Subscribe
Share
Share
Embed
Welcome to Skinside Out! In this episode, Dr. Zain, Heather, Courtney, and Crystal discuss hyperpigmentation, its different types, and its causes. They cover topics such as acne-related hyperpigmentation, inflammatory causes, medication-induced pigmentation, and the impact of sun exposure. Gain insights into conditions like melasma, acanthosis nigricans, and the role of skin care in managing pigmentation. Stay tuned for the next episode where we'll explore prevention and treatment options.
00:00 Introduction to Hyperpigmentation
00:53 Understanding Hyperpigmentation
01:27 Common Causes of Hyperpigmentation
02:26 Post-Inflammatory Hyperpigmentation
03:31 Drug-Induced Hyperpigmentation
08:40 Sun-Induced Hyperpigmentation
10:10 Uneven Skin Tone and Sun Protection
20:06 Conclusion and Next Episode Preview
Creators and Guests
Host
Host
What is Skinside Out?
Welcome to Skinside Out, where science meets beauty, the ultimate dermatology podcast! Dive deep into the fascinating world of skin health with expert insights, evidence-based discussions, and myth-busting truths. Each episode explores the medical, cosmetic, and surgical aspects of dermatology, while keeping you informed about trending skincare topics. Whether you’re a skincare enthusiast, medical professional, or just curious about how to achieve your best skin, Skinside Out is your go-to resource for staying informed and inspired.
019 Skinside Out
===
Dr. Zain Husain, MD: [00:00:00] welcome to Skin Side out where Science meets Beauty. I'm your host, Dr. Zane, with Heather, Courtney, and Crystal. So today's episode we're gonna be talking about hyperpigmentation, what types there are, what causes it, and in another episode we're gonna be talking about all the ways we can prevent and treat it.
So, Heather, let's start off. What is hyperpigmentation?
Heather Murray, PA-C: So hyperpigmentation is really just this [00:01:00] excess pigment. Mm-hmm. Um, whether it's browns or reds, there are different types that we'll go into, but it pretty much just means more pigment or something that is not your normal skin tone.
Dr. Zain Husain, MD: Great. And it can happen in any skin type or just darker skin types, any skin type.
Heather Murray, PA-C: Yep.
Dr. Zain Husain, MD: So we're gonna discuss the different types of hyperpigmentation and then where and which populations we typically see it in. Let's dive into some of the most common causes of hyperpigmentation that we encounter in the dermatology office. So Courtney, let's start off.
Courtney Carroll, LE: Um, so we do see a lot of hyperpigmentation, specifically from acne patients who might have spots that are kind of left over specifically.
Sometimes those cystic bumps that tend to take a long time to heal. Um, specifically we'll see them as well for patients who are not wearing sunscreen, which we'll get into later. Um, we tend to see a lot of hyperpigmentation. Um, maybe after, , you know. Like a treatment [00:02:00] sometimes, um, after, um,
Dr. Zain Husain, MD: rashes.
Rashes.
Courtney Carroll, LE: Mm-hmm. Yeah. All sorts of different skin conditions. Um, melasma being one of them. Again, I know we'll kind of get into the depth of melasma, very common hyperpigmentation that we see. So it can kind of come from any kind of, I guess. Inflammation in the skin, whether that be kind of an autoimmune sense or something like a contact dermatitis.
Different different things.
Dr. Zain Husain, MD: Yeah. Um, so the skin is very sensitive to inflammation and while it's repairing itself, it can leave behind pigmentation. We call that post-inflammatory hyperpigmentation and very common, and it manifests in different ways, in different skin types. Um, but it's that inflammation that really sets that off.
It can take a while for post-inflammatory hyperpigmentation or PIH to fade, especially in darker skin types. Um, we see that a lot with our acne patients, like you mentioned. Um, but we're seeing it, you know, in other conditions. You know, we see it in [00:03:00] our lupus patients, we see it in post-surgical cases, um, where we see some hyperpigmentation associated with that.
Um,
Courtney Carroll, LE: ECOS patients. Mm-hmm. Um, you know, who have extensive hair growth in their chin and um, you know, neck area, especially after like years of plucking or shaving or manipulating or even sometimes those ingrown can cause that discoloration there
Dr. Zain Husain, MD: and even rubbing constant friction mm-hmm. Can lead to pigment deposition like ification or thickening of the skin.
And you see that hyperpigmentation also manifests. so let's also talk about, um, drug-induced hyperpigmentation. 'cause that's pretty unique. So Heather, talk to us a little bit about
Heather Murray, PA-C: Yeah, so I think most commonly we see this with a medication called minocycline, which is an oral antibiotic. And if you use this long term, um, you can actually get this darkened to you that almost looks blue.
Um, so it's very hard to treat. Um, [00:04:00] minocycline is not something that you should be on long term. Mm-hmm. Um, but that's probably the most common.
Dr. Zain Husain, MD: So guess what? This happened to me as a teenager. Oh gosh. Yeah. My dermatologist put me on minocycline. Um, I wanted to get my skin cleared up before seeing your prom.
And lo and behold, like it was weird. My, the scars that I had in my skin were starting to turn like grayish blue and I'm like, what is going on? And you know, it wasn't until I derm residency did I realize what. That really was, and it took a while for that to go away, but it did eventually go away. But minocycline can be one of those, you know, culprits.
But we do see it in other types of medications. So another one that we commonly see is hydroquinone. I mean, crystal, with your patients with hydroquinone. Like what do we typically use that for? Up their skin. Right?
Crystal: Pretty much.
Dr. Zain Husain, MD: Yeah. And then when you use hydroquinone [00:05:00] excessively for long periods of time, it can cause something, um, called renos where you have actually deposition a pigment in the skin and leads to more hyperpigmentation.
So it's kind of paradoxical, like you're treating the hyperpigmentation with this hydroquinone cream, but then in effect it's becoming darker and there's actually literally. Pigment being deposited under pathology. It's wild. You could actually see the pigment, these banana bodies, what they call in histology, and it's literally pigment, and those are very difficult cases to treat.
You sometimes use lasers to kind of help to mitigate some of the pigment deposition.
Heather Murray, PA-C: I know Courtney uses a lot of hydroquinone, especially before chemical peels, but. I've heard her multiple times when she's walking a patient to check out, um, you know, if they wanna refill their hydroquinone and it's been over three months, she's always saying, you know, I, I really gotta get you off of that for a little bit.
'cause you need a, what we call a hydroquinone holiday. Um, just to give yourself a [00:06:00] little bit of break. Sometimes it's hard.
Courtney Carroll, LE: I understand. I mean, they're, they almost become addicted and. But yeah, there, there are times where you do have to take that holiday switch to something like lactic acid or cogic acid in that interim, and then you can go back on it.
Because some of these conditions can be a little bit more chronic, like melasma, where we're kind of controlling it rather than, you know, maybe after acne we've had it controlled, we've controlled the acne, we've stopped the trigger, and then, you know, at that point we've kind of entered cleanup mode. So, yeah.
Dr. Zain Husain, MD: Yeah. Um, and in addition to. Hyperpigmentation from like medications like minocycline, which we take systemically, and also with topical medications. There are also medications that make you photo sensitive, right? Mm-hmm. So indirectly you get more sun exposure, you're more prone to hyperpigmentation. So, you know, there's a lot of different mechanisms which medications can, you know, make you more sensitive to light.
Um, and then also patients who are, you know, immunosuppressed too. Um, you know, they can also be [00:07:00] more prone to hyperpigmentation.
Courtney Carroll, LE: Some different conditions too that we, that we see, um, one of them being acanthosis Niagara cans, and that is when people have an in insulin resistance. And so usually these people are pre-diabetic or diabetic and struggling.
Um, with weight, which can also influence that, um, hyperpigmentation or struggling with their insulin. So we do see that as a, you know, medical condition in the office. It's
Heather Murray, PA-C: very classic on the back of the neck, but you can get it on the front of the neck or on the cheeks and even in the underarms. Um, so I think it's definitely worth addressing that with primary care too.
Dr. Zain Husain, MD: Absolutely. I mean, many times patients. Have come to us first and like, Hey, I have this darkening in my skin. How do you fix it? It's really the first time anyone's looking at it, and sometimes we really do prompt them to see their primary care physicians to get further their value added and lo and behold, like they're pre-diabetic or diabetic, and that can make a [00:08:00] huge impact on your health.
So, you know, it's really important to really dive deeper and, you know, optimizing your health because not only is it affecting your skin, but it's affecting other organs.
Heather Murray, PA-C: Yeah. I never used to see it in kids, but I feel like I see it more in kids now than I do in adults.
Dr. Zain Husain, MD: We're seeing a lot of childhood obesity and it is, um, becoming much more prevalent and we're seeing in a lot of skin of color populations.
Mm-hmm. Where they may not have access to healthcare or healthy food options and. They are starting to develop diabetes at a young age. Obesity,
Courtney Carroll, LE: thank God for ozempic.
Dr. Zain Husain, MD: Um, so another category that we often see hyperpigmentation, especially in our clinic, is due to the sun, right? So melasma, yes, you get a condition that you're sensitized and you, or like light does influence it, but literally just hyperpigmentation brown spots, h spots. You know, [00:09:00] called, um, you know, freckles or S or ets.
These are all kind of related to sun exposure, and they can lead to areas of hyperpigmentation. There's a condition called pi derma, derma of Sava, um, where you have that ruddy, kind of brownish red pigmentation, especially on the sides of the neck. So, you know, we treat a lot of sun damage. So, I mean, what else do we see in related to sun damage?
Um, the type of,
Heather Murray, PA-C: um, I guess just, going back to like the derma really quickly, the reason that we see it on the sides of the neck is because your chin almost acts as like a physical barrier. From the sun so you don't get that sun exposure in on the middle part of your neck. Um, and then kind of going back also to the ESE or, um, what people normally call like age spots or sun spots.
Some people call them liver spots. And no, it does not mean that your liver is causing those spots. [00:10:00] It's just that somebody. Saw them and it looked like the color of your liver because your liver is brown. And so people started calling them liver spots, but it has nothing to do with your liver.
Dr. Zain Husain, MD: So in addition to sun damage, we also hear a term often in our clinic called uneven skin tone. So what does that mean to you guys? Um, what do you, what do you hear when you hear like, uneven skin tone? My patients coming in for uneven skin tone. Well,
Crystal: uneven skin tone. It could be, you know, different things for different people.
You know, some people will say that they have certain. Different colors in different areas. Like they'll say that my, my forehead is darker than my cheeks and, you know, um,
Heather Murray, PA-C: it might be more like diffuse kind of all over the face. Mm-hmm. And kind of patchy. Mm-hmm. Or it might be like a couple little spots and very little like bloche.
Yeah. Yeah.
Courtney Carroll, LE: And I can present differently on different skin types as well. Mm-hmm. I [00:11:00] mean, um, you know, for lighter skin types, maybe seeing more of that truly, um, like post-inflammatory erythema, um, after acne where it's more of a reddish pigment, um, rather than a true like brown pigment. So people might confuse those with acne scars because of that shadowing effect.
Um, whereas in darker skin types after acne, you might see that darkening, um, more of like that brown or darker black pigment.
Dr. Zain Husain, MD: Mm-hmm. Yeah. And you know, sometimes patients come to me and they say, oh, like the skin on my face and neck now their sun exposed areas are much darker than other parts of my body.
And they don't think that's normal. Um, so they're like, I want you to even out my skin tone and make it all uniform. Now, is that actually a medical problem or not?
Courtney Carroll, LE: No.
Dr. Zain Husain, MD: No.
Courtney Carroll, LE: It's years of sun exposure. Exposure, baby.
Dr. Zain Husain, MD: Yeah.
Courtney Carroll, LE: Yeah.
Dr. Zain Husain, MD: And. The interesting thing is many of those populations, especially skin of color, [00:12:00] don't think that they need to use any sun protection.
Mm-hmm. So, sunscreen and they're constantly getting exposed. Of course you're gonna have different, you know, shades of your skin color, um, based on that chronic exposure. Um, so yeah, I think
Crystal: if they're darker, it's like a block, a natural block, and it's not,
Dr. Zain Husain, MD: yeah. Yeah. I mean, yeah, you have more melanin that can protect you, but.
You're still getting affected and it does synthesize more melanin over time. And yeah, we see that a lot. Um, I, I mean, it's happened to me as well, you know, playing sports outside. Um, I didn't wear sunscreen when I was younger and then like my neck and my face were definitely a lot darker than other parts of my sun protected areas, like on my chest or my legs.
Courtney Carroll, LE: Yeah, I think there was a lot of like, you know, a. I know we could even create a whole separate show on this, but just a lot of people didn't know back then, and especially skin of color, I feel like there was always this like, um, you know, just I [00:13:00] guess overall like agreement, well, we don't get skin ca we don't burn.
Mm-hmm. So we don't get skin cancer, so we don't need sunscreen. And I'm glad that as we are like moving forward. We are recognizing like, hey, like you still do need sunscreen and even if you are at a lesser percent of, you know, chance of getting skin cancer mm-hmm. Um, even for some of these cosmetic reasons, which is I think equally valid, if you know that's your mm-hmm.
Um, you know. Insecurity or if, if you're wanting to manage these things. Um, and then again, just yeah. With the, um, potential for skin cancer, I think it's so important.
Crystal: Like, I won't lie, I didn't start using any sunscreen until about five years ago because that's how I was raised, like in this Hispanic community.
We're raised. You just, you can burn and then it's gonna turn over and get it tan. Or we just lather ourselves in oil. Yeah. You know? Well,
Courtney Carroll, LE: and the zinc and the sunscreens were so white on these people of color. So of course there's this aesthetic component too where, oh, I don't wanna go out looking like gray and past tasty, [00:14:00] understandably.
Dr. Zain Husain, MD: Yeah. And the South Asian population too, like it wasn't really a thing, like there was no concept of wearing sunscreen. Um, you know, we just went outside. We didn't really put anything on and you know, they just told us not to go out in the middle of the day, so you wouldn't like tan necessarily. But that's about it.
There was no talk about prevention, um, or using any sunscreen. I didn't start using sunscreen until I was in residency in my mid twenties. Um, and after learning about how much the sun can damage your skin. Like, whoa, I gotta really do something about this. And I became very religious about wearing sunscreen daily and it's just part of my routine, like brushing my teeth on my sunscreen.
And it's, I think that's contributed to kind of the slower aging process and also optimizing, you know, skin health with everything that I'm doing for my skin. So. I don't think that, you know, doing all these procedures and all these treatments are gonna do anything if you don't protect your skin. I mean, it's just an investment.
Crystal: I know there's a lot of people [00:15:00] that think that if it's cloudy or like partly cloudy outside, that they don't need it either. Yeah, they're like the sun's, but you do.
Heather Murray, PA-C: Depends on the UV index too. Mm-hmm.
Dr. Zain Husain, MD: Yeah. But we're constantly getting exposed to UV UV rays from the sun, even if it's cloudy raining, if
Courtney Carroll, LE: the sun is up in the sky, it is producing uv.
And I used to work with a doctor that used to joke, well, if the sun is really not out, then we have a bigger problem if the sun's out out. Yeah.
Dr. Zain Husain, MD: And then it does penetrate through glass. Mm-hmm. Right? Mm-hmm. So you gotta be careful. Um, you know, we see time and time again with. Patients with a lot of sun damage on the left side of their faces because that's their driving side.
They're constantly getting exposed to UV light. You have that famous New England Journal of Medicine photo, that trucker, mm-hmm. Literally. His left side of the face looks probably 30 to 40 years older than the other side. Like the wrinkles, the sun damage, everything. It's such a startling photo to see, but it's, it [00:16:00] raises the point like, Hey, like you really have to protect your skin.
Heather Murray, PA-C: Yeah, we should have had that at the, on the screen, but Google truck driver sun damage and you'll see the picture. It's very classic. It is very abrupt. Kind of left versus right, and I think it's really interesting too, not only that, but like you were mentioning, just like. Face and neck exposure. Mm-hmm. I think, you know, I've seen people come in for their skin exam and originally they're, you know, dressed in clothing, covering most of their skin, and then they get in a gown and undressed.
Hmm. And I see the difference mm-hmm. Between their face, neck and then the rest of their body. And it's, it's really impressive how much of a contrast it can be.
Dr. Zain Husain, MD: Yeah.
Courtney Carroll, LE: Well, I'm white as white can be, and my parents. My mom's gonna listen to this and be like, that's not true. But it is true. She grew up, you know, she's Italian.
She didn't really wear a lot of sunscreen growing up and. I think she didn't realize how pale and how much Irish I inherited. And yeah, we would go to the beach and you know, she'd use the spray sunscreen. Of course that [00:17:00] spray is not getting anywhere on me. It's like drifting off in the wind. So I would get so burnt on beach days and literally I'm like in the hotel room, like taking a shot, like crying 'cause I'm so cold and hot from the sunburn.
So I think even like, yeah, just our like parents generations. Um. Didn't know. And I don't know, like I, again, I didn't use sunscreen probably till I was 20 or 21. So Got that nice chest, um, that I've been trying to laser away.
Dr. Zain Husain, MD: Yeah. I mean, and it affects other areas that are sun exposed, dete. Mm-hmm. The hands that can often shoulders.
Yeah. Um, so anywhere where you get sun exposure, it will lead to photo aging, including. You know, hyperpigmentation. Mm-hmm.
Courtney Carroll, LE: And some of these conditions are even just triggered by sun, but also the heat that's being produced. So some, um, some conditions like melasma, for example. Yeah.
Dr. Zain Husain, MD: And blue light. Blue light as well.
Right. Blue light.
Courtney Carroll, LE: Exactly. So not only does the sunscreen help, um, protect, you know, especially mineral [00:18:00] sunscreen, protect against the, um, the light, but also kind of that heat component. Yeah.
Heather Murray, PA-C: I think melasma is, there's a misconception that melasma is a, like hormonal abnormality. I mean, yes, we do see it a lot of times post pregnancy or if you're on like a birth control pill, but it's really just that those hormones are making you more sensitive to the sun.
Um, and. Most of the time if we were to check hormones in patients that have melasma, it'll likely all be normal.
Dr. Zain Husain, MD: Yeah. Because a lot of those melanocytes, those pigment producing cells actually get excited from the effects of those hormones and they produce more pigment as a result. And you know, we definitely see it more often and you know, skin of color, we see it very commonly in, you know, the Asian South Asia, middle Eastern, Hispanic.
And African populations because there's just more melon in their skin, and those triggers can [00:19:00] really make it very sensitive. So when you got already, you have melon in your skin, you've got sun exposure. You know, that's like the recipe to kind of really develop a lot of these, um, you know, these incidents of the melasma.
Courtney Carroll, LE: I think people don't realize also, um, you know, you have, especially now that you have so many people working from home and mm-hmm. You know, we touched on the blue light and the windows, but. It's really that accumulation that people don't realize. I think they say like your accumulated, um, time in the sun is equivalent to like a day at the beach.
Like one week is equivalent to like a day at the beach. Just like going to the mailbox, driving to the grocery store, walking your dog. I mean, these are all times that Okay. You're saying in your mind, oh, well I'm only out for a few minutes. Well, I work from home. I work from home, but Okay. Do you. You go get your man, are you?
Yeah. Yeah. Are you like in a closet? Like, you know, um, these times do add up over the course of the day, over the course of the week. So it is really, um, important. Even if you feel, oh, well, I'm only out for a few minutes, you know? Mm-hmm. [00:20:00] I don't say that when I brush my, oh, I'm, I'm only going out to the grocery store.
I don't have to brush, you know? Yeah.
Dr. Zain Husain, MD: Um, and then another thing I wanted to point out before we wrap this up is that you can have more than one type of hyperpigmentation, so multiple things going on, and it can be very difficult. I mean, we've had patients who have melasma. Post-inflammatory hyperpigmentation.
Um, and it can be really tricky to treat, um, because you may make one thing better, but the other's not really budging. So sometimes we need to use more than one technique or treatment to really get the results, um, that we're looking for. So I think that segues nice way nicely into our next episode where we're gonna talk about prevention and treatment of hyperpigmentation.
So hopefully you guys enjoyed this episode. We talked about the different forms of hyperpigmentation, what causes it, and we're gonna dive deeper into how we can treat it until next time. Skin side, out,
riverside_episode_1_raw-synced-video-cfr_skinside_out_0019: out. [00:21:00]