Hyperpigmentation: Causes & Treatment

Singapore Dermatologist Dr. Teo Wan Lin explains the common causes of hyperpigmentation in the Eucerin x Watsons Facebook live. She shares her scientific research on the dermocosmetic ingredient Thiamidol, which Eucerin holds the patent for and incorporates in their Spotless Brightening Booster Serum. This is clinically proven to reduce dark spots by up to 75% without laser treatment when applied twice daily.

The following is an excerpt from the Facebook Live session, where Dr. Teo Wan Lin shares her expertise as a dermatologist. She shares on the causes of hyperpigmentation. An example is the hormonally-triggered pigmentation condition melasma. Age and genetics can cause solar lentigo, also known as sunspots. All causes of hyperpigmentation is linked to sun exposure. Other causes of hyperpigmentation include post inflammation hyperpigmentation, which can arise from acne scars and eczema. She also shares with Victoria Cheng, Amander Sings co-hosts of the Facebook Live event the relevance of Thiamidol. Thiamidol is the tyrosinase inhibitor patented by Eucerin. It is effective for treating various sorts of hyperpigmentation. Dr. Teo also highlights the good side effect profile of Thiamidol. There are no adverse events compared to other hyperpigmentation treatment options when evaluated in clinical trials.

Host: I completely agree that it is never too early to start taking good care of your skin because you really don’t know what’s going to happen. Like you mentioned before, dark spots can be quite stubborn and difficult to remove as well. Perhaps Dr Teo, you can share a little bit more about the cause of these dark spots.

What are the different types of hyperpigmentation? 

Dr. Teo: Definitely. Hyperpigmentation is actually a very common concern of both men and women. There are several causes of hyperpigmentation. You may have heard of melasma. That is hormonally triggered and is more common in darker skinned individuals. There’s also sunspots, or Solar Lentigo as they are known medically. These are actually largely affected by sun exposure. Finally, individuals who suffer from post inflammatory hyperpigmentation can get this, say with acne scars and facial eczema. This also includes any other type of dermatitis, the inflammation itself can lead to hyperpigmentation.

Host: I see, and you’re talking about hyperpigmentation, can you explain a little bit more about the cause behind it. Also, how does hyperpigmentation form on our skin?

What are the causes of hyperpigmentation? 

Dr. Teo: Pigmentation is essentially due to a deposition of melanin in our skin. The process by which skin cells, known as melanocytes produces pigments is called melanogenesis. Cumulative sun exposure affects this process and the way these cells produce melanin. As Victoria mentioned before, sometimes when you’re younger, that’s when you are a little bit less cautious about sun exposure. What you don’t realise is that it does appear several years later.

Host: I do have a question for Dr. Teo, it says here that the Eucerin Spotless Brightening Booster Serum has a special ingredient called the Thiamidol. I’m a big fan of reading active ingredients of products, I like to do my own research. But can you please share with our audience and our viewers here a little bit more about Thiamidol?

Tell us more about Thiamidol for hyperpigmentation

Dr. Teo: That’s great to hear about your interest in this. Thiamidol is what we consider a potent enzyme inhibitor. In the context of hyperpigmentation, it inhibits an enzyme known as tyrosinase. In fact, Eucerin research has found that it is the most potent inhibitor of tyrosinase. This is when compared to over 50,000 other active ingredients that are also functioning as tyrosinase inhibitors.

What is the significance of tyrosinase for our skin?

Dr. Teo: Well that’s a great question. Tyrosinase is actually a very important enzyme in melanogenesis, which is the very process by which our skin produces melanin. This is what is causing hyperpigmentation disorders that we’ve mentioned before.

Victoria: Exactly. Throughout this process I have learned a lot more about the brand and Eucerin has invested 10 years of research into this product and has tested more than 50,000 ingredients. Thiamidol emerged as the winning agent that is the most effective ingredient in all of this. What I really like is that 10 years is not a short time. It makes me feel more confident to use this product, because I know so much time and research has gone into this, and that it  is a safe product. This is our face after all, we only get one of them, so you want to make sure it’s treated right. 

The research behind Thiamidol as an effective ingredient to treat hyperpigmentation 

Dr. Teo: I personally find that Thiamidol is very interesting and very relevant to my dermatology practice. In fact, the research that has been published, we’re going to talk a little bit about it now, in the International Journal of Cosmetic Science. We find in a randomized split phase control study that Thiamidol was highly effective in preventing and treating hyperpigmentation. This same result was also found in a separate study in the Journal of Investigative Dermatology in 2019. Thiamidol was very much comparable to the gold standard treatment for hyperpigmentation -Hydroquinone. What was really impressive was that it was very tolerable. Thiamidol was definitely better in terms of its side effect profile than Hydroquinone.

Host: Actually I did some research on Thiamidol, and I might have come across the same people as well. But I was just looking at the effects and how effective the ingredient is. I think to most people, that’s what they look out for when they look at a skincare product. You’ve mentioned tolerance as well. Could you please elaborate a little bit more about what you mean in this case by tolerance? Is it a product or an active ingredient that is being tolerable?

Tolerable ingredients for sensitive skin 

Dr. Teo: So when we discuss active ingredients in cosmeceuticals, we find that a lot of these are synthetic actives. We’ll just take hydroquinone for example, they do have the potential to interfere with skin physiology. That’s actually the mechanism of action in which it inhibits the enzyme that causes hyperpigmentation. But at the same time, we find that it produces side effects, such as redness, dryness. Users, very often report stinging, flaking and this overall, very sensitive phenomenon on this skin which is really quite uncomfortable.

Therefore, for the two studies that we mention above, it was really quite remarkable that the study participants report no significant side effects in terms of the usual stinging, burning, dry skin, sort of irritation symptoms with Thiamidol. This is in contrast with the arm that was using Hydroquinone. It was equally impressive that both arms achieved a statistically significant reduction in the hyperpigmentation. For Thiamidol, we find that there were no such adverse events with regards to skin irritation that observable in the hydroquinone arm.

Host: For me right, when I hear skin irritation, I normally associate it with visible skin irritation. Could you please share a little bit more for our audience at home, on how perhaps they can detect these signs of skin irritation. Could you give us some symptoms of what they should observe?

What are the signs of skin irritation? 

Dr. Teo: Let me just put it in the context of our viewers here. If you find yourself having any of these skin symptoms, then you may very well be suffering from dermatitis. You may more commonly know this as a form of eczema. Dryness, redness, flaking, an uncomfortable burning sensation. We want to be a little bit specific here. In the context of what we discussed, we’re talking about individuals who have been applying certain cosmetic ingredients on their skin. However, if you already suffer from these symptoms you may have an underlying skin disorder. 

Sensitivity is actually very much a lay person, sort of perception of what dermatologists would consider, you know dermatitis and that refers to failure of the skin barrier. So any form of barrier dysfunction can give rise to these symptoms. However, with regards to today’s discussion, and especially the research that was conducted about Thiamidol in comparison to hydroquinone, we’re really talking about the adverse events induced by synthetic cosmeceuticals, such as hydroquinone.

Victoria: I wanted to know, Dr. Teo, if I prevent this when I was younger, would it have made a big difference versus you know starting now when I’m in my 30s?

How early should you start dark spot prevention? 

Dr. Teo: Well, I think what both of you have shared is very helpful for our viewers, and I’m sure many of them have similar questions. What you said Victoria about prevention, being better than cure, or treatment. It does hold true in many aspects when we talk about hyperpigmentation.

Going back to your specific question as to whether your sun exposure would have made a difference to how your skin looks now, how it will look in 10 years or 20 years. Well the answer is that science tells us that yes, there is a significant component of hyperpigmentation, especially in terms of photoaging, which is, you know, primarily the mechanism of skin aging because of environmental factors. It is also quite a blessing for us to have more melanin in our skin. So compared to, say, Caucasian counterparts of the same biological age, we expect to have lesser signs of photo aging simply because of our innate photoprotective capabilities of increased melanin.

Thiamidol – an effective treatment for dark spots and pigmentation 

I think we want to highlight the significance of thiamidol here. We actually find thiamidol to be the most effective tyrosinase inhibitor. Even when you compare it to other very well established, well known active ingredients such as Arbutin, Kojic acid, we find that in cell cultures thiamidol had superior abilities to inhibit Tyrosinase. Something that perhaps our viewers may find interesting is that a lot of prescription pigmentation treatments, such as hydroquinone which we mention a lot, because we consider that for a long time to be the gold standard of pigmentation treatment for melasma. We also use it together with laser treatments for sunspots.

Hydroquinone is actually quite well known to have certain adverse events, and not just skin irritation which we talked about earlier, but also rarer side effects such as rebound hyperpigmentation. This is where the pigmentation, instead of becoming lighter, after a few months of using the product actually darkens your skin. Also something known as chemical leucoderma where the skin cells actually lose their natural melanin, and the skin becomes depigmented. These are certainly adverse events that we want to avoid when treating hyperpigmentation. Besides that, I think that the value of thiamidol is that it should be highly tolerable. It’s also appropriate for use in disorders such as post inflammatory hyperpigmentation, such as what arises from eczema dermatitis, as well as acne scars because traditionally these conditions can be triggered off by Hydroquinone.

Is Thiamidol suitable for sensitive skin? 

Dr. Teo: Thiamidol is a very gentle ingredient that is suitable for sensitive skin, so even if you have a history of eczema it would be considered suitable for your skin.

What should I do if I have dark spots? 

Dr. Teo: Well, I mean I think it is human to have flaws. So, there is nothing embarrassing about it when you ask this question. It is important for us to realize that not all forms of hyperpigmentation are so called age related, or even, caused by environmental exposures. I have naturally quite fair skin, so even from my teen years I had freckles. I still have them, they’re quite faint, I’m actually not wearing makeup now other than for lipstick, so if your camera is able to zoom in you can see. We do not treat freckles, because they are not in any way related to photoaging or, even any sort of pathological process.

You’ll notice that a lot of fair skinned individuals and especially in individuals of light colored eyes and red hair. These individuals genetically have a higher tendency to develop freckles, which we also call ephelides. For anybody that has even suffered from a mosquito bite, sometimes after the bite you do get hyperpigmentation as well. Growing up, we all have had bouts of physiologic, so even as adults, we do still see individuals who suffer from hormonal acne. That is exactly the post inflammation hyperpigmentation that I was talking about earlier, that Thiamidol can effectively target.

Dr. Teo has a series of articles and podcasts related to the topic of skin brightening, as well as attitudes towards whitening in Asian beauty trends.

Dr. Teo Wan Lin is an accredited dermatologist practicing in TWL Specialist Skin & Laser Centre. If you have concerns about skin pigmentation, you may book an appointment here.