its specific type, contributing factors, and individual skin characteristics. At Karwal Aesthetics, our evidence-based protocols combining hydroquinone, high-concentration vitamin C, retinoids, and advanced treatments like Sunekos provide comprehensive care for this common concern.
Equally important is the accurate diagnosis between true hyperpigmentation and tear trough deformity, as the treatment approaches differ significantly. Our expertise allows us to distinguish between these conditions and recommend the most appropriate interventions.
If you're struggling with uneven skin tone or under-eye concerns, we invite you to schedule a consultation at Karwal Aesthetics, where science meets artistry in addressing your unique skin needs.
References
Vashi NA, Kundu RV. Facial hyperpigmentation: causes and treatment. Br J Dermatol. 2013;169(Suppl 3):41-56.
Sarkar R, Arora P, Garg VK, et al. Melasma update. Indian Dermatol Online J. 2014;5(4):426-435.
Brenner M, Hearing VJ. The protective role of melanin against UV damage in human skin. Photochem Photobiol. 2008;84(3):539-549.
Sofen B, Prado G, Emer J. Melasma and Post Inflammatory Hyperpigmentation: Management Update and Expert Opinion. Dermatol Surg. 2016;42(5):619-630.
Desai SR. Hyperpigmentation therapy: a review. J Clin Aesthet Dermatol. 2014;7(8):13-17.
Stamatas GN, Zmudzka BZ, Kollias N, Beer JZ. Non-invasive measurements of skin pigmentation in situ. Pigment Cell Res. 2004;17(6):618-626.
Pinnell SR, Yang H, Omar M, et al. Topical L-ascorbic acid: percutaneous absorption studies. Dermatol Surg. 2001;27(2):137-142.
Kang S, Duell EA, Fisher GJ, et al. Application of retinol to human skin in vivo induces epidermal hyperplasia and cellular retinoid binding proteins characteristic of retinoic acid but without measurable retinoic acid levels or irritation. J Invest Dermatol. 1995;105(4):549-556.
Starkman SJ, Mangat DS. Hyaluronic Acid in Facial Rejuvenation. Facial Plast Surg Clin North Am. 2019;27(3):311-320.
Pilkington SJ, Belden S, Miller RA. The Tricky Tear Trough: A Review of Topical Cosmeceuticals for Periorbital Skin Rejuvenation. J Clin Aesthet Dermatol. 2015;8(9):39-47.
Book Your Consultation Today
Ready to address your hyperpigmentation concerns with our evidence-based treatments? To book a consultation with a member of our team, please book online through our secure booking system.
Our specialists will provide a thorough assessment of your skin concerns and develop a personalised treatment plan tailored to your specific needs.
Comprehensive skin analysis
Personalised treatment recommendations
Expert advice from qualified medical practitioners
Take the first step towards clearer, more even-toned skin by scheduling your appointment today. Our clinics are located in London Mayfair and London Kingston.
