CAUSES OF HYPERPIGMENTATION
Different forms of hyperpigmentation, such as post-inflammatory hyperpigmentation, melasma, periorbital hyperpigmentation, and solar lentigines, do share some common triggers and potential root causes, which can be addressed with a strictly holistic and integrative approach. These causes include: high levels of toxicity in the body; micronutrient deficiency; processed and junk food diets that are high in sugar, artificial sweeteners, preservatives, fillers, and other food additives; and food sensitivities, intolerances, or undiagnosed allergies.

Hyperpigmentation can also be caused by underlying stealth infections or autoimmune disease; gut dysbiosis, including candida overgrowth; overexposure to both UVA and UVB rays, either from the sun or from indoor tanning beds; stress; skin trauma, such as constant picking or acne excoriee; regular use of exfoliants, such as alpha and beta hydroxy acids, strong enzymes, microdermabrasion, scrubs, and dermaplaning; laser treatments and improper usage of microneedling; consistent exposure to environmental toxicants; and consistent application of irritating or sensitizing topical ingredients.

A WHOLEFUL APPRAOCH
A holistic topical approach alone, meaning one consisting purely of natural and organic products and non-invasive or alternative/complementary treatment modalities, will not be enough for lasting results. Suppressing melanin production or inhibiting tyrosinase with cosmeceutical ingredients is also not truly helpful for solving the problem – it merely makes the problem more pleasant for the client. However, it is not a long-term solution and suppressing one function often leads to the imbalance of another. Treating symptoms only with topical ingredients and treatments is a reactive, allopathic approach and does not support a whole, healthy person, especially when the root causes of the visible symptom lie in the person's diet, lifestyle, or mindset.

A beneficial topical regimen, however, can be very helpful when complementing diet, lifestyle, and mindset shifts. When treating hyperpigmentation, it is important to be gentle with the skin; as tempting as it is to try to scrub, burn, needle, or zap away dark spots or uneven pigmentation, this kind of behavior can often do more harm than good. It is also helpful to reduce chemical exfoliation and completely avoid mechanical exfoliants, such as scrubs, dermafiles, and microdermabrasion; while gentle enzymes are generally beneficial, acids can be too irritating. Remind clients not to over-cleanse their skin as this practice can cause irritation and make their skin more susceptible to topical inflammation – they should use soothing oil, milk, or lotion cleansers rather than those that produce foam.

When treating hyperpigmentation, sun protection is essential. Look for sunscreens that contain soothing ingredients, such as zinc oxide, rather than potentially irritating, synthetic sunscreen ingredients. Clients should keep their skin hydrated and lubricated with both water-containing botanical preparations (herbal infusions and hydrosols) and natural carrier oils. Let them know that spot treatments on dark areas are fine, as long as the products are used as directed and not overused. Some ingredients they should look for in a topical regimen for hyperpigmentation include aloe vera gel, green tea, calendula, rose geranium, chamomile, bilberry, blueberry, paper mulberry, licorice root, turmeric, chickory root, gingko, green coffee, and niacinamide. Other ingredients include vitamin C in the forms of tetrahexyldecyl ascorbate, sodium ascorbic phosphate, and magnesium ascorbyl phosphate; pomegranate seed oil; sea buckthorn oil; red raspberry seed oil; cypress; frankincense; and sandalwood essential oils.

HYPERPIGMENTATION AND DIET
Although hyperpigmentation shows up on the surface of the skin and melanocytes reside within the layers of the skin, the health and functionality of those cells largely rely on the nutrients they receive from a person's diet. Diets rich with fresh, whole foods containing high amounts of phytonutrients (plant-based vitamins and antioxidants), minerals, amino acids, proteins, and essential fatty acids are crucial for healthy cells, which are the key to beautiful, healthy skin.

Diets that consist of packaged, processed, convenience, and fast foods lack nutrient density and quality. They also contain high levels of manufactured, unhealthy fats; sodium; and sugar. They tend to be difficult to digest and acidic, both of which are factors that contribute to systemic inflammation. The nutrients that are printed on food product labels are often added to fortify these food-like substances and are not derived from whole foods. They are most often synthetically manufactured substances that are not bioavailable; therefore, they are not able to be properly absorbed by the body and utilized to build healthy cells and support the tissues, organs, or bodily systems.

When the skin is malnourished at the cellular level, DNA mutations are more frequent and cells do not function as they should. Improperly functioning melanocytes due to DNA mutation plays a primary role in hyperpigmentation. Furthermore, pro-inflammatory diets, like those mentioned above, will continuously send distress signals to the cells in the body, triggering a constant inflammatory response, thus keeping the pigment umbrellas open. While skin care professionals cannot prescribe nutritional protocols to prevent or treat skin conditions like hyperpigmentation, there are many simple and general dietary improvements that, over time, can significantly reduce triggers and address root causes.

One dietary improvement includes eating lots of fresh, dark, leafy greens, such as romaine, kale, collards, broccoli, and dandelion greens. Clients can try these greens in salads, lightly steamed or sautéed, or blended into smoothies with fruit. Another change clients can make is to eat colorful fresh fruits and vegetables, like beets, sweet potatoes, peppers, tomatoes, eggplant, blueberries, strawberries, kiwi, and pineapple. With fresh foods, a good rule of thumb is to eat a variety of colors because natural pigments contain high amounts of antioxidants that help to neutralize free radical damage on the inside, which protects and nourishes the cells.

Clients should also try to reduce or eliminate processed sugars and simple carbohydrates, such as white rice, white flour, and white pasta. Complex carbohydrates, like whole or sprouted grains (brown rice, quinoa, millet, and buckwheat) may work for some clients. They can also support their gut health and their gut microbiome with homemade bone broth, which is rich in healthy fats, minerals, and gelatin (cooked collagen); and naturally fermented foods, like kimchi, raw sauerkraut, and kefir. Another helpful dietary change is the consumption of organic animal foods. Conventional meats and dairy products are made from animals that are frequently treated with hormones; adding these hormones to an already hormonally imbalanced body will not help a hormone-related skin condition. Clients can also reduce their alcohol and caffeine intake and keep an eye out for food triggers. Different people react to different things, so if a client's pigmentation seems more prominent after eating certain foods, there is a good chance the client has a sensitivity.

LIFESTYLE CHANGES
With rampant pollution in the air and waterways, in addition to exposure to countless toxicants – such as pesticides, herbicides, fungicides, antibiotics, steroids, plastics, aluminum, detergents, solvents, and perfumes – in skin care, personal care, and household cleaning products, people's collective body burden is at an all-time high. In fact, "tests suggest that women can absorb five pounds of chemicals each year from their daily makeup routines alone! On average, women apply 126 different ingredients to their skin daily and 90 percent of them have never been evaluated for safety."2 Many of these toxicants are endocrine-disrupting chemicals that have the ability to mimic the body's natural hormones, throw them off balance, and interfere with the endocrine system's abilities to regulate vital functions and communicate properly with cells.

Other than avoiding toxic chemicals, other lifestyle factors, like adequate sleep, proper hygiene practices, and physical activity, can make a significant difference in the health of cells, and, as a result, the skin.

For starters, clients should remove as many toxicants from their life as possible, including detergents, perfumes, household cleaning products, BPA, and air fresheners; invest in a water filter for their shower or bath, as chlorine and heavy metals can lead to skin disorders and cause inflammation; and use indoor air filters in the home or workplace. Clients should also keep their bath and shower temperatures lukewarm, as extreme heat can aggravate pigment cells just like it can trigger flareups of other inflammatory conditions like rosacea and psoriasis. It is also important for clients to move their body daily, even if it is only for a few minutes – a little bit of movement, whether it is a traditional exercise like weight lifting or jogging or something like yoga, rock climbing, or ballet, is critical to keep internal detoxification pathways clear and the lymphatic system flowing. Stagnant lymph nodes can cause toxic build up and inflammation, which stresses the liver and puts additional pressure on the skin's various functions. Do not forget to encourage clients to drink enough water on a daily basis and to have a regular sleep schedule with six to eight hours of sleep per night.

THE POWER OF A POSITIVE, PEACEFUL MINDSET
It is a known fact in health and wellness that a positive mindset can do wonders for helping someone achieve and maintain health-
related goals. Whether it is a chronic goal, like weight management, or a more acute goal, like recovering from cancer treatment, science has shown that adopting a positive, healing mindset really sets the stage for desired results to occur. According to science researcher and journalist, Jo Marchant, there are now several lines of research suggesting that a person's mental perception of the world constantly informs and guides their immune system in a way that makes them better able to respond to future threats.3

While thoughts of looking on the bright side and being optimistic in the face of sadness, despair, or fear may induce anything from an eye roll to more negative feelings, simply tricking oneself into thinking positively or putting on a happy face when thoughts are exactly the opposite is not always realistic. When people attempt to control every thought, and then fail when something outside of their control elicits an unplanned, unrehearsed emotional response, the effect can be both emotionally and physically detrimental due to the added stress.

There is a difference between a positive mindset and a peaceful, calm state of mind. Dr. Deepak Chopra prefers the calm state of mind to facilitate healing: "The alternative to thinking is a calm mind that is at peace with itself. I believe that such a mind delivers the benefits that positive thinking cannot."4 Dr. Chopra is promoting a state of mind that is calm and at peace, in spite of external circumstances, rather than the more controlling method of trying to control every thought that leaves the consciousness and every conscious and subconscious response to external stimuli.

Hyperpigmentation has the ability to emotionally affect people as strongly as any other skin condition, especially when it is hormone-related, which it often is. Feelings of shame, imperfectness, doom, hopelessness, and ugliness really play a strong factor. Many skin care professionals and other holistic practitioners report that hyperpigmentation clients, especially younger ones, often present with a great deal of desperation and emotional weight. All of these feelings and emotions greatly increase the levels of stress hormones in the body, which negatively affect the health and appearance of the skin. The persistent presence of elevated cortisol and adrenaline helps keep the body's inflammatory response process going into overdrive. Inflammation is a known cause, or underlying factor, of all skin conditions, including melasma and post-inflammatory hyperpigmentation, due to the constant stimulation of the melanocyte stimulating hormone.5
Instead of potentially adding more stress by promoting the attempted control of emotions, it is far gentler, and often more effective, to provide a framework to support calmness and peace of mind.

While skin care professionals are not therapists or mental health professionals, simple practices, both in the treatment room and with homecare recommendations, can go a long way to facilitate an improvement in mindset.

INDUCING A CALM AND PEACEFUL MINDSET
If clients are having trouble staying calm, have them try a simple deep breathing exercise, like the 4-7-8 method.6 This practice is simple: inhale for four seconds, hold for seven seconds, and exhale for eight seconds. Repeat this cycle four times. Clients will be amazed at how quickly this breathing method can affect the mood. Deep breathing is proven to quickly alter brain chemistry and promote calmness
and relaxation.

Utilize aromatherapy in the treatment room and recommend it for homecare use. Many essential oils and hydrosols, such as lavender, rose, and Roman chamomile, are known to promote relaxation and induce calmness. Professionals can diffuse essential oils in their room, incorporate hydrosols into warm facial compresses or a Lucas sprayer, or even use it to reconstitute dry masks. Clients can diffuse essential oils at home, apply them diluted to pressure points, or inhale them right from a tissue for instant relaxation.

Do not perpetuate drama. If a client comes in with a lot of negative self-talk and feelings of despair, often trying to talk the person out of their feelings or self-perception can do more harm than good. At that moment, the person's mind is made up and the professional is not going to convince the client otherwise. Rather than trying to shift the client's frame of mind from negative to positive, it is best to acknowledge it and then change the subject. If negative self-talk continues to pop up during the treatment, continue to divert the conversation to something more neutral.

During their treatment, ask the client about their preference in background music. Sometimes clients prefer silence; other times, soft classical or new age music does the trick. Music is very subjective and having an undesirable type of relaxing music in the room during a treatment has the opposite effect.

Skin care professionals have the unique privilege of working in a space where they can automatically hold space. It is a safe, trusting space that promotes the giving and receiving of care, comfort, and healing hands. Just holding that space – not rushing to fill it with too much chatter – and deeply listening, not only to the words that are being said, but also to the emotion and energy behind those words, can work wonders for clients. Just being heard is a gift that many clients do not often get to receive and feeling validated can work wonders to support a positive mindset shift.

References
1 Cayce, K.A., McMichael, A.J., and Feldman, S.R. (2004). "Hyperpigmentation: An Overview of the Common Afflictions." Medscape. WebMD.
2 Mercola, J. (2015, June 6). "Documentary Reveals: Chemical Exposure Is in Our Daily Lives." Mercola.com.
3 Cook, G. (2016, January 19). "The Science of Healing Thoughts." Scientific American. Nature America.
4 Chopra, D. (2011, December 5). "Can Positive Thinking Make You Well?" CNN.
5 Gulla, L. (n.d.). "The Effects of Hormones on the Skin." DERMASCOPE Magazine.
6 DrWeil.com. (2016, July 25). "The 4-7-8 Breath: Health Benefits & Demonstration."

Rachael Pontillo is the bestselling author of Love Your Skin, Love Yourself and co-author of the cookbook, The Sauce Code. She is an award-winning AADP board-certified holistic health and image coach, certified metaphysical practitioner, licensed aesthetician, natural skin care formulator, and educator. She is the creator of the popular blog and lifestyle site, holisticallyhaute.com, and the six-week online course, Create Your Skincare™. Pontillo is a recipient of the Institute for Integration®'s esteemed Health Leadership Award and is also a brand ambassador and spokesperson for NeoCell™. She is currently working towards a Ph.D. in Holistic Life Counseling.