Hyperpigmentation is the Latin term for excessive pigment or discolouration. Hyper means excessive and this presents clinically with patches of darker discolouration in the skin. Pigment is produced in the skin by highly specialised cells called melanocytes which are referred to as the pigment producing cells. The melanocytes are very sophisticated cells that produce our pigment which is called melanin then packs this pigment into small packets called melanosomes. These melanosomes are then transferred through tentacles which are finger-like projections of the melanocytes and distributed to nearby skin cells which are called keratinocytes. It is the presence of melanin in the keratinocytes that gives the skin colour we have. Darker skin individuals produce more melanin and their keratinocytes have more melanin compared to fair skin individuals. This process of melanin production is highly specialised and involves some key enzymes to initiate the melanin production as well as ultraviolet light which stimulates the melanocytes into action.
Hyperpigmentation clinically can result from a number of different causes. This can be due to certain diseases that affect the melanocytes leading to excessive pigment production or due to physiological reasons such as excessive sun exposure which leads to stimulation of the melanocytes. In some cases there are multiple factors that play a role in the development of hyperpigmentation such as a primary disorder related to the melanocytes as well as excessive sun exposure. It is therefore recommended that for any successful treatment of hyperpigmentation adequate sun protection measures are used to minimise the stimulation of the melanocytes.
There are a number of treatments for hyperpigmentation ranging from topical creams to chemical peels and lasers. Depending on the type of hyperpigmentation one particular treatment method may be preferred. In general topical creams which act on slowing down the enzymes that are involved in initiating the melanin production as well as its transfer to keratinocytes are used. These can be over-the-counter creams or prescribed by the dermatologist. Chemical peels can be used to exfoliate the skin that contains the pigment and are used in conjunction with the creams. Lasers can be highly effective in the treatment of hyperpigmentation and the choice of laser will depend on the diagnosis.
It is advisable that a correct diagnosis of the type of hyperpigmentation is established first by the dermatologist and appropriate treatment options explained.