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Skin Pigmentation: Causes and Treatment

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Many, if not almost all of us, have some skin pigmentation in the form of freckles, brown spots, sunspots, or age spots. More than 80 per cent of women over the age of 25 suffer from pigmentation and is the second biggest skin concern after wrinkles and fine lines.

Pigmentation can be split into three major types and treated in several ways, which can become quite confusing and disheartening. But first, what causes pigmentation?

Melanocytes, found in the deepest layer of the epidermis, produce melanin. Melanin is a brown pigment that is responsible for the colour of your skin and protects it from the harmful effects of ultraviolet (UV) light. Melanocytes are also found in the hair and in the irises of the eyes.

Hyperpigmentation

Hyperpigmentation is an increase in the melanin content and distribution in the skin. However, when there is too much melanin produced in one area you are left with skin discolouration.

This pigmentation can be triggered by a whole host of factors, which include exposure to UV light, hormonal changes, skin inflammation, injury, and genetics. There are three major types of skin pigmentation:

Solar Lentigines or Sunspots

These are non-cancerous, clearly defined, and pigmented sunspots that are larger than freckles. They are found in the upper layers of the epidermis and are mostly superficial. Lentigines can develop over years or appear suddenly and occur anywhere on the body, ranging from light brown to black in colour.

Being caused by UV light, the degree of the pigmentation depends on the intensity and duration of exposure. Sunspots should be monitored, as they do have the potential to turn into skin cancer and melanoma. Sunscreen and proper sun protection (hats, rash guards, etc.) can help reduce flare-ups and deepening pigmentation. To fade dark marks and patches quickly and safely, prescription pigmentation treatments that contain powerful active ingredients are ideal for smoothing and brightening uneven skin tone and texture.

Post-Inflammatory Hyperpigmentation (PIH)

Post-inflammatory hyperpigmentation occurs as a result of injury to the skin, which includes acne, burns, surgery, scrapes, insect bites, rashes, and aggressive skincare treatments. In some instances, PIH can fade over time – while in other instances it requires a prescription skin pigmentation treatment that considers lifestyle factors and triggers.  

Melasma

Melasma is pigmentation that occurs deeper in your skin’s dermis on areas of the face, neck and sometimes the chest and arms. Hyperpigmentation from melasma appears as darker patches in symmetrical patterns (think the centre of the face, forehead, cheeks, upper lip, nose, and chin). It often presents in women more often than in men (just 10% of men suffer from melasma). People with darker skin, those of Latin/Hispanic, African, Asian, Middle Eastern, or Mediterranean descent are much more likely to suffer from melasma. 

Melasma is commonly caused by exposure to UV light, which stimulates the skin’s melanocytes. Just a small amount of time spent in the sun can cause melasma to return even after it has faded. This is why there is always an increase in people looking to treat their melasma in the summer. 

Changes in hormones can also trigger melasma, most commonly occurring during pregnancy, which is why it is often called “the mask of pregnancy”. Using birth control pills and hormone replacement treatment can also trigger melasma.

Pigmentation Treatments

Lightening and Brightening Creams

Over the counter (OTC) treatments can help decrease pigmentation, and many of these creams are available in clinical-strength prescription formulas. Some of the commonly used ingredients include hydroquinone, liquorice extract, niacinamide and retinoids. While these are more readily accessible, they often take longer than other professional, clinically prescribed treatments.

Clinically Compounded Prescription Creams

If OTC creams and treatments fail to yield optimal results, there is the option of prescription pigmentation treatments that have been tailored specifically to your skin’s needs. After consulting a doctor, who accounts for your lifestyle and skin sensitivity and tolerance, a specialist compounding pharmacist will tailor a customised cream with a blend of active ingredients for fast and safe pigmentation removal

Dermatologist-approved pigmentation treatment ingredients that are clinically proven to produce results include hydroquinone, retinoids, kojic and azelaic acids, alpha-arbutin, tranexamic acid, and hydrocortisone.  

Chemical Peels

Acid and chemical facial peels work by exfoliating the top layer of your skin, encouraging new skin cells to emerge. This process aids in the evening of skin tone and texture. Many of these products are available OTC in drugstores and beauty stores. Look out for a few different ingredients such as alpha-hydroxy acids (glycolic, lactic, citric, and malic acids), azelaic acid, kojic acid, salicylic acid, and l-ascorbic acid.

Although chemical peels are available OTC, consider a professional-grade peel at your dermatologist’s office. These are more powerful, and they yield quicker results.

Laser Peels

Sometimes referred to as ‘resurfacing’, laser peels use targeted beams of light to reduce pigmentation in the skin using ablative or non-ablative lasers. Ablative lasers are the more intensive of the two and are used to remove layers of the skin. Non-ablative lasers target the dermis, promoting collagen production and a tightening of the skin. 

Intense Pulse Light Therapy (IPL)

IPL is a form of non-ablative laser treatment that stimulates collagen production in the dermis. Treatment requires multiple sessions to achieve the desired effects, with flat dark patches being particularly responsive to this treatment while it also aids in the reduction of wrinkles, spider veins, and enlarged pores.

Pigmentation Prevention

What is better than treating pigmentation? Prevention! Now that we know that the major contributing factor in the appearance of unwanted pigmentation is sun exposure, sunscreen should be high on your priority list. 

A ‘broad-spectrum’ SPF of 30 and above should be your go-to product, and part of your daily skincare routine. Even if the weather is overcast, put on your sunscreen – UVA and UVB light cuts through cloud cover, and UVB penetrates through water. There is no one sunscreen on the market that can give you total protection, which is why sunglasses, hats, and protective clothing are often necessary when the sun is particularly harsh.  

While many of us do suffer from unwanted pigmentation, there are a whole host of ways to treat, manage and prevent future flare-ups. Finding the right combination for your skin can take time while seeking the help of a dermatologist can greatly increase your chances of success.

Jon Mills

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