Hyperpigmentation: A reader’s question(s)

About 3 years ago I began to develop melasma from birth control pills, which I discontinued. I have discoloration above the lip (like a dark mustache), on my forehead near the hairline, directly above my eyebrows, and various other patches. I went to a dermatologist, stayed out of the sun, and used two different prescribed bleaching creams and was scrupulous with sunscreen.

Both products worked well superficially, but during the sunnier months, the darkness came back. Then, one of the products gave me whiteheads, which I still have to this day. I no longer use those bleaching products, and I still have hope that this condition may reverse itself.

Can you make some recommendations? Right now I use drugstore products. Have you ever had a client experience a total reversal of melasma? Do I have hope, or am I doomed to wear this shadowy mustache for the rest of my life?

This email says a lot. She developed hyperpigmentation (also called melasma or chloasma) from taking the Pill; she tried, unsuccessfully, to use prescription bleaching treatments; she is frustrated and is looking for a miracle (reversal of this condition). The questions and their answers are important to understand if you are ever going to take hold of your hyperpigmentation and have more evenly pigmented skin. The answers, however, may not be what you want to hear. Let’s break this email down into smaller pieces.

About 3 years ago I began to develop melasma from birth control pills. When you are pregnant, on the Pill (when your body thinks you’re pregnant), going through perimenopause, or just having fluctuations in your hormones (perhaps showing up as irregular periods), the result may be the same: hyperpigmentation or brown spots. Hormones can and do cause photosensitivity. Translation: hormones make your skin sun-sensitive. And although men are subject to hyperpigmentation (men have hormones too!), it is the hormone fluctuations females experience that can really cause pigmentation irregularities.

I went to a dermatologist, stayed out of the sun, and used two different prescribed bleaching creams and was scrupulous with sunscreen. It is common for people to seek the advice of a dermatologist for help in lightening their pigmentation spots. She had the right idea as far as staying out of the sun and always using sunscreen. It is direct sunlight that is going to darken the spots; no matter how long you are in the sun— minutes or even seconds—it all adds up.

Both products worked well superficially, but during the sunnier months, the darkness came back. The prescription creams or even over the counter types are only going to work to change what is on the surface of your skin. They are not meant to go deeper. But, and this is important, trying to treat the pigmentation problems in the warmer months is almost always going to be a lesson in futility. 

During the sunnier months, the sun is literally closer to the earth, and therefore the UV rays are going to be stronger. It’s just a fact. So the best time to try bleaching or lightening hyperpigmentation is during the cooler months of the winter. You are inside more, unless you live in Florida or another year-round sunny climate, and you just aren’t exposed to the degree you are in the summer months. I tell my clients if they are going to try to get rid of the spots, wait until the fall or winter when their efforts will possibly give them some results. 

Unfortunately, trying to treat the brown spots in the summer— especially if you are outside a good deal—for the most part is going to be all for naught. Summer is for prevention, preventing an increase in the darkness and preventing new pigmentation; winter is for lightening, due mostly to less UV radiation and any lightening creams you may be using.

Then, one of the products gave me whiteheads, which I still have to this day. I no longer use those bleaching products. I’m not sure why whiteheads were forming, but perhaps there was an ingredient in these prescription creams that this reader’s skin couldn’t tolerate—something too thick and occlusive. Discontinuing use of a product that appears to be doing something negative to your skin is always a good thing. In this particular case, I would recommend that you get in touch with your dermatologist, explain your complaint (whiteheads from the pigmentation creams), and see what he or she says. Perhaps there is another prescription treatment you can try that would work just as well on the spots without causing other conditions, like whiteheads.

I still have hope that this condition may reverse itself. The reversal is only possible if sunlight is no longer a factor. Obviously I am not advocating not going outside, but you have to get used to the idea of covering your face physically. This is done with hats or even putting your purse up to block the sun on your face while you are walking to and from your car. You will have to become diligent and conscientious of any and all sun hitting your face if you truly want to reduce the color of these spots. I don’t view hyperpigmentation as curable, but it can be managed by making awareness of the sun a habit—for life.

Can you make some recommendations? Right now I use drugstore products. Again, my answer is not the one you are looking for. The “product” to watch out for is the sun. Try any and all of the products available for reducing the darkness of chloasma, but in my experience they don’t give the 100% results most people are looking for. There are laser procedures constantly being invented, and lasers for hyperpigmentation are no exception. Check with your dermatologist to see if there is a laser that can help with pigmentation irregularities. But be aware: sometimes these procedures can cause more harm than good. Do your research and proceed with caution.

Have you ever had a client experience a total reversal of melasma? I will speak for myself here. I haven’t seen a “total reversal” of my melasma, but because I am so hyperaware of sun on my skin, I have decreased the look of hyperpigmentation on my face a thousandfold. Most people can’t see the pigmentation spots because they are so faint. I can because it’s my face, but the spots are so light even I don’t notice them anymore. In the summer, especially if I’m roller blading or playing a lot of golf, watch out! Even the most diligent person (me!) cannot keep all darkness away. But I choose to trade some discoloration on my face for the pleasure that being outside provides for me in my life. But please know, when I am out enjoying various activities, my face is covered in a waterproof sunscreen, and I always have a hat on. I don’t want to tempt fate, and I know I am prone to chloasma. So hats are simply a necessary part of my life.

Do I have hope, or am I doomed to wear this shadowy mustache for the rest of my life? If you are constantly controlling the amount of sun your face gets, your moustache can and probably will go away or at least lighten considerably.We tend to sweat more on the upper lip area than other places on our faces, so keeping sunscreen there will be a bit of a challenge. The drill is sunscreen is great, but it is direct sunlight you want to avoid.

I hope this client’s questions and my answers are starting to help you understand more about pigmentation and sun exposure.

For more information on pigmention issues, see:

• Hyperpigmentation: A few Q & As
• Hyperpigmentation and perfume
• Pigmentation is so one-sided