Pigmentation

Pigmentation refers to the unexplained darkening (hyperpigmentation) or lightening (hypopigmentation) of the skin. Causes can usually be pinpointed to UVR exposure, trauma, medication, a chemical substance, or hormonal and Vitamin A & C deficiencies. And not forgetting essential fatty acid deficiencies. Other causes trigger skin diseases such as dermatitis, eczema and psoriasis.

Normal skin contains cells called melanocytes that produce melanin, the brown skin colouring pigment of the skin, and when these melanocytes are either abnormal or abnormally distributed, it results in pigmentation ‘problems’. Although most skin conditions that cause discolouration are harmless, people need to know when there is a cause for concern

Types of Pigmentation:

Hormonal Pigmentation

Chloasma and melasma are terms used to describe pigmentation that is caused due to abnormal hormone levels in the body. These levels are influenced by pregnancy, mild ovarian or thyroid dysfunction, the contraceptive pill and some photosensitising medications.Chloasma is also referred to as the pregnancy mask and will often fade after birth.
Melasma is seen as symmetric pigmented macules extending over large areas, the cheeks, upper lip, chin and forehead and is more common in women than men. It is also more common in you darker skin types. This however does not exclude lighter skins if there is a family history of pigmentation.

Photomelanosis

This is increased pigmentation due to sun exposure and is most commonly found on the face, neck and back. It may appear patchy or as diffused darkening of the exposed skin.

What Causes Pigmentation

Eventually most of us will struggle with some kind of pigmentation problem that occurs regardless of your ethnicity or skin colour. The skin will either appear lighter (hypopigmentation) or darker (hyperpigmentation) than normal in certain areas. This occurs because the skin produces either too much or too little melanin. Melanin is produces by melanocytes and is the pigment/colour of your skin. The amount of melanin present will determine your skin colour. Melanin is triggered by an enzyme called tyrosinase, which creates the colour of our skin, eyes, and hair.

Melanin has two major forms.

Eumelanin- brown skin and hair colour,
Pheomelan- imparts a yellow to reddish hue

Melanin is also the skin’s natural ‘Sun block’ as, depending on the amount present, it protects the skin for UV rays. You could then say that melanin or in this case a ‘tan’ is the skin’s natural defense mechanism against the sun. This is why skin type IV to VI is less susceptible to sunburn. This however, does not mean that these skin types are immune to the problems associated with pigmentation. On the contrary, pigmentation is most often seen in light to medium brown skins, such as Indian and Mediterranean skins.

Aside from sun exposure and hormones, hyperpigmentation can be caused by skin damage, such as is present in scars. Once again this is usually most prevalent in those with darker skin tones.

The major cause of darkened areas of skin, brown spots or areas of discoloration is unprotected sun exposure. These brown spots were once referred to as liver spots, but really have nothing to do with the liver. They are solely caused by the damage that UV (sun) rays cause on the skin due to over exposure and not using a good SPF. They also do not form over night and most forms of pigmentation only appear later in life due to years of sun exposure.

How do you treat pigmentation

Sunscreen

This is your skin’s major defense against the sun and is the first step in treating as well as preventing pigmentation. It is very important to use a SPF of at least 15 on your skin everyday. This is due to the fact that it is not just the sun that causes pigmentation; Fluorescent lights have also been known to cause pigmentation as well as most major light forms.

It is not only important to use UVB blockers which are blockers that prevents the skin from burning. UVA rays are the rays that age, as they penetrate deeper into the skin layers causing damage in the ‘living’ layer of the skin and therefore ageing the skin prematurely. Good UVA-protecting ingredients are titanium dioxide, zinc oxide as they are physical blockers that reflect these rays off the skin.

It is also important to remember that reapplication of a lower SPF such as a 15 is more important than putting high levels of chemicals on the skin. An important thing to remember is that an SPF gives you 93% sun coverage and an SPF 30 95% but with double the chemical content.

Vitamins

There are many vitamins on the market that help with skin dicolouraration, however the most effect are Vitamin A as it is a skin normalizer and Vitamin C as is the only vitamin that actually stops the enzyme tyrosinase form triggering the formation more melanin. There are many forms of Vitamin C used in skin care preparations. Of all the different forms, L-ascorbic acid is the most effective, because it penetrates and works in the dermis (the active layer of the skin). It is also capable of controlling the inflammatory response associated with UV light. It also speeds up the healing process in the event of a sunburn

Alpha Hydroxy Acids

It is important to remember that AHA work as exfoliants on the skin and for this reason will help lighten pigmentation of used in combination with other products. The best AHA on the market that are natural and not need to be buffered like glycolic acid, are malic and lactic acid. The AHA not only exfoliate the skin, causing better penetration of product, but also have a biological, therapeutic action within the deeper layers of the skin, which increases cell renewal.

Kojic Acid

This form of acid is often used in skin care products and is a by product of fermented rice. Some studies have shown that it can be effective in the treatment of pigmentation when combined with glycolic acid ( a synthetic, potentially irritating AHA, and if used in the daytime, can actually cause pigmentation) or glycolic acid and hydroquinone. Hydroquinone however, is an extremely controversial chemical additive used in skin lightening products, which has, in many cases, caused scarring and hyperpigmentation and are therefore restricted to prescription treatment.

Azelaic Acid

This acid is a component of grains, such as wheat, rye, and barley. If used in a 20% concentration of the cream, it has been shown to have an effect on many skin conditions. It is usually recommended to be used on acneic skins, however, some studies show an effect on skin discolouration. It also does not show severe side effects such as allergic sensitization or exogenous ochronosis, which is common in most high level pigmentation preparations. Other studies however show that it is still more irritating to the skin than hydroquinone combined with glycolic acid.

Laser Treatments

There are both ablative and non-ablative lasers on the market. They have been shown to have positive effects on the reduction of pigmentation, however with many side effects. The Laser light absorbs into the skin layers and actually ‘pushes’ the pigment to the surface and then effectively ‘strips’ the top layer of the skin, taking the pigment with it. This in turn opens the skin up to many other things, such as sundamage (which in turn would increase pigmentation), bacteria and pollution.

There are new technologies on the market that are as effective as laser treatments on pigmentation with reduced side effects. One such technology is IPL (Intense Pulsed Light) treatments that is also a form of light treatment on the skin, and has the same mechanism as Laser, without the side effects on the surface layers of the skin. The IPL light work within the deeper layers of the skin, ‘pulling’ the abnormal pigment to the surface, where it will form a ‘scab’ and once the roughness has been the removed, with the pigmentation in tow, there will be lightening of the skin in the area of treatment.

Combination Treatments

It is vitally important to remember that not one treatment will be effective on pigmentation on its own. This is why most skin care therapists as well as doctors will recommend that you use different treatments in combination with one another.

Therefore it is important to remember that using a skin care product with high levels of L-ascorbic acid (vitamin C) with a SPF 15, with AHA at night and possibly going for IPL/Laser treatments is a more effect way of treating pigmentation than having only IPL/Laser treatments.

Always remember that the pigmentation did not form overnight and it would therefore not improve overnight. It is lengthy process to lighten pigmentation; however, by following the correct methods, you will have success.