Melanin is the pigment that makes up our skin tone and is produced by Melanocytes, and it is distributed among our other skin cells (keratinocytes) to create our unique skin color. Every person is born with the same number of melanocytes and our genetics determine how much pigment will be produced and provide a unique skin color for each individual. In addition to its protective role, melanin contributes to the diversity of human appearance, including variations in skin, hair, and eye color. The amount and distribution of melanin in the skin determine an individual’s skin tone, while variations in melanin production and distribution influence hair and eye color. Damage or dysregulation of melanin production can lead to pigmentation disorders, which can affect skin coloration and overall skin health. Hyperpigmentation, or dark areas of the skin, can create skin concerns like uneven complexions, dark spots, and acne scars that lead to a loss of confidence in your appearance, and consequently affect your daily life. Although hyperpigmentation is one of the most difficult skin concerns to target, there is a path to clear, even complexions and restore confidence in your skin.
The Pigmentation Pathway
Melanin is a natural pigment found in the skin, hair follicles, eyes, and certain other tissues in the body. It is responsible for the coloration of these tissues and plays several important roles in human physiology. Melanin has two primary pigments:
- Eumelanin produces shades of brown to black pigments and is the most common type of melanin found in human skin, hair, and eyes.
- Pheomelanin produces shades of red to yellow pigments.
Most individuals have a mixture of these two pigments that make up their complexion.
Melanin’s primary function is to protect tissues from the damaging effects of UV radiation. It accomplishes this by absorbing UV rays and converting them into heat, preventing DNA damage and mutations that can lead to skin cancer.
Melanin is synthesized through a series of complex biochemical reactions within specialized cells called Melanocytes, which are primarily located in the basal layer of the epidermis, the outermost layer of the skin. The process of melanin production, known as Melanogenesis, involves several key steps:
- Tyrosine Production: The precursor for melanin synthesis is the amino acid tyrosine, which is obtained from the diet and also produced within the body. Tyrosine serves as the starting point for melanin production and is transported into melanocytes through specialized transport proteins.
- Tyrosinase Activation: Tyrosinase is a copper-containing enzyme that catalyzes the oxidation of tyrosine to dopaquinone, a critical step in melanin production. Limiting this important enzyme is the key to lightening hyperpigmentation discussed later.
- Dopaquinone Conversion: Dopaquinone undergoes further enzymatic reactions, ultimately leading to the production of two main types of melanin: eumelanin and pheomelanin. The specific biochemical pathways involved in eumelanin and pheomelanin synthesis differ, resulting in the production of different pigments.
- Eumelanin Synthesis: In the pathway leading to eumelanin synthesis, dopaquinone undergoes additional enzymatic reactions, including polymerization and oxidation, to form the final eumelanin pigment. As mentioned, eumelanin produces shades of brown to black pigments and protects against UV radiation.
- Pheomelanin Synthesis: Pheomelanin synthesis involves the conversion of dopaquinone to cysteinyldopa, a precursor for pheomelanin production. As mentioned, pheomelanin produces shades of red to yellow pigments and is synthesized through a pathway that involves the incorporation of sulfur-containing amino acids, such as cysteine, into the pigment structure.
- Melanosome Formation: Throughout the process of melanin synthesis, melanocytes produce specialized organelles called melanosomes, which are responsible for storing and transporting melanin pigment. Melanin is deposited into melanosomes and then transferred from melanocytes to neighboring keratinocytes, the predominant cell type in the epidermis, as they move toward the skin’s surface.
- Melanin Transfer: Once melanin is synthesized and stored within melanosomes, it is transferred from melanocytes to keratinocytes through a process called melanosome transfer. Melanocytes extend their dendritic processes, called melanocyte dendrites, into neighboring keratinocytes, delivering melanosomes containing melanin pigment.
The regulation of melanogenesis is influenced by various factors, including hormonal signals, environmental stimuli (such as UV radiation), and genetic factors. Dysregulation of melanin production can lead to pigmentation disorders, such as hyperpigmentation (excessive melanin production) or hypopigmentation (insufficient melanin production), which can affect skin coloration and overall skin health.
We are all the same…but different.
Every human is born with the same number of melanocytes, however, the density and size of the melanin that is produced and packaged within your melanosome determines your skin’s color. For example, a lighter-skinned individual has the same number of melanocytes, but the amount of pigment produced is less as well as the size of the pigment. A darker-skinned individual has larger pigment particles and produce more.
Overall, the variation in skin color among individuals is a complex interplay of genetic, environmental, and evolutionary factors. It reflects the incredible diversity of human populations and their adaptations to different geographic regions and climates over time. Here are some factors contributing to the diversity of skin colors:
- Genetics and Evolutionary Factors: Genetic factors play a significant role in determining an individual’s skin color. Variations in genes associated with melanin production, such as TYR (tyrosinase), MC1R (melanocortin-1 receptor), and OCA2 (oculocutaneous albinism II), can influence the amount and type of melanin produced by melanocytes. Different combinations of genetic variations contribute to the wide range of skin colors. Over millennia, human populations have adapted to diverse environments through natural selection. Skin color is believed to have evolved as a result of selective pressures related to UV radiation exposure, dietary factors, and cultural practices. Different skin colors have provided survival advantages in various environments, contributing to the diversity of skin tones observed today.
- Geographic Origin: Skin color is also influenced by the geographic origin of an individual’s ancestors. People from regions with higher levels of UV radiation, like near the equator, tend to have darker skin tones, as increased melanin protects against UV-induced damage. In contrast, individuals from regions with lower UV radiation levels may have lighter skin tones.
- Adaptation to Environment: Skin color can be viewed as an adaptation to environmental factors, particularly UV radiation. Darker skin tones provide better protection against the harmful effects of the sun, such as sunburn and skin cancer, while lighter skin tones allow for more efficient vitamin D synthesis in regions with limited sunlight. Although I do not recommend relying on your natural SPF.
How Melanin Affects the Color of Our Scars
As a scar heals, the body’s natural response involves the production of new skin cells and the deposition of collagen to repair the damaged tissue. Eumelanin (brown to black pigment) may be produced in the scar tissue, resulting in darker pigmentation compared to surrounding skin. Pheomelanin (red to yellow pigments) may contribute to the coloration of scars, particularly in individuals with fair skin tones. While scars typically start pink or red during the early stages of healing due to increased blood flow and inflammation, pheomelanin may also be present in the scar tissue, contributing to its coloration. I have seen this in clients who have microbladed eyebrows. This can be corrected by the artist during touchup, however, it is likely going to change color as the ink fades. The way your skin scars is going to continue and the presence of mixed melanin in scar tissue may lead to variations in scar coloration depending on the individual’s natural skin pigmentation.
In addition to melanin, other factors can also influence scar color, including the depth and severity of the wound, the healing process, and individual differences in skin healing. Scars may change color and appearance over time as they mature and remodel. Remember, our skin is always moving, changing, and renewing. It’s essential to protect scars from sun exposure during the healing process, as UV radiation can exacerbate pigmentation changes and make scars more noticeable. Applying sunscreen to scars and keeping them covered with clothing or bandages can help minimize the risk of hyperpigmentation and promote an even complexion as scars heal.
Hyperpigmentation
This common skin condition is characterized by patches or areas of skin that become darker in color than the surrounding skin. This darkening occurs due to an excess production or accumulation of melanin, the pigment responsible for skin coloration. Hyperpigmentation affects people of all skin types and ethnicities and occurs in various forms and patterns.
**This article will focus on hyperpigmentation as this is my specialization, although this is not the only pigmentation-related disorder.
How does hyperpigmentation occur?
- Exposure to ultraviolet (UV) radiation from the sun is one of the primary triggers for hyperpigmentation. UV radiation stimulates melanocytes to produce more melanin as a protective response to shield the skin from further damage. This can lead to the formation of sunspots, also known as solar lentigines or age spots, which are areas of localized hyperpigmentation.
Hormonal fluctuations, particularly during pregnancy (melasma or cholasma) or starting/stopping contraceptives, can trigger hyperpigmentation. This type of hyperpigmentation is often called melasma or pregnancy mask and typically appears as symmetric brown patches on the face, particularly on the cheeks, forehead, upper lip, and chin. I have found in my experience that hormonal fluctuations can also create skin disorders like breakouts and inflammation. These two factors, can cause pigmentation issues that display as spots and are not related to melasma.
- Inflammation resulting from skin injuries, acne, eczema, or other skin conditions stimulate melanocytes during the healing process and lead to hyperpigmentation. Post-inflammatory hyperpigmentation (PIH) occurs when dark spots or patches develop in areas where the skin has healed following inflammation or injury.
- Some individuals may be genetically predisposed to developing hyperpigmentation. Certain ethnicities, such as those with darker skin tones, are more prone to conditions like melasma and PIH. My family has an extensive history of pigmentation issues, and this is something I see in my family members and myself.
- Hormone levels, disorders such as Addison’s disease and Cushing’s syndrome, or pregnancy and hormonal fluctuations throughout your lifetime can disrupt melanin production and lead to hyperpigmentation. I have experienced clients with non-hormone related diagnoses that affect their skin causing breakouts and inflammation that will be followed by PIH. Although pigmentation is connected to disorders like Hashimoto’s, it may not be directly causing pigmentation but is a by-product that we may encounter.
- Certain medications, such as oral contraceptives, hormone replacement therapy, and some antibiotics, can increase the skin’s sensitivity to UV radiation and trigger hyperpigmentation. Additionally, topical products containing irritating or sensitizing ingredients may exacerbate hyperpigmentation. This also goes for our treatments discussed below. As we start to manage pigmentation disorders, we essentially will limit the amount of pigment being produced. This will make our skin more vulnerable to UV damage and needs to be protected, or pigmentation will worsen.
- Trauma to the skin, such as cuts, burns, friction from clothing, or repetitive rubbing, can lead to post-inflammatory hyperpigmentation. This can be exacerbated by picking, applying too many topicals to the area, and not protecting damaged skin from the sun.
How does inflammation cause hyperpigmentation? Why do I get scarring after blemishes?
- Increased Melanin Production and Redistribution: Inflammation triggers a series of cellular responses in the skin, including the activation of melanocytes, the pigment-producing cells. When the skin is inflamed, melanocytes may become hyperactive and produce more melanin pigment than usual. This excess melanin can accumulate in the skin, leading to dark spots or patches known as post-inflammatory hyperpigmentation (PIH) in cases where blemishes first were present, regardless of picking. Instead of being evenly distributed throughout the epidermis, melanin may become concentrated in specific areas affected by inflammation. This can result in the formation of localized dark marks or patches, particularly in areas where the skin is healing from injury, acne, eczema, or other inflammatory conditions.
- Prolonged Inflammation: Chronic or persistent inflammation can exacerbate melanin production and prolong the duration of hyperpigmentation. Inflammatory mediators released during ongoing inflammation can continuously stimulate melanocytes, leading to sustained melanin production and darkening of the affected areas.
- Delayed Healing: Inflammation can impede the normal healing process of the skin, resulting in delayed wound closure and prolonged exposure to inflammatory signals. This prolonged inflammatory state can contribute to the persistence of hyperpigmentation, as melanocytes remain activated and continue to produce melanin in response to ongoing inflammation. I see this delayed healing mostly with individuals who pick or obsess over blemish areas by over-applying topicals and causing chemical burns or inflammation.
Inflammatory Mediators: Certain inflammatory mediators, such as cytokines and growth factors, can directly stimulate melanocytes and melanin production. These molecules may be released by immune cells in response to inflammation and can play a role in regulating melanocyte activity and pigmentation.
Preventing and managing inflammation, protecting the skin from further damage, and promoting timely wound healing are essential strategies for minimizing the risk of post-inflammatory hyperpigmentation. If you have a hard time obsessing over blemishes and picking, sticking to natural light, removing any magnifying mirrors, and keeping your skincare area dimly lit will help this. I also recommend hydrocolloid patches (like Mighty Patch) without any additives to protect blemishes and to stop picking.
How does the sun cause hyperpigmentation and make current spots worse?
- UV radiation induces inflammation in the skin, triggering a cascade of inflammatory mediators and immune responses leading to the development of post-inflammatory hyperpigmentation (PIH), particularly in individuals with darker skin types. Prolonged or repeated exposure to UV radiation accelerates the aging process of the skin by damaging collagen and elastin fibers, leading to the accumulation of abnormal melanocytes in localized areas. This results in the development of flat, brown spots on sun-exposed areas of the skin, such as the face, hands, arms, and décolletage. UV exposure can exacerbate existing pigmentation and trigger the recurrence of pigmented lesions by stimulating melanocytes in general, leading to increased melanin production and darkening of the skin patches. Once hyperpigmentation occurs, it can be assumed that this will be a life-long treatment to lighten, and prevent more from occuring. Often, even after pigmentation is lightened or lifted, it can return after sun exposure. I have had several clients go on vacations closer to the equator and their dark spots and freckles returned even with sunscreen. This is normal and all have lightened again after a few weeks. I like to refer to the skin sometimes as a chameleon, it changes based on our environment, especially related to the sun. UV radiation includes heat (from infrared), even protecting with sunscreen and hats may signal Melanogenesis.
Protecting Our Skin
I’ve heard people talking about not using SPF, that our skin is our natural sun protector? Is this true?
While your skin does provide some level of natural sun protection, relying solely on it as a substitute for sunscreen or other sun protection measures is not advisable.
- Reason 1: The natural SPF (Sun Protection Factor) provided by the skin varies depending on factors such as skin type, melanin content, and sun exposure history. While darker skin tones naturally have more melanin and offer some inherent protection against UV radiation, this protection is limited and may not be sufficient to prevent sun damage, especially with prolonged or intense sun exposure. Natural SPF provided by the skin may not offer comprehensive protection against both UVA and UVB radiation, which can penetrate different layers of the skin and cause different types of damage.
- Reason 2: Even with natural melanin protection, prolonged exposure to UV radiation can still cause sunburn, leading to long-term consequences such as wrinkles, sunspots, and skin cancer.
- Reason 3: The natural SPF provided by the skin can vary depending on factors such as skin hydration, thickness, and the presence of melanin. Factors like sweating, swimming, or toweling off can also reduce the effectiveness of natural sun protection, leaving the skin more vulnerable to sun damage.
- Reason 4: Environmental factors such as cloud cover, altitude, and time of day can affect UV radiation levels and sun exposure intensity, making it difficult to rely solely on natural sun protection.
To effectively protect your skin from sun damage and skin cancer, it’s important to use broad-spectrum sunscreen with an SPF of 30 or higher, wear protective clothing, seek shade during peak sun hours, and avoid prolonged sun exposure. Additionally, practicing sun safety habits such as wearing sunglasses and a wide-brimmed hat can further reduce the risk of sun damage and protect your skin’s health in the long term.
What’s worse than pigmentation disorders? SKIN CANCER.
More than 90% of skin cancer is caused by sun exposure. Skin cancer develops when genetic mutations occur in skin cells, leading to uncontrolled growth and proliferation. There are three primary types of skin cancer: basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. Each type has distinct characteristics and can arise from different types of skin cells.
- Basal Cell Carcinoma (BCC):
- BCC is the most common type of skin cancer, accounting for the majority of cases.
- It typically develops in the basal cells, which are located in the deepest layer of the epidermis (the outermost layer of the skin). This is also where our skin cells are made.
- BCC usually appears as a pearly or waxy bump, a flat, flesh-colored or brown scar-like lesion, or a pink growth with raised edges.
- Squamous Cell Carcinoma (SCC):
- SCC arises from the squamous cells, which are found in the upper layers of the epidermis.
- It often appears as a firm, red nodule or a flat lesion with a scaly or crusty surface.
- Like BCC, UV radiation is a significant risk factor for SCC, as it can cause DNA damage in squamous cells, leading to cancerous changes.
- Melanoma:
- Melanoma develops from melanocytes.
- It can occur in pre-existing moles or appear as new, abnormal growths on the skin.
- Melanoma often presents as an asymmetrical, irregularly bordered, multicolored lesion with an evolving appearance (ABCDE criteria: Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolution).
- UV radiation exposure is a significant risk factor for melanoma, particularly intense, intermittent sun exposure that leads to sunburns. However, genetic factors and family history also play a role in melanoma development.
Early detection and prompt treatment are crucial for effectively managing skin cancer. Regular skin self-examinations, annual skin checks by a dermatologist, and sun protection measures (such as wearing sunscreen, protective clothing, and seeking shade) can help reduce the risk of skin cancer and improve outcomes with early detection.
What can I do aside from skincare, to support my skin while it heals from hyperpigmentation, or to avoid it in the future?
While there isn’t a specific diet that can completely stop hyperpigmentation, incorporating certain nutrients and foods into your diet may help support skin health and minimize the risk of hyperpigmentation. Here are some dietary recommendations that may help:
- Antioxidants help protect the skin from oxidative stress and damage caused by free radicals, which can contribute to hyperpigmentation. Include plenty of fruits and vegetables in your diet, particularly those rich in vitamins C and E, such as citrus fruits, berries, kiwi, spinach, kale, and almonds. There will be more information on free radicals in a future article.
- Vitamin A and its derivatives, such as retinoids, play a role in regulating skin cell turnover and may help improve hyperpigmentation. Include foods rich in vitamin A, such as sweet potatoes, carrots, leafy greens, and eggs.
- Omega-3 Fatty Acids have anti-inflammatory properties and may help reduce inflammation associated with hyperpigmentation. Include sources of omega-3s in your diet, such as fatty fish (salmon), flaxseeds, chia seeds, and walnuts.
- Zinc is involved in skin healing and may help support healthy skin function. Include zinc-rich foods in your diet, such as lean meats, poultry, seafood, nuts, seeds, and whole grains.
- Polyphenols are plant compounds with antioxidant and anti-inflammatory properties that may benefit skin health. Include foods rich in polyphenols, such as green tea, dark chocolate, red grapes, berries, and olive oil.
- Drinking water is essential for maintaining skin hydration and overall skin health. Aim to drink plenty of water throughout the day to keep your skin hydrated and support its natural repair processes.
- Limit Sugar and Processed Foods. These can contribute to inflammation and oxidative stress in the body, which may exacerbate skin conditions like hyperpigmentation. Limit your intake of sugary snacks, desserts, and processed foods, and focus on whole, nutrient-dense foods instead. Alcohol should be highlighted under this category as well.
A balanced diet rich in nutrients that support skin health can complement your treatments and skincare ritual.
Skincare Rituals
A skincare ritual at home is the most important to manage hyperpigmentation and optimal skin health. Without a daily dose of a tyrosinase inhibitor, the enzyme mentioned above that is needed to start melanogenesis, your melanocytes will continue to function abnormally.
We start with Essentials, then add in products as we need. This allows the ability for newbies to get used to a habit, and skin connoisseurs to phase out products that are no longer needed. These are products that I trust, and cannot guarantee results without them. With this said, I have had success stories with clients using other brands at home. My studio is a judgment-free zone, and the most important part about skincare is that YOU LOVE IT, and you love the products you put on your skin. We can discuss the ins and outs, as well as customized steps at your appointment.
Essentials:
Amandola Milk Cleanser (Dry Skin), or
Cleansing Gel with Mandelic (Normal/Oily)
Vitamin C Reversal Serum (Morning & Evening)
Licorice & Bearberry Brightening Mist (Morning & Evening)
Light Day Sunscreen with SPF 37 (Morning)
White Veil Brightener (Evening)
Amazing Additions:
Serum 71 (Evening, the Vitamin C Reversal will change to Morning)
Bright White (Evening Spot Treat)
Nighttime Repair or Revita-Cyte (Evening, this is based on your tolerance and will be the age prevention part that is added to continue evening your complexion. This is a retinol, or retinol alternative)
Click each product to see more information on the science behind them! When we choose a ritual for you, each product will be explained so that you have the knowledge you need to be confident in your routine, as well as access to guidance with me in between facials via text or email. You are not alone on your skincare journey!
Treatments
Hyperpigmentation is one of the hardest skin concerns to correct, and will likely be something you will continue to correct into the future. In my practice, we start from the root cause. What is causing your pigmentation? Is it current breakouts that leave PIH? Is it a hormonal change from pregnancy? Did you not wear sunscreen in your 20s and it’s catching up to you? The possibilities are, to me, endless. We find the answers to these questions in your consultation and I formulate a customized treatment plan going forward. Pigmentation correction can be easy for some, and never-ending for others (I fall into the latter category). In either case, I am open to working with medical professionals to get you the results you want. A skincare ritual at home is where we start, and monthly facials will continue to build your skin’s resiliency and create change. After 3 months we re-assess and move on to the next 3 months with a clear directive. If at any time we decide you need medical intervention, for example a laser, you will be prepared with your current skincare and treatments, providing you with the healthy skin needed to get the best results with these cosmetic procedures.
There will be successful results with consistency in your skincare ritual, commitment to your treatments, and creating a habit of practicing sun safety. However everyone is different and a timeframe often cannot be given
The New Client Facial is for all new clients with skin concerns who are looking to commit to monthly facials to correct them. We will have a consultation and a customized facial to meet your needs and start your skincare journey, as well as leave with recommendations and a treatment plan.
The Corrective Facial is the most popular based on timing. This 1hr10min facial includes dermaplaning and features the Rezenerate Nano Infusion to increase results and target a variety of skin concerns.
The Oxygen Rx Facial is best for active breakouts, including those with Post Inflammatory Hyperpigmentation. We have to control the blemishes and inflammation first, and then lighten pigmentation. This facial will work on all three.
If you are looking for a facial with more time, or just MORE of everything, The Everything Facial is perfect for those who are on a corrective skincare journey but want ALL THE THINGS. I formulated this facial (even though it’s still customized) so that each step works synergistically and gives you everything you need for healthy, glowing skin and the ultimate relaxing treatment. At 1hr30mins, it’s a client favorite. If you are a current client, try the new Luxury Lift & Peel!
Research:
Melanogenesis Pathway Photo: https://www.researchgate.net/figure/The-key-components-of-the-melanogenesis-signaling-pathway_fig5_341907742 and https://onlinelibrary.wiley.com/doi/full/10.1111/ics.12466
Red Scarring from Microblading – with after: https://www.kellylouiseaesthetics.com/microblading-removal-birmingham-wolverhampton-botched-ink/
Hyperpigmentation Therapy: A Review by Seemal R Desai, MD, FAAD https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4142815/
The Behavior of Melanocytes in Inflammation by Christopher M Papa, MD and Albert M. Klingman, MD, PhD. The Journal of Investigative Dermatology. Vol 45, No. 6
Melanoma, Melanin, and Melanogenesis: The Yin and Yang Relationship by Rodomir M Slominski, Tedeusz Serna, Przemyslaw M. Plonka, Chander Raman, Anna A Brozyna, and Andrej T Slominski. Volume 12, Article 842496 www.frontiersin.org
Invited Editorial: Unraveling the Melanocyte by Vincent J. Hearing.
Physiology of the Skin II by Dr Peter T. Pugliese. 2001
Photo Credits:
UVA vs UVB Photo: https://www.mdanderson.org/publications/focused-on-health/what-s-the-difference-between-uva-and-uvb-rays-.h15-1592991.html
Melanocyte Diagram: https://stock.adobe.com/search?k=melanocyte&asset_id=485134797
ABCDE of Melanoma: https://katudermatology.com/en/post_service/melanoma/