What can I do about my pigmentation?

Most unfortunately the skin on our faces is very prone to freckles, sun spots, Melasma, and acne post inflammatory hyperpigmentation.

Depending on the type of pigment and its origin, there are a few treatments that can reduce or eliminate the pigment.

Types of pigmentation

Freckles

Freckles are small clusters of pigment that become more accentuated after sun exposure. They more common in people with fair skin.

Sun spots/Liver spots

They are caused by overexposure to the sun during the early years but they usually don't become visible till the person is over 40. The body tries to protect itself from harmful UV by creating melanin  clusters in the deep layers of the skin. As age advances the pigment raises to the surface becoming visible.

Birthmarks

They appear at birth and are characterized by light to dark brown spots

Post inflammatory hyperpigmentation
It is the result of minor skin injuries. It can arise due to acne inflammation, psoriasis, eczema and even harsh skin care products.

Melasma

Melasma is the result of an overproduction of melanin by the pigment cells. Usually there is an inherited tendency and it's more common in people with dark skin. It can be triggered by the sun exposure, hormonal changes, pregnancy, Hypothyroidism, and certain medications. For further information about Melasma please visit this link: http://www.dermnetnz.org/colour/melasma.html

Available Pigmentation Treatments

Foremost, it's important to use a good sunscreen, even in cloudy days. No matter what type your pigmentation is, it's likely to get worse with UV exposure.

All types of pigmentation will also benefit from a good skin care regime. Products containing AHAs (Alpha Hydroxy Acids), Retinoids (Vitamin A), Salicylic Acid, Ascorbic Acid (Vitamin C) are specially good at reducing pigmentation and inhibiting the formation of melanin.

Chemical peels and dermabrasion can also help with pigmentation, however caution is needed with these treatments because they are quite harsh on the skin and can cause post inflammatory hyperpigmentation, specially on sensitive skins. It is best to try a gentle peel such as lactic acid, which exfoliates the skin without destroying the live cells barrier.

Lasers and IPL work by burning the top layer of the pigment without affecting the surrounding area. Depending on the depth of the pigment you may need a number of treatments to resolve the condition.

Melasma is the most difficult condition to treat because of the underlying causes:

•  If the Melasma is caused by pregnancy it may disappear by itself a few months after childbirth.  In any case it cannot effectively be treated during pregnancy.
• If you are on the pill or undergoing hormonal replacement therapy they should be discontinued
• Depending on the depth of the pigment and the colour of your skin it may be possible to treat Melasma with lasers or IPL. These treatments are not suitable for very dark skinned people.

Unfortunately even with great results after treatment, pigmentation may reappear after sun exposure or hormonal changes.

What causes pigmentation and how can it be treated?

There may be many different causes for pigmentation. The most common being hyperpigmentation from sun damage.

Sun Damage

Most of the sun damage is done during our childhood and adolescent years but it doesn't manifest until later in life. Freckles and brown or sun spots are a result of sun damage.

In an effort to protect the skin from the damaging UV rays the body produces excess melanin in the deep layers of the skin. Over time this melanin moves to the surface creating visible pigmented areas.

To treat this kind of pigmentation, a combination of more than one, of the following treatments is recommended:

Daily Skin Care:

A salon recommended skin care range specifically formulated for pigmentation or that contains high levels of vitamin A.

IPL or Laser:

Intense Pulsed Light (IPL) or Q-switch lasers can treat hyperpigmentation by burning the pigment without damaging the surrounding skin. The pigmented area will turn dark and may lightly scab 1 or 2 days after treatment. The scab will fall off in 1 or 2 weeks. It is important not to scratch or pick at the scab and avoid sun exposure and solariums. Deeper pigmented layers will rise to the surface and must be treated again. It usually requires 2 to 6 treatments. Treatments are spaced every 4 weeks.

Skin Peels:

Superficial skin peels with glycolic acid, salicylic acid, or lactic acid can also be used in combination with some of the other methods to enhance the results.

Daily use of a broad spectrum UVA & UVB sunscreen is paramount to avoid further sun damage. It is also recommended to wear a wide brimmed hat for long periods under the sun.

Melasma

Another cause for pigmentation is Melasma. Melasma affects mainly dark skinned people and is more difficult to treat. It often occurs during pregnancy and it is caused by hormonal changes. Because Melasma usually resides in the deep layers of the skin more aggressive treatments are needed. To effectively treat Melasma it may be recommended to combine all of the treatments bellow.

Daily Skin Care:

A daily skin care programme with high levels of vitamin A

Chemical Peels:

Stronger chemical peels that can penetrate to the deep layers of the skin as well as dermabrasion can also help.

Elos IPL:

Elos IPL which combines IPL and RF (radio frequency) may also work, however it may require multiple treatments. IPL is set low to avoid burning of the surrounding skin. The IPL energy creates a path of low resistance for the RF which is not colour dependant.

Hydroquinone Therapy:

Hydroquinone therapy it is also quite effective for the treatment of Melasma. Hydroquinone is a bleaching agent that decreases the production of melanin and breaks down the melanosomes (pigment granules of the skin's pigment cells). Hydroquinone cream is applied topically to the affected area only.

Again the use of a broad spectrum sunscreen is essential.

Post-inflammatory Hyperpigmentation

PIH (Post-inflammatory Hyperpigmentation) is also a frequent cause of pigmentation. In PIH an injury in the skin causes excessive pigment production. The most common causes are acne, burns, and psoriasis and they are more often found on dark skinned people.

PIH treatment is also quite difficult because it involves a deeper layer of the skin. Treatment options are the same as in Melasma (see above).