How to reduce hyperpigmentation?

Question

I'm having hyperpigmentation around mouch for atleast last 15 years.I'm 23 now. I have tried all home remedies but nothing seems to work. I'm also having hypothyroidism for past 11 years and PCOS   since 2021. Is the hyperpigmentation persist due to these disorders? But for these I'm taking medications.I had gone through weight loss also.Sometimes the hyperpigmentation reduces and sometimes it worsens.My skin is so sensitive.But I'm not having acne issues.Can you please suggest me some dermatological products for reducing hyperpigmentation.

Dr. Neeraj Agarwal · Accepted Answer

It sounds like you're dealing with a combination of hyperpigmentation, hypothyroidism, and PCOS, which can indeed influence skin health, including pigmentation issues. The fact that you've been dealing with this for such a long time—15 years—suggests that there may be underlying factors like hormonal imbalances, increased sensitivity due to thyroid and PCOS-related skin changes, or perhaps even sun exposure that could contribute to your hyperpigmentation.

### Possible Causes of Hyperpigmentation:
1. **Hypothyroidism:** The hormonal changes related to hypothyroidism can sometimes affect the skin, making it more sensitive or prone to pigmentation issues. When thyroid levels are not well controlled, it may cause a variety of skin changes.
  
2. **PCOS:** Polycystic ovary syndrome often results in hormonal imbalances, including increased levels of androgens (male hormones). This can lead to skin issues, including pigmentation problems. People with PCOS are also at higher risk of developing **melasma** or **post-inflammatory hyperpigmentation**, which may worsen with sun exposure.

3. **Sun Exposure:** Even without acne, prolonged exposure to the sun can lead to pigmentation, especially in sensitive skin areas like around the mouth.

4. **Hormonal Changes:** Your hormonal fluctuations due to PCOS can contribute to skin pigmentation issues. Since you mentioned weight loss, changes in body weight can sometimes trigger these fluctuations, affecting the skin.

### Dermatological Products for Hyperpigmentation:
Here are a few types of products and ingredients that can help target hyperpigmentation. It's important to start with gentle formulas given your skin sensitivity:

1. **Vitamin C (Ascorbic Acid)**: This antioxidant helps brighten the skin and can lighten dark spots. Look for serums that contain stabilized forms of Vitamin C, like **ascorbic acid** or **sodium ascorbyl phosphate**.
   - **Recommended Products**: La Roche-Posay Pure Vitamin C Face Serum, SkinCeuticals C E Ferulic.

2. **Niacinamide (Vitamin B3)**: Known for its brightening properties, niacinamide helps reduce the appearance of dark spots and even out skin tone.
   - **Recommended Products**: The Ordinary Niacinamide 10% + Zinc 1%, Paula’s Choice 10% Niacinamide Booster.

3. **Retinoids (Retinol)**: These can accelerate skin turnover, helping to fade dark spots and improve overall skin texture. Start with lower-strength retinols to avoid irritation.
   - **Recommended Products**: Differin Adapalene Gel 0.1%, The Ordinary Retinol 0.2% in Squalane.

4. **Alpha Hydroxy Acids (AHAs)**: Glycolic acid or lactic acid gently exfoliate the skin, which can help fade hyperpigmentation over time.
   - **Recommended Products**: The Ordinary Glycolic Acid 7% Toning Solution, Pixi Glow Tonic (contains glycolic acid).

5. **Azelaic Acid**: This is another gentle exfoliant that helps reduce pigmentation and even out skin tone. It's especially good for sensitive skin.
   - **Recommended Products**: The Ordinary Azelaic Acid 10% Suspension, Paula’s Choice 10% Azelaic Acid Booster.

6. **Sunscreen (SPF 30 or higher)**: Always apply sunscreen in the morning to prevent further darkening of hyperpigmentation. Sunscreen is crucial for preventing UV-induced pigmentation and maintaining the progress of your treatment.
   - **Recommended Products**: La Roche-Posay Anthelios Melt-in Milk Sunscreen SPF 60, EltaMD UV Clear Broad-Spectrum SPF 46.

### Routine Suggestion:
- **Morning**:
  1. Cleanser (gentle, non-stripping)
  2. Niacinamide serum (or Vitamin C serum)
  3. Sunscreen (important for preventing further hyperpigmentation)

- **Evening**:
  1. Cleanser
  2. Retinol or Azelaic Acid (alternating days)
  3. Moisturizer (to maintain hydration)

Since you have sensitive skin, start with lower concentrations of active ingredients and patch-test new products to avoid irritation.

### Other Tips:
- **Consistency is Key**: Hyperpigmentation can take time to improve, sometimes up to several months, so regular use of the right products will help.
- **Avoid Picking at Skin**: Even without acne, irritation or scarring from picking at skin can worsen pigmentation.
- **Consult a Dermatologist**: Since you've been dealing with this for years, it could be helpful to consult a dermatologist for a personalized treatment plan, especially given your thyroid and PCOS history.

Lastly, while medications for hypothyroidism and PCOS can help manage hormonal imbalances, they may not directly target skin pigmentation, so it's important to focus on topical treatments that can address the pigmentation directly.

Dr. Alan Reji · Answer

Thanks for sharing openly—it really helps paint the full picture. Yes, your long-standing hyperpigmentation around the mouth is very likely linked to your hormonal conditions—especially hypothyroidism and PCOS, both of which can disrupt melanin production and skin repair. Since your skin is sensitive, many common DIY treatments may actually worsen things by causing irritation or rebound pigmentation. Also, fluctuations in hormone levels or weight changes can make the pigmentation come and go. The good news is: with the right dermatological routine, it can be managed and even significantly reduced.

Here’s a gentle but effective dermatologist-recommended routine you can try:

1. Face Wash (AM/PM): Cetaphil Gentle Cleanser or Bioderma Sensibio Foaming Gel – great for sensitive skin.

2. Morning Cream (AM): Minimalist Vitamin C 10% + E + Ferulic Acid Serum (apply only on dry skin, avoid mouth corners if irritated).

3. Moisturizer (AM/PM): Sebamed Moisturizing Cream or CeraVe Moisturizing Cream – fragrance-free and hydrating.

4. Sunscreen (AM, even indoors): La Roche-Posay Anthelios SPF 50 or Neutrogena UltraSheer Dry Touch SPF 50 – crucial daily.

5. Night Treatment (PM): Azelaic Acid 10% (The Ordinary or Minimalist) or Kojic Acid + Niacinamide cream (like Demelan Lite or Kojiglo Gold), which gently target pigmentation without irritating skin.

Avoid scrubbing or using lemon, turmeric, or baking soda on that area—they can make pigmentation worse over time. Also, continue managing your thyroid and PCOS with your current meds—it makes a difference. Give this routine at least 8–12 weeks, and you’ll start seeing real changes.

Dr. Mayuri Kakoti · Answer

Dear Droupathy,

I understand how frustrating it must be to deal with hyperpigmentation for so many years, especially when nothing seems to work. Since you have hypothyroidism and PCOS, hormonal fluctuations could be contributing to the pigmentation around your mouth. Even though you’re on medication, these conditions can still affect skin tone over time.

To help manage this, I’d recommend a gentle but consistent skincare routine:
	1.	Morning Routine
	•	Wash your face with a mild cleanser like Cetaphil or Bioderma Sensibio.
	•	Apply a Vitamin C serum (Minimalist 10% or La Roche-Posay) to brighten the skin.
	•	Use a Niacinamide serum (5%) to help reduce pigmentation.
	•	Finish with a broad-spectrum sunscreen (SPF 50+) like Re’equil or La Roche-Posay to prevent further darkening.
	2.	Night Routine
	•	Cleanse your face again with a gentle face wash.
	•	Apply Azelaic Acid (10-20%) to lighten dark spots without irritating sensitive skin.
	•	Use a moisturizer like Bioderma or Cetaphil to keep your skin hydrated.
	3.	Twice a Week
	•	Exfoliate gently with Mandelic Acid (10%) to help improve skin texture.

Since hyperpigmentation takes time to improve, consistency is key. Avoid excessive scrubbing or switching between too many products, as that can irritate your skin. Sun protection is crucial, even when staying indoors.

If the pigmentation still doesn’t improve or worsens, it’s best to consult a dermatologist for personalized treatment options, such as prescription creams or mild chemical peels.

Dr. Shaikh Fawaaz Lateef · Answer

Hello 
With regards to your concern 
Kindly dont follow advise generated by chat gpt.
Consult a dermatologist and undergo retinol peels to reduce the pigmentation.
Melalumin cream over the pigmentation area.

How to reduce hyperpigmentation? - #9466

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