Pigmentation of the skin is a current skin topic that many people want to know more about. We asked prominent dermatologist Dr Esther Hong to explain what skin pigmentation is and what to do about it. Dr Hong has 8 years of experience working in clinical and research dermatology across New South Wales and currently consults at St George Dermatology and Royal North Shore Hospital.

How does skin pigmentation occur?

Pigmentation occurs by production of melanin (a type of skin protein) by melanocytes (a specialised type of cell in the skin). Melanin is then deposited in the top layers of the skin and is responsible for our skin colour.

Melanocytes numbers are the same for each racial group, but the amount of melanin produced by the melanocytes differs in each person. Darker skin tends to produce more melanin, while fair skin produces less.

Is there a difference between pigmentation and hyperpigmentation?

Hyperpigmentation often refers to a secondary process of skin darkening due to injury to the skin, as in post-inflammatory hyperpigmentation. In these cases, injury to the skin such as an oven burn or insect bite can activate melanocytes to produce increased amounts of melanin.

Melasma is a type of hyperpigmentation affected by exposure to UV radiation. It also occurs through a combination of other factors including genetics and hormones.

Are there different types of hyperpigmentation?

Hyperpigmentation may be classified by cause (e.g. hormonal, post-inflammatory, drug-induced), and type of hyperpigmentation – for example, epidermal (where the pigmentation is superficial) and dermal (where pigmentation is deeper). Dermal hyperpigmentation can appear as grey/blue tones and is often harder to treat.

How is skin pigmentation associated with pregnancy?

Hormones of pregnancy, mainly oestrogen, can activate melanocytes and cause darkening of skin. “Mask of pregnancy” refers to facial hyperpigmentation or melisma. Linea nigra (dark line down the centre of the lower abdomen) is a type of hormonal hyperpigmentation seen during pregnancy.

Regarding pigmentation and pregnancy, can you prevent it?

No, but strict sun protection helps prevent worsening of pigmentation and so does avoiding other potential sensitizers (medications, perfumes and fragrances etc)

Does it disappear after giving birth?

Hormonal skin pigmentation usually fades within a few months after giving birth.

What advice would you give to someone concerned about pigmentation during pregnancy?

Sun protection is very important! But due to pregnancy, you have to be careful when using certain products. In this sense, it’s best to always consult with a doctor before using any products.

What's the starting point for everyone concerned about pigmentation?

Prevention is key! Sun protection with 50+ sunscreen and a wide brimmed hat helps greatly. Treatment using a combination of creams that incorporate ingredients that help fade and stop formation of new pigmentation. Products containing hydroquinone, kojic acid, soybean extracts, vitamin C and azelaic acid. Combining fruit acid (AHA) peels can help remove existing pigment. Stubborn cases may need review by a dermatologist who can recommend the best approach. Laser treatment can also play a role in some cases.