Author: Dr Mpume Zenda.
I am Dr. Mpume Zenda (dr.gynae), let’s chat about hyperpigmentation. Whilst it’s not harmful and does not pose serious risk to one’s health, it certainly is distressing for many women. As an obs-gynae sexologist I see many women who struggle with hormonal hyperpigmentation and its impact on their self-confidence. My hope in partnership with BIODERMA, is to shed some light into the condition, as well as credible information that will assist in how you can deal with hyperpigmentation .
Let’s start with some definitions:
Hyperpigmentation
Uneven skin pigmentation (or hyperpigmentation as it is often known) is a common skin complaint. Dark spots – known as age spots or sun spots – or dark patches of skin frequently appear on the face, hands, and other parts of the body regularly exposed to the sun.
There are three types of hyperpigmentation. They are:
- Age Spots
- Melasma
- Post-Inflammatory Hyperpigmentation
Why does it occur?
Hyperpigmentation is caused by an excess in the production of melanin in your skin. Melanin is responsible for your skin’s colouring. If too much melanin is produced, hyperpigmentation occurs. Melanocyte-stimulating hormone is a collective name for a group of peptide hormones produced by the skin, pituitary gland, and hypothalamus. In response to ultraviolet (UV) radiation, its production by the skin and pituitary is enhanced, and this plays a key role in producing coloured pigmentation found in the skin, hair, and eyes. It does this by inducing specialised skin cells called melanocytes to produce a pigment called melanin; melanin protects cells from DNA -(1)'>DNA damage, which can lead to skin cancer (melanoma).
The melanocyte-stimulating hormone also affects a range of other processes in the body; it has anti-inflammatory effects, can influence the release of the hormone aldosterone, which controls salt and water balance in the body, and also has an effect on sexual behaviour.
Melanocytes, the cells that produce colour are stimulated to produce pigment by :
- Hormones (oestrogen and progesterone )
- Sun exposure
- Aging
- Injury to skin
Who gets it?
A direct consequence of high levels of the melanocyte-stimulating hormone is increased production of melanin. Melanocyte-stimulating hormone levels are also raised during pregnancy and in women using birth control pills, which can cause hyperpigmentation of the skin. Cushing's syndrome, due to an excess production of adrenocorticotropic hormone, can also lead to hyperpigmentation. other reasons include :
- Genetics plays a significant role
- This occurs more in women
- Occurs more in dark skin
- Occurs commonly in pregnancy
- Medical conditions (Addison’s disease, Cushing’s syndrome)
- Gynae conditions such as PCOS, women on a contraceptive pill
Hormonal hyperpigmentation:
Hyperpigmentation on the upper lip can occur due to hormonal changes Melasma – a form of hormone-induced hyperpigmentation – is common during pregnancy
Also known as chloasma, melasma is a condition where larger patches of hyperpigmentation develop mainly on the face. ”
Although it can affect both men and women, melasma is most common in women and is thought to be triggered by changes in hormone levels. Melasma occurs in 10–25 percent of women taking oral contraceptives and in 45-75 % of pregnant women is sometimes referred to as chloasma “the mask of pregnancy”.
Melasma is not in any way harmful but can cause distress when it is very noticeable.
The sun is a major contributor to, and aggravator of, the development of melasma, and other factors such as family predisposition, age, and certain anti-epilepsy drugs can also play a role.
There are three types of melasma:
- Epidermal melasma affects the top layer of skin and the discolouration is brown with well-defined borders.
- Dermal melasma affects the deeper dermal layers of skin and is characterised by blue-grey patches.
- Mixed melasma (a combination of epidermal and dermal) shows as a brown-grey pigment.
Is it reversible?
no curative treatment is available, significantly impacting the quality of life, including low self-esteem that leads to social consciousness, anxiety, and depressive symptoms. While melasma induced by pregnancy or photosensitising drugs has a better outcome after the causative factor ceases, most patients experience a chronic disorder, with seasonal variation and relapse after successful treatment, requiring post-treatment maintenance. In general, melasma fades with aging, and it disappears in most women after menopause, although extra facial melasma can persist longer
PREG MENSES POCOS
Changes in pregnancy:
Many women notice changes to their skin, nails, and hair during pregnancy. Some of the most common changes include the following:
- Dark spots on the breasts, nipples, or inner thighs
- Melasma—brown patches on the face around the cheeks, nose, and forehead
- Linea nigra—a dark line that runs from the navel to the pubic hair
- Stretch marks
- Acne
- Spider veins
- Varicose veins
- Changes in nail and hair growth
Almost all pregnant women experience some level of skin pigmentation, because of increased melanin production .reasons are not well understood but thought to be due to pregnancy hormones. Melasma “mask of pregnancy” affects mostly the face and can occur in up to 75% of pregnant women
Areas affected: sun-exposed, discrete localised areas where melanin density is higher
Most common skin pigmentation: Linea nigra, midline of the abdomen from below breastbone to the pubic bone.
Other common areas: areola ( around nipples ), underarms, anus, neck, inner thighs, and perineum
Post-partum most of the pigmentation fades away over several months. Characterised by the darkening of skin along the cheeks, forehead upper lip, nose, and chin. melasma fades within 1 year postpartum if it persists talk to your dermatologist.
Does my menstrual cycle predispose me to hyperpigmentation?
MENSTRUATION
Changes in skin pigmentation patterns related to the fluctuation of oestrogen receptors and progesterone receptors during menstruation, also known as catamenial hyperpigmentation, have been reported in several studies. Oestrogen and progesterone are two of the major factors responsible for catamenial hyperpigmentation of the skin. Generally, the changes happen in the luteal phase of the menstrual cycle when the serum levels of sex hormones are at their peak. Although the exact balance of influence is controversial, most recent studies indicate that oestrogen has a more prominent role than progesterone in inducing hyperpigmentation.
What about gynaecological conditions that cause hyperpigmentation?
Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine disorder affecting 5%-10% of women worldwide.
Diagnostic criteria is defined by the presence of at least two out of the three following findings: (a) oligomenorrhea or amenorrhea, (b) clinical signs or biochemical evidence of hyperandrogenism (HA), and (c) polycystic ovaries
PCOS patients usually present with skin manifestations of hyperandrogenism, such as acne, hirsutism, and androgenic alopecia.
The condition impacts how female ovaries function: PCOS can result in fertility problems, as well as irregular periods or absent periods, weight gain, thinning hair and female hair loss, and acne, and it can also be linked to skin pigmentation (i.e., PCOS hyperpigmentation).
The condition impacts how female ovaries function: PCOS can result in fertility problems, as well as irregular periods or absent periods, weight gain, thinning hair and female hair loss, and acne, and it can also be linked to skin pigmentation (i.e., PCOS hyperpigmentation).
According to the NHS, the exact cause of PCOS is unknown, yet most clinical evidence links it to abnormal hormone levels. Here are the common causes of PCOS.
- Excess insulin
- Inflammation
- Heredity
- Excess androgen
When should I be concerned and consult my doctor?
Melasma and age spots are harmless. Melanoma (a type of skin cancer) can be life-threatening. If you have any concerns about your dark spots – if they change shape, size, and colour or if they become itchy and start to bleed – it’s important that you consult your doctor.
What can I do at home to minimise hyperpigmentation?
TIPS:
- A sensible attitude to sun protection is the most significant step you can take to helping to prevent or reduce the severity of melasma.
- Limit the time you spend in the sun, keep out of the sun during its most intense hours, and wear protective clothing and sun hats whenever possible. This is particularly important if you have a genetic disposition to melasma (i.e., it runs in your family) or if you are pregnant, on the pill, or taking another form of hormone supplement.
- Sun protection is not just for sun-tanners.
- Please also remember the sun’s rays affect skin even on cloudy days, so give your skin the daily protection it needs.
What treatment options are available?
- Over and above a healthy diet, exercise
- At-home cosmetic-care
- Medication
- Dermatological treatments such as chemical peels and laser therapy and dermabrasion are often reserved for severe cases not responding well to non-invasive treatments. speak to your dermatologist
Last note:
Hormonal hyperpigmentation is often a chronic condition which means there are no shortcuts. Also, your skin is the largest organ of our bodies protecting us from so many harmful dangers, it is only right that we nurture and look after it. Always use credible information, and reputable cosmetic skin ranges, and when in doubt speak to a qualified professional regarding your skin.