Hyper-pigmentation

Hyper-pigmentation is excess production and deposition of melanin by melanocytes - the pigment-producing cells in the skin. The number of melanocytes you have and how much pigment they make determines your natural skin colour. Melanin production also rises with UV exposure, which is the skin's own protective response.

Hypo-pigmentation is the opposite: loss of pigment through reduced melanin.

The distinction that decides treatment

Hyper-pigmentation is classified by how deep the pigment sits:

Epidermal (superficial) - pigment in the outer layer. Generally the most responsive.
Dermal (deep) - pigment in the deeper layer. Harder to treat, slower to respond, and more prone to disappointment.
Mixed - both.

This classification is the single biggest determinant of which treatments are likely to work. It is assessed during consultation, and it is why a treatment that cleared a friend's pigmentation may do very little for yours.

Common causes

Sun exposure - by far the most common
Hormonal influence, including pregnancy and the oral contraceptive pill (see melasma)
Post-inflammatory pigmentation - marks left after acne, injury or an aggressive treatment
Genetics and skin type
Certain medications, which can make skin more reactive to sun
Ageing and cumulative damage - see age spots

Assessment first

Pigmented patches are examined before treatment. Several benign pigmented lesions look similar to each other, and some look similar to early melanoma. A patch that is new, changing, irregular in border or colour, or different from the others on your skin should be assessed before any thought of laser - because laser destroys the tissue and removes the ability to test it. See skin cancer and mole removal.

Skin type also matters. Darker skin types carry a higher risk of post-inflammatory pigmentation from treatment itself - which means an over-aggressive attempt to clear pigment can leave the skin darker than it started.

Treatments used for hyper-pigmentation

Depigmenting lotion treatments - topical agents that inhibit pigment production
Cosmeceutical skincare - retinoids, vitamin C and other antioxidants, pigment inhibitors
Chemical peels
Laser and light - Nd:YAG for deeper pigment, erbium and Fraxel for resurfacing, IPL for diffuse superficial pigment
Microdermabrasion and epidermal levelling
Skin needling
Mineral make-up - cover while treatment progresses, and a physical sun barrier

Most plans combine a topical regimen with in-clinic treatments. The topical part is not optional filler: pigment inhibition and sun protection between sessions are usually what determines whether a result holds.

What results are realistic

Epidermal pigmentation often lightens substantially over a course of treatment. Dermal pigmentation responds more slowly and less completely, and some does not clear.

Pigmentation is prone to returning, particularly where the driver - sun, hormones - is still present. Ongoing sun protection and maintenance are part of the plan rather than an afterthought. Individual results vary.

Risks

Post-inflammatory hyper-pigmentation - the treatment causing more pigment, particularly in darker skin types
Hypo-pigmentation - patches lighter than surrounding skin, which can be permanent
Redness, swelling, crusting and blistering
Scarring
Infection
Irritation or contact reaction to topical agents
Incomplete clearance and recurrence
Increased sun sensitivity after treatment

Some depigmenting agents and topical treatments are prescription-only and are not suitable in pregnancy. Tell your practitioner if you are pregnant, breastfeeding, or taking any medication. See risks and complications.

Cost

As at September 2024 and including GST, a skin assessment is $50 and a Cosmetic Doctor consultation is $150. Dermal skin treatments start from $130. A course is quoted after assessment. Cosmetic treatment is not covered by Medicare.

Booking

Me Clinic, 4 Burke Road, Malvern East VIC 3145. Phone 1300 852 050 or (03) 9569 3511, or use the online consultation form.

Individual results may vary. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.