Hyperpigmentation (excess skin darkening) is one of the most common reasons for patients to request an office visit or consultation with a dermatologist. The etiology of hyperpigmentation is multifactorial. Medications, acne, sun exposure, unbalanced hormones, oral contraceptives, unbalanced minerals, and adrenal insufficiency are amongst the most common causes of unwanted hyperpigmentation.

An in-depth evaluation, along with a detailed history and physical exam are crucial in order to establish an underlying etiology for the hyperpigmentation. If an accurate assessment is provided, the greater the chance is for therapeutic success.

In my 16 years of practicing dermatology and seeing many patients with hyperpigmentation, I noticed that many of these patients did not improve with most of the topical regimens i.e. hydroquinone, tretinion cream, chemical peels, microdermabrasion, and even laser. As a matter of fact, lasers cleared most people immediately and shortly thereafter, the hyperpigmentation recurred and was even worse than it was prior to laser therapy.

As I attended (and even now attend) most Cosmetic Dermatology meetings and conferences, I heard the “experts” providing information on which topical regimens would completely erase the hyperpigmentation. I tried the same things on my own patients that were advised by the expert dermatologists in hopes of finding a satisfactory solution. Again, not so!

As my frustration grew, along with my desire to offer the best treatments to my patients, I thought that the only way we could perhaps combat hyperpigmentation would be to learn the normal physiology of pigment synthesis and then evaluate each step in the pigmentary cascade. If one can understand the normal melanogenesis process, then one can attack the various levels where pathology takes place.

As I started to delineate the differences between normal pigmentation and abnormal hyperpigmentation, it started to become clear to me why we were not successful in treating our patients with hyperpigmentation.

To effectively manage hyperpigmentation, a successful strategy combines an integrative approach that utilizes treatments geared at treating the inside and the outside. As hormones (mainly estrogen) are frequently cited for melasma or hyperpigmentation, it is vital to describe that estrogen elevates copper levels and decreases zinc levels. If copper is not present or is deficient, melanin (the pigment protein) is not made. If there is no melanin produced, one will have milk white skin color. If we reverse the situation and one has excess copper, one will have much darker skin tones. So in conclusion, one of the most important factors in hyperpigmentation is to decrease copper levels.

Treating hormonal, vitamin and mineral imbalances along with a good balanced diet with fruits (blueberries, raspberries, pears) and vegetables (green leafy vegetables) from an internal approach and proper sun protection along with effective topical regimen (Vitamin A cream, Vitamin C, Glutathione, Niacinamide, Azelaic Acid, Arbutin, Hydroquinone, etc.) to an external approach will give our patients the best chance for an optimal and successful therapeutic outcome.

My Biodata:

Dr. Ayyaz M Shah
President, Global Dermatology Institute
Medical Director & Board Certified Dermatologist at Shah Dermatology, LLC
A Leading Physician of the World, The Leading Physicians of The World
Top Cosmetic Dermatologist, International Association of Dermatologists
Medical Advisory Board, Hair Loss Control Clinic
Top Doctor, LocateAdoc.com
Cosmetic Dermatologist, Covington Who’s who

Full scope dermatology practice offering medical, surgical and cosmetic dermatology. Procedures offered include: Laser Hair Therapy, Skin whitening, microdermabrasion, chemical peels, Botox, Dermal Fillers, Platelet Rich Plasma, skin biopsy, skin cancer surgery and much more.