Hyperpigmentation is one of the biggest concerns for Dr Sam’s customers, and Google searches are up 100% since 2019. Why?

Because it’s the biggest stealer of radiance.

But the good news is it’s one of the easiest beauty fundamentals to improve.

Hyperpigmentation is a catchall term that covers a number of different complaints, but the top three that I see in clinic are melasma, post-acne marks and sun damage - what we call solar lentigines, or sun spots - which are fixed, flat round brown lesions which don’t change in appearance with the season (unlike freckles). They don’t change much through the year, but they’re a culmination of a lot of UV exposure over time.

Melasma is distinctive in appearance with map-like patches of grey or brown pigmentation seen on the forehead, cheekbones and upper lip. It’s strongly influenced by genetics, and can be triggered by hormonal changes and UV and Visible Light exposure. Whereas post-acne marks are the red or brown footprints that remain after blemishes resolve.

So when it comes to tackling hyperpigmentation, here’s the top 10 behaviours and practices that really move the needle.

This is utterly crucial. Whilst the 3 commonest conditions mentioned are usually clearcut, there are more unusual conditions that can look similar but require very different treatment. If in any doubt, see a dermatologist.

We know that UV rays are a major culprit but it’s mainly a UVA issue - the rays that penetrate deeply into the dermis. So that means really paying attention to daily sunscreen use and it must be broad-spectrum - SPF15 in your foundation isn’t going to cut it as it only protects against UVB rays. Remember it’s the daily actions that really matter when it comes to your skin’s health. So use the right amount to get the promised level of protection on the pack and seek out an SPF 50 with broad spectrum protection, so you’re getting a UVA PF of at least 1 ⁄ 3 of the SPF level.

Visible light has a big role to play in hyperpigmentation, especially high energy blue light. It seems to produce darker and more persistent pigmentation in darker skinned individuals. This is especially problematic if you suffer from melasma. Unless you’re using non-micronized zinc oxide sunscreen (a rarity these days as it’s cosmetically inelegant) you’re not going to be protected by traditional UV filters. So consider an SPF with iron oxide - 2% is ideal, although it’s a challenge to get brands to divulge the actual amount present in their products. This inorganic filter scatters and reflects VL and some UVA1 too and has been proven to improve melasma control over time. It’s usually found in tinted sunscreens and in high coverage make-up.

We know that the generation of free radicals in our skin from pollution, UV and cigarette smoking can also trigger that pigmentation pathway. So one of the best ways to neutralise that effect is by incorporating ingredients that have antioxidant functions, into your skin care routine. Now, many different skin care ingredients have an antioxidant function, so it’s not just the likes of vitamin C. Many of the ingredients that suppress pigmentation, also exhibit antioxidant functions - for example bakuchiol is an effective antioxidant, as are niacinamide and retinoids. So a well structured routine contains sunscreen, ideally visible light protection and antioxidants will be your best bet at preventing future hyperpigmentation.

Next we look at the melanocyte itself, the cell that produces melanin and passes it into our skin cells, the keratinocytes. The most effective way of suppressing melanocyte function is to target an enzyme called tyrosinase, which is the rate-limiting step in the production of melanin.

The gold standard is topical hydroquinone, which we use on prescription in the clinic at a 4% strength and I would always recommend that this is done under the supervision of a physician because there is quite a lot of nuance to how its prescribed - in terms of how long for and the way it’s used - in order to be used correctly and safely.

Alternatives include azelaic acid, which is one of my favourite ingredients to use in rotation with hydroquinone and I really do like to adopt that practice with my pigmentation patients - this can be used at a strength of 5 to 20%; above 10% is prescription-only and you’ll get good results throughout that dose range. Azelaic acid is something that’s also very helpful because you can use it in lots of different settings, including pregnancy and breastfeeding, both of which are times when hormones can drive pigmentation to worsen. And it can even be used when other issues co-exist (like acne or rosacea).

Vitamin C has additional benefits to its antioxidant properties in inhibiting melanogenesis, or the manufacturing of melanin. And a final ingredient to consider is bakuchiol. Not only does it tend to reduce the activity of tyrosinase, it also has a suppressing effect overall on the activity of the melanocyte - this makes it a really useful new ingredient to have in our pigmentation toolkit.

So now you’ve controlled the melanin production, you can then look at controlling the melanin transfer into the skin cells, and the most notable ingredient for doing this is niacinamide - one of its key benefits is to reduce the activity of the ‘conveyor belt’ of melanin being exported into our skin.

The final consideration is exfoliation of melanin in existing skin cells, and its removal from our skin altogether. The two categories of ingredients that will stimulate this process most effectively are alpha-hydroxy acids and retinoids, both of which will encourage the elimination of keratinocytes from the stratum corneum.

What I also want you to appreciate from this overview of the ways we can impact pigmentation due to melanin in our skin is that many of those ingredients, if carefully chosen, can also tackle those other key causes of why we lose our glow. Niacinamide will boost skin barrier function and improve hydration. Azelaic acid will improve texture, as will AHAs; and retinoids and bakuchiol will improve the quality of your dermis. Azelaic acid will even redness.

It’s tempting to want a quick fix for skin issues - but I have to caution you, that if it’s faster, it’s also likely to be riskier. I’ve seen too many patients regret laser treatment for melasma or microdermabrasion for acne. This also applies to breakouts - if you pick or scratch your pimples you’re going to create a lot more pigmentation than if you just left it be!

Polypodium leucotomos is a very interesting fern extract from South America - it seems to developed some excellent survival skills as it transitioned from aquatic existence to land. Clinical studies have shown that it has antioxidant and photo-protective properties that help shield against the harmful effects from the sun. And it’s been found to improve melasma control in a clinical study in those who took it at a dose of 240mg twice a day.

So you can see that with carefully chosen ingredients that act at different points, you can target hyperpigmentation synergistically, but also get a lot of upside in terms of the general appearance of your skin, blemish management and overall radiance of your skin - nice!

I hope that’s helped you think about your hyperpigmentation in a really structured way. It involves quite a complex pathway - but if you break it down into these 10 action points, you’ll be making all the moves that matter!