Ask Alexis: Our Resident Dermatologist Helps a Reader With Hyperpigmentation

Updated 08/28/18

After sound skin advice? We know exactly where to find it: our monthly columnist, dermatologist Alexis Granite, MD. In each instalment of Ask Alexis, Granite answers one reader’s burning skin query or concern with helpful, easy-to-understand, fundamentally reliable advice. This week, Granite responds to Rebecca, who developed a patch of hyperpigmentation on her cheek after giving birth.

hyperpigmentation on face: woman applying face cream
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Dear Dr. Granite…

"I have a small patch of pigmentation on my cheek, and nothing seems to shift it. I first spotted it when I was pregnant with my first daughter around 12 years ago, and it got darker when I was pregnant with my second daughter seven years ago. It's the only patch I have, and it's more noticeable in the winter, maybe because I'm less tan then. I'm not very stringent with my SPF use, and I hardly ever wear it on my face. In terms of products, I use Dr. Sebagh Serum Repair, Clinique Moisture Surge foundation and M&S Formula Absolute Night Cream.

I tried Alpha H's Liquid Gold to try and get rid of the pigmentation, but it didn't work very well, so I tend to cover it with foundation. What I'd like to know is if there is a particular vitamin or serum I could try that would make it lighter? And what SPF should I be using on my face to stop it from getting worse? I've also heard derma-rolling is good for hyperpigmentation—is that true?"

— Rebecca

Dear Rebecca..

"It sounds like you have a mild form of a condition called melasma. This is characterised by hyperpigmented patches (most commonly on the face), and it may be triggered by hormonal fluctuations during pregnancy or when starting oral contraceptives. It's so common during pregnancy that it's also known as the mask of pregnancy."

The solution

"I would absolutely recommend wearing a daily broad-spectrum sunscreen with an SPF of 45 or 50 daily, as UV exposure as well as heat are both well known triggers of melasma, and wearing regular sunscreen will help prevent your condition from worsening. I like Elta MD UV Clear SPF 46 as well as Kiehl's Ultra Light Daily Defense SPF 50. When at the beach or on holiday in strong sun, it's important to reapply sunscreen every two to three hours, and always after swimming and/or heavy exercise. A broad-brimmed hat will also help to keep UV rays off your face.

Your melasma is likely more noticeable in the winter because the rest of your face is less tan, but exposing melasma to the sun unprotected will only exacerbate it in the long run."

hyperpigmentation on face: Kiehl's Ultra Light Daily Defense SPF 50
Kiehl's Ultra Light Daily Defense SPF 50 $38
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hyperpigmentation on face: Elta MD UV Clear Facial Sunscreen Broad-Spectrum SPF 46
Elta MD UV Clear Facial Sunscreen Broad-Spectrum SPF 46 $38
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"Melasma can be more difficult to treat than other forms of hyperpigmentation. Products that contain vitamin C, a powerful antioxidant, can be helpful in preventing and treating hyperpigmentation. I like SkinCeuticals CE Ferulic for use during the day."

hyperpigmentation on face: Skinceuticals CE Ferulic
Skinceuticals CE Ferulic $135
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"Retinol can also help at night to fade existing melasma and prevent new patches from forming. SkinCeuticals Retinol 0.3 is a nice one to try."

hyperpigmentation on face: Skinceuticals Retinol 0.3
Skinceuticals Retinol 0.3 $55
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"Dedicated skin-lightening products that contain ingredients such as azaleic acid, kojic acid and arbutin can also be helpful. Try NeoStrata Enlighten Pigment Lightening Gel and Obagi Blend Fx."

hyperpigmentation on face: Neostrata Enlighten Pigment Lightening Gel
NeoStrata Enlighten Pigment Lightening Gel $28
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hyperpigmentation on face: Obagi Blend FX
Obagi Blend FX $74
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Further treatment

"Prescription-strength products that contain hydroquinone can be very beneficial for melasma, These are safe for up to three months at a time. There are also prescription-strength azaleic acid and retinoid formulations that help fade and prevent pigmentation. In-office chemical peels also help in treating the condition; I especially like a strong peel called Dermamelan and have had great results with it for hyperpigmentation. I generally avoid lasers for melasma, as they may improve the appearance temporarily but have the potential to worsen melasma over time."

Got a skin concern you'd like Dr. Granite's advice on? Come ask us in our dedicated Facebook group, The British Beauty Line.

Dr. Alexis Granite is a consultant dermatologist at Mallucci London. For appointments at Mallucci London, visit the practice's website.

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