Hyperpigmentation can occur anywhere on the skin – the face, neck, chest, arms, legs etc. It can be brought on by a variety of factors including diet, genetics, inflammation, oxidative compounds, and most notably, UV radiation. Moreover, certain areas of the body have a propensity for developing hyperpigmentation through unique circumstances (elbows, knuckles etc.).
Regardless of where on the body it manifests, the treatment of hyperpigmenation should adhere to the 3 fundamentals of skin lightening – protect (sunscreen, sun avoidance etc.), exfoliate (hasten expelling of existing melanin filled cells, enhance efficacy of treatment products), and treat (discourage the formation of new melanin). The biggest difference in treating common forms of hyperpigmentation on the body as opposed to the face has to do with money. Areas of hyperpigmentation which span large surface areas may require more economical treatment products, as products designed for facial skin tend to be small to moderate in size and simply uneconomical for larger areas such as the body. Also, specific areas of hyperpigmentation on the body do require unique protocols.
In this post, I will address the general treatment plan for common forms of hyperpigmentation on the body, as well as discuss how to approach specific forms of hyperpigmentation uniquely found on areas other than the face.
The single most crucial aspect to any anti-hyperpigmentation plan is sunscreen! Increased melanin production is a response to DNA damage most commonly induced by exposure to UV radiation. Avoiding excessive sun exposure and being diligent with sunscreen can prevent this by-product and allow for skin lightening products to work without compromise.
There are plenty of sunscreens in the market which are economical in size and price that are perfect for the body. Some excellent ones include: La Roche Posay Anthelios 50 Mineral Ulta Light Sunscreen Fluid (USD$36.99), Kiehl’s Activated Sun Protector Water-Light Lotion For Face & Body SPF 30 (USD$29.99), Ole Henriksen Protect the Truth Sunscreen SPF 50+ with vitamin C derivative (USD$35.00), and UNT UV Bright Plus EX White Body Sunscreen Lotion with tranexamic acid for brightening (USD$18.99).
Sunscreen sprays (i.e. La Roche Posay Anthelios Ultra-Light Invisible Mist SPF 50+ (USD$35.99)) are also an excellent and convenient way to protect areas of the body. Just remember, you will need to spray on more than you would if you were applying a lotion, since sunscreen sprays are less dense (thinner).
Treating Hyperpigmentation On Large Surface Areas
Hyperpigmentation can be localized to small and large areas of the body. With larger lesions that cover a significant amount of skin, it’s best to adopt both an economical and multifaceted approach.
Utilizing skin brightening soaps and cleansers are a way to exfoliate and/or brighten overall skin tone on the body. Their benefits lie in their cumulative effect. The key to obtaining this effect is by allowing a longer period of time for the soap or cleanser to be on the skin before rinsing off. I dub it the ‘2 minute rule‘. Lathering a soap or cleanser with tyrosinase inhibiting ingredients or exfoliating ingredients onto the skin for a duration of time (2 minutes or more) can yield some positive anti-hyperpigmentation results overtime (albeit nothing compared to a leave-on product).
Popular skin lightening soaps are: Kojie San Skin Lightening Soap (USD$6.29 for 2-pack), which contains kojic acid and vitamin C, Likas Papaya Soap (USD$7.89), which has papain (from papaya), an enzyme which breaks down certain proteins in the skin resulting in smoother more even skin, and Belo Essentials Kojic Acid + Tranexamic Acid Intensive Whitening Bar (USD$7.19). I have personally found great success in using the DDF Brightening Cleanser (USD$27.30), which contains a host of plant extract based tyrosinase inhibitors and hydroxy acids to exfoliate and brighten tone. To make the product more economical, I would lather it on my body with a loofah, which in turn also added a bit more exfoliation.
Applying facial skin brightening and skin lightening products to smaller areas of hyperpigmentation on the body is fine, however, with large surface areas, mixing products as well as using body-specific skin lightening products are the names of the game. Mixing a skin lightening product that contains ingredients like arbutin, licorice extract, rumex extract, gigawhite, chromabright, and sepiwhite with a bland moisturizing body lotion is an economical approach to treating larger lesions of hyperpigmentation. Caution is needed when mixing retinoids with alpha hydroxy acids, vitamin C (in the form of L-ascorbic acid) with niacinamide, and vitamin C with alpha hydroxy acids, as these combinations can be irritating for some individuals.
Body products which can treat hyperpigmentation include exfoliating body lotions (and washes) and skin lightening products. AmLactin Moisturizing Body Lotion (USD$22.99) is a phenomenal body lotion which lightly moisturizes skin while exfoliating with 12% ammonium lactate (lactic acid combined with ammonium hydroxide for pH adjustment). Other exfoliating and/or skin lightening products include: Glytone Retexturize Body Lotion SPF 15 (USD$30.00), which has glycolic acid + sunscreen, Reviva Labs Skin Lightener Body Lotion (USD$15.00), contains kojic acid and mulberry extract, AHAVA Dead Sea Osmoter Body Concentrate (USD$45.00), which has vitamin C derivatives and brown algae to inhibit melanin, and Perfect Image Gly + Sal Exfoliating Body Lotion (USD$29.95), which is an amalgamation of 10% glycolic acid plus 2% salicylic acid for exfoliation, and green tea, papaya, bearberry extract, chamomile extract, and licorice extract for skin lightening.
Knuckles, Elbows, and Knees
The knuckles, elbows, and knees are prone to hyperpigmentation due to their anatomical location. They are hot-spots for friction and mechanical stress, two factors which lead to post-inflammatory hyperpigmentation (increase in melanogenesis as a response to irritation).
Using exfoliating and skin lightening body washes and lotions can lighten hyperpigmentation in these areas, but the role of adequate moisturization is even more pivotal.
Moisturizing these areas can prevent the development of post-inflammatory hyperpigmentation, as well as other conditions such as eczema, which also contributes to darkened knuckles, elbows, and knees. When moisturizing these areas, look for a moisturizer with humectant ingredients (ingredients that draw in moisture such as glycerin, hyaluronic acid, sodium hyaluronate) as well as emollient ingredients (ceramides, stearic acid, linoleic acid, lauric acid), which can smooth the skins surface by filling in cracks. A favorite of mine is the CeraVe Moisturizing Lotion (USD$12.99), which contains emollients, humectants, and occlusive agents to lock in moisture and prevent dryness.
In regards to knuckles, it is crucial to avoid over-drying the skin, which can lead to an inflammatory pigmentation response. To avoid over-drying, refrain from excessively wash hands, or use dish washing gloves to protect the skin. Additionally, avoiding the use of excessive hot water (i.e reduce the heat in showers, or shorten the duration of hot showers) is important as it can strip skin of essential oils.
Acanthosis Nigricans is a term to describe lesions of darkened skin often accompanied by a leathery texture. It is most commonly found in areas such as the back of the neck, underarms, groin area, knees, knuckles, elbows, beneath breasts (in women), and the face. Aside from their superficial appearance, this condition is symptomless in terms of pain and itchiness.
Its etiology can stem from numerous factors ranging from genetics (with individuals with darker skin being more prone to developing this form of hyperpigmentation), high levels of insulin, obesity, hormonal issues (thyroid disorders, complications with adrenal glands), and certain medications, such as corticosteroids and birth control.
Treating Acanthosis Nigricans goes beyond topical products, and should focus on addressing systemic issues, as these are often the root cause – type 2 diabetes being the most prevailing factor. Check with your doctor if you have Acanthosis Nigricans to rule out any systemic causes, or to begin treatment of any causes.
Dark underarms can be seen in individuals of all ethnic groups. Its root cause is based in its anatomical position, which is an area in constant friction. To cut down on the friction, try to keep the underarms as dry as possible (showering regularly, wearing antiperspirants if one excessively sweats), as perspiration can make the skin sticky, exacerbating friction.
Irritation can also lead to hyperpigmentation in the underarms. This can be brought on by shaving as well as the presence of sebaceous cysts which can leave behind hyperpigmentated scars. While eliminating shaving entirely isn’t a viable option for everyone, those with dark underarms should either reduce the frequency of shaving in these areas OR look into other methods of hair removal (i.e. waxing, laser hair removal), however these can also pose risks for developing post-inflammatory hyperpigmentation.
Other causes include obesity and pre or type 2 diabetes. Managing these two conditions can be beneficial in alleviating darkened underarms in certain individuals.
Since the skin is quite sensitive in the underarms, treatment should consist of gentle yet effective melanin inhibiting ingredients. Active ingredients to look for include chromabright, licorice extract (reduces inflammation), rumex, sepiwhite, and gigawhite. There are specific products in the market that treat dark underarms, one of them being the DermaDoctor Total NonScents Ultra-Gentle Brightening Antiperspirant (USD$28.00), a 2-in-1 roll on product, which has aluminium zirconium tetrachlorohydrex gly to provide anti-perspiration benefits and kojic dipalmitate, a derivative of tyrosinase inhibiting ingredient kojic acid, that is less irritating, and more stable in the presence of light and air, however lacks in vivo studies. PFB Vanish + Chromabright (USD$29.00) is another promising product, which also comes in a roll-on gel. Its formulated to fight razor bumps, ingrown hairs and lighten dark spots caused by ingrown hair scarring or post-inflammatory hyperpigmentation. It contains salicylic acid to exfoliate and clarify pores, letting ingrown hairs free, camphor leaf oil to prevent infection, and chromabright to lighten hyperpigmentation via tyrosinase inhibition.
Treating hyperpigmentation in intimate areas can be problematic, as these areas can be sensitive as well as constantly being wiped or cleansed. Implementing a routine that fosters undisturbed application of products is important. An example would be using treatment products at night or perhaps applying around areas that are constantly being cleaned during active hours. Non-irritating ingredients are optimal for these areas of hyperpigmentation.
A specific product designed for intimate areas of hyperpigmentation is Secret Bright – Skin Brightener for Intimate and Delicate Areas (USD$39.99). This leave-on gel contains alpha-arbutin and kojic acid to inhibit melanin production, and lactic acid to break up existing melanin and gently exfoliate surface layer skin. Additionally, it contains a host of plant extracts to stimulate cell renewal and soothe the skin. Although this product can be incredibly beneficial to those who can tolerate it, it can be troublesome for sensitive skin types due to the kojic acid content. Kojic acid can be sensitizing to the skin, especially when used consistently for more than a few months. In fact, most dermatologists recommend alternating kojic acid with other tyrosinase inhibiting ingredients to cut down on potential irritation. Irritation within intimate areas is a huge no-no!
Alternating this product with non-kojic acid based skin lighteners over a period of time (i.e. every 4 months) can work to lighten hyperpigmentation in intimate areas without the risk of irritation developing.
Regardless of where hyperpigmentation appears on the body, the treatment plan should be multifaceted (regimen of skin lightening products, moisturizing products, exfoliating products, sun protecting products). Certain areas of the body require specific care such as avoiding irritation, lifestyle changes, and ruling out health issues in combination or in lieu of topical cosmetic treatments to alleviate hyperpigmentation.