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Hyperpigmentation: Treating Pigmentation Issues in Black Skin

You might have heard the term ‘pigmentation’ used in aesthetics and dermatology, but what exactly are pigmentation issues, and how can you effectively treat them? I spoke to GP and aesthetic practitioner Dr Joyce Ameh to get the scoop.

Hi Dr Joyce. Ok, so first things first - what is pigmentation?

We all have pigment within our skin. In fact, pigment is the substance that is responsible for skin colour. The pigment within our skin is called melanin, and melanin is produced by cells called the melanocytes. People who have darker skin have very active melanocytes, so they produce a lot more melanin compared to people who have lighter skin.

Pigment is also the reason that we are blue-eyed, green-eyed or brown-eyed, have blonde hair, red hair or dark hair. The reason we have different colour hair, skin and eyes is down to the quantity of pigment in those structures.

So, when you talk about pigmentation issues, what exactly are you referring to?

When we talk about pigmentation problems, we are referring to an over exaggeration of the natural quantity of pigment within in your skin. For example, if a person develops brown spots - freckles or lentigines - that is a pigmentation issue. Babies are not usually born with freckles; they are something that can develop with sun exposure; however, they are not problematic.

There are two main types of pigmentation conditions – hyperpigmentation when you have excessive amounts of pigment in the skin and hypopigmentation when there is a reduced amount of pigment within the skin. Let me explain in a bit more detail...

Hyperpigmentation is a type of pigmentation condition that occurs as a result of the production of too much melanin by the melanocytes. This causes darker patches on the skin & these patches can be irregular. This can cause a lot of distress to clients, and I have seen women use copious amounts of makeup to cover the patches. It affects their confidence a great deal. One type of hyperpigmentation is melasma, which tends to be caused by hormonal changes, and often occurs during pregnancy or while taking the contraceptive pill. It may go away on its own once the hormone levels are back to normal, i.e. once the pregnancy period is over, or the patient has stopped taking the pill. There are some people, though, who are predisposed to melasma and develop chronic melasma, which is much more difficult to treat.

Then, there’s hypopigmentation, which is where the melanocytes don’t produce enough melanin, resulting in lighter patches on the skin. These can show up in small areas or all over the body and, once again, it can be extremely distressing.

When we refer to pigmentation problems in aesthetics, we’re talking about more significant issues. More specifically, the overproduction of melanin as a result of too much sun, or due to trauma to the skin. One of the most common things I see clients about is post-inflammatory hyperpigmentation (PIH) following skin trauma. Lots of things can traumatise the skin – acne, chemical peels, laser treatments, microneedling. All these can trigger inflammation and, subsequently, the client can be left with darker, irregular patches. Essentially, any form of trauma to the skin can trigger the melanocytes to start producing more melanin than usual, resulting in post-inflammatory hyperpigmentation. You generally find more pigmentation issues in people whose melanocytes are already very active, which means that people of colour are most at risk. The issue is that many practitioners are not clear about how to effectively and safely treat black skin, which can lead to further issues.

So, how do you prevent post-inflammatory hyperpigmentation in black skin?

It is not too difficult – it is all about skin preparation. Before doing a chemical peel, laser treatment or IPL on a person of colour, it is necessary to prepare the skin for a number of weeks leading up to the treatment. By this, I mean optimising the clients’ current skincare routine and updating to a good regimen that can start to work on the skin condition, especially improving the skin's moisture level and also applying products that work on the melanocytes and sedate them, so to speak, so as not to cause an overproduction of melanin. I also make sure they’re applying a good SPF. The idea that black people don’t need to wear SPF is very much a myth.

How do you treat pigmentation issues like post-inflammatory hyperpigmentation?

If someone came to me with a pigmentation issue, I would do a full and thorough consultation to try and determine the cause, the depth and the duration of the issue. I always do a skin analysis to see if the pigmentation is superficial or deep. Post-inflammatory hyperpigmentation, fortunately, is not difficult to treat, as long as it’s done properly.

Possible treatments for post-inflammatory hyperpigmentation actually include treatments that can (in the wrong hands) cause pigmentation in the first place! In my practice I regularly use topical skin agents as well as chemical peels and microneedling to treat the condition. Other treatments include laser and IPL. The important thing is to be well-versed in treating ethnic skin and understanding the issues that can arise from certain treatments.

It is essential that you go to see a practitioner who knows the Fitzpatrick scale and how to treat patients of colour - and be able to truly recognise and treat issues that can occur in black skin without making them worse. Also, the practitioner should be able to identify more serious types of pigmentation issues, such a worrying moles and melanomas, and make appropriate assessments.

What other pigmentation problems can people suffer from?

Older women are particularly prone to sunspots otherwise called age spots or solar lentigines. You usually see them on the temple or on the cheeks and on the backs of the hands. They are usually harmless, and I treat them in my clinic with either skin peels or cryotherapy after a thorough assessment has been done

I really do enjoy treating pigmentation issues in my clinic – it is quite a rewarding treatment and it always gives me great pleasure to see the results.

Thanks, Dr Ameh! It was a pleasure chatting with you and hearing how passionate you are about treating pigmentation issues.

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