Hyperpigmentation means the abnormal darkening of skin, usually in a specific area of the body. This may be due to an injury, such as a burn, or from inflammation, such as an infection (e.g. a skin infection that was treated). Normal pigmentation is from melanin which is produced by melanocyte cells in the skin. Anytime there is an inflammatory stimulus, melanocytes might be triggered to produce extra melanin as part of the healing process. Increased melanin production by the melanocytes occurs in response to thermal changes and inflammation. It usually goes away but may last anywhere from a few weeks to many months. It is different from scarring. Scarring means that there is increased collagen production in the area and that the texture of the skin has changed. Hyperpigmentation causes no textural change of the skin, just a change in color.
Laser treatment of the skin can also occasionally lead to hyperpigmentation. Any laser transmits light into the skin. If there is heat generated or cells damaged, inflammation and thereby hyperpigmentation may be stimulated. The ideal in most cosmetic laser treatment is to target specific elements within the skin, such as hair or age spots, and avoid thermal damage to surrounding structures. This kind of targeted approach is usually successful in avoiding hyperpigmentation.
In published research, it has been shown that darker-skinned patients are more likely to be affected by hyperpigmentation when treated for laser hair removal. Darker skin types may have a 10 times risk versus the lightest skinned patients. In hair removal, some lasers have a lower risk of hyperpigmenation than others. The diode laser, for instance, has a much lower risk than the ruby. For this reason, the ruby is no longer commonly used for hair removal.
THe main treatment for hyperpigmenation has been hydroquinone. It varies in strengths from 2% to 4% or much higher. Hydroquinone works by blocking the tyrosinase enzyme which is important in the making of melanin. It is not recommended for long term use but may be very useful in the short term to prevent hyperpigmentation in patients prone to it who are receiving laser hair removal or other laser procedures. It may even be used as pre-treatment in darker-complexioned patients. There are many natural alternatives to hydroquinone, such as kojic acid, azelaic acid, and licorice extract. Their effectiveness in comparison to hydroquinone has not been well-tested.
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