Sunday, 24 March 2019 12:10

Fitzpatrick Skin Types 4-6: Causes, Treatments, and Prevention of Common Hyperpigmentation Issues

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Hyperpigmentation is a common skin condition characterized by the appearance of darker pigmented skin relative to the surrounding skin tissues. More likely than not, you’ve tried to explain what pigmentation is, where it comes from, and how to make it go away. Take heart! Pigmentation is a challenging condition that is multi-factorial. Even though pigmentation can be difficult to treat, the light at the end of the tunnel may be that you’re at least educating clients about their case. There are various types of hyperpigmentation with excessive amounts of melanin being the common characteristic. Here’s a list of intrinsic factors that will dictate how pigmentation functions.


Heredity: Especially in the case of birthmarks and taking into consideration race and natural skin color, some skin tones are more prone to photoaging compared to other skin tones. Several recent studies have compared the photosensitivity of people with different skin colors. One such study found that the skin’s photosensitivity is determined by skin color and, people who have darker skin tones where higher levels of melanin can already be found, are more vulnerable to different types of hyperpigmentation.1


Natural Aging: Our body’s natural aging process brings about cellular senescence, which simultaneously affects the efficiency of the body’s functional mechanisms in general, including possible irregularities in melanin formation and even immune response, which can also contribute to the formation of dark skin patches.


Excessive and Unprotected Sun Exposure: The sun is the most common cause of hyperpigmentation. When ultraviolet rays enter the skin, the body responds by producing more melanin to protect skin from damage. In vivo studies have given clear evidence that UVA radiation significantly contributes to long‐term dermal structure deterioration and clinical signs of photoaging. It is responsible for the early appearance of signs of photoaging, which include patchy and mottled pigmentation, wrinkling, laxity, sagging, and dryness.1


Hormonal Changes: Excessive melanin formation can be triggered by hormone fluctuations due to pregnancy. This condition causes chloasma, dark underarms, and darker skin on the neck and joints during pregnancy.


Skin Trauma: The body releases more melanin to support skin healing following wound and acne scarring. This is the body’s natural mechanism for healing and it’s called post-inflammatory hyperpigmentation (PIH). In some cases, the darker skin eventually evens out with surrounding skin.


Medications: Certain drugs, including birth control pills and cancer chemotherapy drugs, can also cause a spike in melanin formation.



Listed below are the most common types of pigmentation and the corresponding recommendations on how to treat hyperpigmentation.


Sun Spots: Typically, these are hyperpigmentation on the face, but may also be commonly found on the neck, chest, hands, or any other part of the skin that is exposed to sunlight. These lesions, also called solar lentigines, become more common as skin ages. Treatments include topical application of skin brightening agents, as well as chemical peels to help lighten skin gradually. Fractional laser resurfacing may also be a treatment option.


Melasma: Also termed chloasma, “the mask of pregnancy,” is used synonymously to describe uneven patches of light to medium brown skin often showing up on areas frequently exposed to sunlight. Melasma is relatively easy to identify with its bilateral presentation across the face. Melasma may naturally fade following childbirth. For faster skin healing, retinol and hydroquinone creams are possible options or any hyperpigmentation product for that matter. Boosting antioxidant levels can also help skin heal faster. Plus, wearing sunscreen can help the skin better cope with repairs.


Freckles: These are common in fairer skinned individuals and may be present at birth or developed as a result of regular or excessive sun exposure. In general, these are caused by UVB damage on the surface of the skin. Since freckles are in shallow layers, these are relatively easy to fade using products such as kojic acid for hyperpigmentation. However, since this type of pigmentation is genetic or intrinsic, freckles will return with sun exposure.


Post-Inflammatory Hyperpigmentation: PIH is very common in higher Fitzpatrick types. Skin infections, trauma, and other forms of inflammation, including acne, will bring on pigmentation as the skin heals. The textbook definition from Pivot Point International is that PIH is a disorder that results from trauma to tissues from acne, burn, injury, or some skin rashes, such as dermatitis or psoriasis. The condition creates flat, darkened patches that are irregular in shape and appear anywhere that the inflammation occurred. Like age spots, this type of pigmentation issue can be treated with chemical peels. You can also treat hyperpigmentation by using topical skin lighteners. Enzymes are a gentle approach when working with pigmented lesions. Various acids, namely lactic acid, will effectively treat pigmentation; however, exfoliation is only the beginning. To successfully treat pigmen, the client will also need to use lightening products and re-evaluate their work-play lifestyle.



The following are some tips to help clients prevent and manage hyperpigmentation.


Clients must be sunscreen compliant. Applying sunscreen on skin daily is just one way to help protect skin from damaging ultraviolet radiation. Clients should complement it with properly timing sun exposure and wearing appropriate clothing when out in the sun. Encourage them to re-evaluate how much sun they are receiving.


Evaluate inflamed skin and treat skin infections, including acne correctly. Typically, if professionals can appropriately get rid of the inflammation quickly, hyperpigmentation will not be able to develop as readily.


Teach proper skin care. Assist clients in developing a proper skin care routine. Help them understand that there is no miracle product that will magically take away the neglect. Know clients’ skin types, so you can complement each skin type with the right skin care regimen. Teach clients to be gentle with their skin. T

each them not to rub, prick, or scrub vigorously.


Ask for alternative medical. If a client is prescribed medication, encourage them to ask their doctor how or if the medications affect with the skin.



  • Genetically have longer melanocyte dendrites, which places the melanin in the upper layers of the stratum spinosum layer.3
  • Darker toned skin will carry more black or brown pigment (eumelanin) and very little, if any, red pigment (pheomelanin).
  • The size of the pigment granule is larger in darker skin tones.
  • The size of the melanosome is also larger in darker skin tones.
  • However, the amount of pigment is the same in all skin types.



1 Battie, Claire, Setsuko Jitsukawa, Françoise Bernerd, Sandra Del Bino, Claire Marionnet, and Michèle Verschoore. “New insights in photoaging, UVA induced damage and skin types.” Experimental Dermatology (2014).

2 Advanced Skin Analysis. Pastiche Resources Ltd., 2012, page 62.


Dave Waggoner is a licensed aesthetician with experience as both an educator and practitioner. He has a master’s degree in education and currently serves as director of education and public relations at Skin Script Skin Care in Tempe, Arizona. Contact him at This email address is being protected from spambots. You need JavaScript enabled to view it..

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