Hyperpigmentation has multiple causes and may be focal or diffuse. Most cases are due to an increase in melanin production and deposition.

Focal hyperpigmentation is most often postinflammatory in nature, occurring after injury (eg, cuts and burns) or other causes of inflammation (eg, acne, lupus). Focal linear hyperpigmentation is commonly due to phytophotodermatitis, which results from ultraviolet light combined with furocoumarins in limes, celery, and other plants.

Hyperpigmentation also has systemic and neoplastic causes.

Melasma (chloasma):
Melasma consists of dark brown, sharply marginated, roughly symmetric patches of hyperpigmentation on the face (usually on the forehead, temples, and cheeks). It occurs primarily in pregnant women (melasma gravidarum, or the mask of pregnancy) and in women taking oral contraceptives. Ten percent of cases occur in non-pregnant women and dark-skinned men. Melasma is more prevalent and lasts longer in people with dark skin.Because all cases are associated with sun exposure, the mechanism probably involves overproduction of melanin by hyperfunctional melanocytes. Other than sun exposure, aggravating factors include:

Pigmented Skin

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  • Autoimmune thyroid disorders
  • Photosensitizing drugs


In women, melasma fades slowly and incompletely after childbirth or cessation of hormone use. In men, melasma rarely fades.

Treatment depends on whether the pigmentation is epidermal or dermal; epidermal pigmentation becomes accentuated with Wood's light or can be diagnosed with biopsy. Only epidermal pigmentation responds to treatment. First-line of therapy includes a combination of DNA Skin Care Product which is earmarked at the bottom of this page.

To buy the above products click on this link
, Buy DNA products

Lentigines: Lentigines (singular: lentigo) are flat, tan to brown oval spots. They are commonly due to chronic sun exposure (solar lentigines; sometimes called liver spots) and occur most frequently on the face and back of the hands. They typically first appear during middle age and increase in number with age. Although progression from lentigines to melanoma has not been established, lentigines are an independent risk factor for melanoma. They are treated with cryotherapy or laser.

Nonsolar lentigines are sometimes associated with systemic disorders, such as Peutz-Jeghers syndrome (in which profuse lentigines of the lips occur), multiple lentigines syndrome (Leopard syndrome), or xeroderma pigmentosum.

Diffuse hyperpigmentationdue to systemic disorders: Common systemic causes include Addison's disease (see Adrenal Disorders: Addison's Disease), hemochromatosis (see Iron Overload: Primary Hemochromatosis), and primary biliary cirrhosis (see Fibrosis and Cirrhosis: Primary Biliary Cirrhosis (PBC)). Skin findings are nondiagnostic as to cause.

Drug-induced hyperpigmentation: Changes are usually diffuse but sometimes have drug-specific distribution patterns or hues (see Table 1: Pigmentation Disorders: Hyperpigmentation Effects of Some Drugs and Chemicals ). Mechanisms include:


  • Increased melanin in the epidermis (tends to be more brown)
  • Melanin in the epidermis and high dermis (mostly brown with hints of gray or blue)
  • Increased melanin in the dermis (tends to be more grayish or blue)
  • Dermal deposition of the drug or metabolite (usually slate or bluish gray)


Focal hyperpigmentation frequently follows drug-induced lichen planus (also known as lichenoid drug reactions).

In fixed drug eruptions, red plaques or blisters form at the same site each time a drug is taken; residual postinflammatory hyperpigmentation usually persists. Typical lesions occur on the face (especially the lips), hands, feet, and genitals. Typical inciting drugs include sulfonamides, tetracycline Some Trade Names: ACHROMYCIN V, TETRACYN, TETREX, NSAIDs (especially phenazone derivatives), barbiturates, and carbamazepine Some Trade Names, TEGRETOL.
Most prescription creams used to lighten the skin contain hydroquinon and bleaching agents which are so dangerous to health and skin.


Most prescription creams used to lighten the skin contain hydroquinon and bleaching agents which are so dangerous to health and skin. 

Bleaching creams

Bleaching or skin lightening creams or ointments are widely used worldwide either to attempt to remove localised dark patches (e.g. melasma or postinflammatory hyperpigmentation) or as a fashion trend aiming to reduce normal melanin in the skin.

What do bleaching creams contain?

Bleaching creams may contain a variety of ingredients. Some of these are more effective than others. In many areas, unregulated products are sold, often without listing their contents or they are labelled incorrectly. They may be safe but completely ineffective, or the chemicals may result in side effects and toxicity.

Skin lightening agents may include:


  • Hydroquinone
  • Topical retinoids
  • Botanicals
  • Other agents
  • Topical corticosteroids
  • Mercury


What are the risks and side effects?

The risks depend on which ingredient is being applied to the skin, in what concentration, over what area, and for how long it is used.

Hydroquinone

Hydroquinone is an effective skin lightening agent. It is no longer available in some parts of the world because of the damaging affects of longterm use. The recommended concentration over the counter is 2%, but up to 4% is available from a dermatologist in some countries. It should be used daily for no more than 6 months.

Its initial effect of inhibiting pigmentation is lost with prolonged application and sun stimulation.

Exogenous ochronosis is the main risk of continued use. This results in an irregular blue-black staining affecting sun-exposed skin and nails. It is due to deep deposition of the same pigment that occurs in alkaptonuria (endogenous ochronosis). Exogenous ochronosis may also occur from phenol, quinine or resorcinol.

Ochronosis may also result in loss of elasticity of the skin and impaired wound healing.

In some subjects, excessive use of hydroquinone in combination with certain foods in the diet (fish, eggs, offal, beans) can result in an unpleasant fish odour in the body secretions such as sweat and urine (trimethylaminuria).

Hydroquinone is sometimes given another name, such as:


  • 1, 4-Benzenediol
  • Quinol
  • Benzene-1
  • 4-Diol
  • p-Diphenol
  • p-Dihydroxyl benzene
  • Hydrochinone
  • p-Hydroxylphenol
  • Hydrochinonium
  • Hydroquinol
  • Tequinol


Monobenzyl ether of hydroquinone is a strong derivative of hydroquinone that almost always causes nearly irreversible complete depigmentation of the skin (white patches).

Topical retinoids

Tretinoin is the main topical retinoid that has been used in skin lightening products. It thins the skin, increasing the penetration of other agents. as well as having a direct effect in reducing melanisation. It is a prescription medication because of potential risk in pregnancy. It can be quite irritating and may cause contact irritant dermatitis.

Botanicals

New active skin lightening compounds isolated from plants are being added to modern cosmetics. They appear to inhibit the production of melanin without being toxic to the melanocyte (tyrosinase inhibitors). It is not yet known which preparations are the most effective. Active ingredients include:


  • arbutin 1% (a glycosylated hydroquinone)
  • paper mulberry 1%
  • glabridin 0.5% (licorice extract)
  • Arctostaphylos patula and Arctostaphylos viscida
  • aloesin
  • gentisic acid
  • flavonoids
  • hesperidin
  • ascorbic acid or its derivative, magnesium ascorbyl phosphate 10%
  • niacinamide
  • yeast derivatives
  • polyphenols
  • soy proteins


Other agents


Other agents in use for their skin lightening effect include:


  • azelaic acid 20%, produced by the yeast, malassezia
  • kojic acid 1-4% (5-hydroxy-4-pyran-4-one-2-methyl), produced by a fungus (may cause contact irritant or contact allergic dermatitis)
  • mequinol 5-20% (4-hydroxyanisole)
  • isopropylcatechol
  • N-acetyl-4-cysteaminylphenol
  • N-acetyl glucosamine
  • piceatannol


Unregulated skin lightening creams may include many other ingredients. These may be relatively safe (e.g. lemon juice), toxic (e.g. camphor), irritating (e.g. detergents) or likely to provoke allergy (e.g. hair dye). Complications may include:



Topical corticosteroids

Topical corticosteroids lighten the skin by the following mechanisms.


  • Initial blanching due to vasoconstriction
  • Slowing down skin cell turnover so reducing the number and activity of melanocytes (pigment cells)
  • Reducing production of precursor steroid hormones thus reducing production of melanocyte stimulating hormone (MSH)


In New Zealand and many other countries, stronger topical corticosteroids are regulated and can only be obtained with a doctor's prescription. However products containing betamethasone valerate, fluocinonide and clobetasol propionate can be purchased over the counter from a pharmacy or from drug vendors in a market place in some places such as Nigeria.

Potent topical steroids have a wide range of local side effects including skin thinning and atypical fungal infections (tinea incognito). When used over large areas for prolonged periods, they may risk serious internal disease from hypopituitarism. Steroid addiction syndrome results in folliculitis and steroid rosacea.

Mercury

Mercury was used as mercurious chloride, oxide and ammoniated mercury in many cosmetics and toiletries in the early part of the 20th century, before it was realised it caused toxicity. It is still found in some skin lightening creams because mercury inactivates the enzyme that leads to the production of melanin.

Longterm application of mercurial products to the skin makes the skin and nails darker, because the mercury is deposited in the epidermis, hair follicles and dermis.Mercury poisoning results in acute and chronic toxicity including acrodynia, as well as neurological and kidney damage.


DNA Clinical Treatment Protocol:


  • MediClear Skin Lightening Wash™ 
  • CryoStem Lift Stick™ - 1-2 times per day
  • Floral Bliss™
  • MediClear 100% Vitamin C Crystals™
  • Supernatural Vitamin A Crème™ - A.M. Program
  • MediClear Skin Lightening Gel™
  • Phyto Collagen Night Crème™ - P.M. Program( For Normal To Dry Skin only)
  • Sunsation™ SPF 28 (4-6 times a day) 


To buy the above products click on this link, www.shop.flawlessskins.com  


Wearing a sunscreen is a must. The sunscreen must be "broad spectrum" (i.e. it blocks both UVA and UVB). A single day of excess sun can undo months of treatment.

Hyperpigmentation Effects of Some Drugs and Chemicals
Substance
Effect
Drugs
Amiodarone
Some Trade Names
CORDARONE
Slate-gray to violaceous discoloration of sun-exposed areas; yellowish-brown deposits in the dermis
Antimalarials
Yellow-brown to gray to bluish black discoloration of pretibial areas, face, oral cavity, and nails; drug-melanin complexes in the dermis; hemosiderin around capillaries
Bleomycin
Some Trade Names
BLENOXANE
Flagellate hyperpigmented streaks on the back, often in areas of scratching or minor trauma
Cancer chemotherapy drugs, including busulfan
Some Trade Names
MYLERAN, cyclophosphamide Some Trade Names
CYTOXAN
dactinomycin
Some Trade Names
COSMEGEN
, daunorubicin
Some Trade Names
CERUBIDINE
, and 5- fluorouracil Some Trade Names
ADRUCIL
(5-FU)
Diffuse hyperpigmentation
Desipramine
Some Trade Names
NORPRAMINImipramine
Some Trade Names
TOFRANIL

Grayish blue discoloration on sun-exposed areas; golden-brown granules in upper dermis
Hydroquinone
Some Trade Names
CLARIPEL
ELDOQUIN
SOLAQUIN
Bluish black discoloration of ear cartilage and face after years of use
Phenothiazines, including chlorpromazine
Some Trade Names
THORAZINE
Grayish blue discoloration on sun-exposed areas; golden-brown granules in upper dermis
Tetracyclines, particularly minocycline
Some Trade Names
MINOCIN

Grayish discoloration of teeth, nails, sclerae, oral mucosa, acne scars, face, forearms, and lower legs
Heavy metals
Bismuth
Blue-gray discoloration of face, neck, and hands
Gold
Blue-gray deposits around the eyes (chrysiasis)
Mercury
Slate-gray discoloration of skinfolds
Silver
Diffuse slate-gray discoloration (argyria), especially in sun-exposed areas