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If you have darks spots or patches on your skin, then you know how difficult it is to find effective pigmentation treatments.
Pigmentation can best be described as a sibling: it will always be part of your life, even if you don’t get along.
Given the complexity of this condition, it’s not easy to banish. But with proper diagnosis, persistence and patience you can improve it.
Beware that some pigmentation treatments can make the pigmentation worse and more resistant. This is why it’s best to be cautious and conservative in seeking to tackle this skin concern.
I hope this guide to pigmentation treatments will help you.
Types of pigmentation
There are many types of skin pigmentation but here I’m referring to the most commonly seen pigmentation known as hyperpigmentation, such as freckles, melasma, sun spots and post-inflammatory hyperpigmentation.
Before you can determine what pigmentation treatments will work best, you need to have an understanding of how pigmentation is dermatologically classified. Some types are epidermal, at the surface of the skin, others are dermal, deeper in the skin, and some are combined. Determining the depth isn’t always easy, even for dermatologists, yet it’s crucial to identifying the most suitable pigmentation treatments.
Epidermal pigmentation (superficial)
- Solar lentigo: sun spots, age spots, liver spots
- Freckles
- Seborrhoeic keratosis
- Congenital melanocytic nevus: moles
- Dyschromia: uneven skin tone
Dermal pigmentation (deeper)
- Melasma
- Post-inflammatory hyperpigmentation
- Hori’s Nevus
- Nevus of Ota
- Tattoos
Characteristics of pigmentation
The most common types of pigmentation are freckles, melasma, sun spots and post-inflammatory hyperpigmentation.
Freckles are small, flat spots that are usually tan or light brown in colour. They’re most commonly found on areas of the skin that are frequently exposed to the sun, such as the face and arms. Freckles are typically genetic and become more pronounced with sun exposure.
Melasma, on the other hand, presents as larger patches of discolouration on the face. It’s often associated with hormonal changes and commonly affects women during pregnancy or while taking oral contraceptives. Melasma can be very challenging to treat, but with the right approach, improvement is possible.
Sun spots, also known as solar lentigines, are dark spots that appear on areas exposed to the sun, such as the face, hands and shoulders. Also referred to as age spots or liver spots. they’re caused by cumulative sun damage over time and can vary in size, shape and depth of colour.
Post-inflammatory hyperpigmentation (PIH) occurs as a result of inflammation or injury to the skin. It is characterised by dark spots or patches that develop after acne breakouts, skin trauma or certain skin treatments. PIH can be a temporary or long-lasting, depending on the underlying cause.
What causes pigmentation?
Pigmentation occurs when melanin, the pigment responsible for skin’s colour, is overproduced or unevenly distributed due to stimulation in a bid to protect the deeper layers of the skin from damage.
Melanocytes in the basal layer of the epidermis produce and store melanin in tiny sacs called melanosomes. The melanocytes transfer the melanosomes, via little hands called dendrites, to other skin cells called keratinocytes. In turn, the keratinocytes take these melanosomes and distribute them to form a protective layer. As the keratinocytes reach the topmost layer of the epidermis, the stratum corneum, the pigment becomes more pronounced.
The amount and distribution of melanin in the skin determine an individual’s skin colour and susceptibility to hormonal changes or sun damage.
Common triggers
Pigmentation occurs when the melanocytes in the deeper layers of the skin produce a skin-darkening pigment known as melanin. If melanin is over-produced, it may result in darker skin patches appearing on the skin’s surface. The production of melanin is influenced by:
Genetics play a significant role. If your parents or those close to you are a spotty lot, the bad news is you’re predisposed to also getting pigmentation.
Hormonal changes also affect pigmentation, particularly in women. Hormone imbalances, oral contraceptives and pregnancy can lead to melasma, a type of pigmentation characterised by brown or grayish patches on the face.
Inflammation or injury to the skin, such as caused by acne or laser treatments, can result in post-inflammatory hyperpigmentation. Dark spots appear at the site of the injury. In most cases, these spots will slowly disappear in time, but in some cases they linger.
UV exposure is the biggest cause of those unsightly spots. The skin produces melanin as a way of defending itself when exposed to UV rays. The more the unprotected sun exposure over one’s lifetime, the more pigmentation you generally have. However some skin types and individuals, like me, are more prone to produce melanin pigment. Lucky us!
Other less common causes include some illnesses, medications and topical products containing certain ingredients, such as essential oils and fragrance. It’s also possible that high levels of denatured alcohol in skin care products may lead to pigmentation, but this has only been seen in testing on mice and the pigmentation was reversible.
Pigmentation pathways
You know that skin pigmentation is primarily determined by the production of melanin, but you also need to understand the primary pathways involved in this process:
1. Tyrosine conversion
The amino acid tyrosine is converted into DOPA (dihydroxyphenylalanine) by the enzyme tyrosinase.
2. DOPA oxidation
DOPA is oxidised into dopaquinone, which can follow two different pathways:
- Eumelanin pathway: Dopaquinone is further oxidised and polymerised to form eumelanin, a brown-black pigment.
- Pheomelanin pathway: Dopaquinone is converted into cysteinyldopa, which leads to the formation of pheomelanin, a reddish-yellow pigment.
3. Melanosome maturation
Melanin pigments are packaged into melanosomes, which are specialised organelles in melanocytes. Melanosomes mature and move towards the dendrites (branches) of the melanocyte.
4. Melanosome transfer
Mature melanosomes are transferred from melanocytes to keratinocytes, which are the main cells found in the epidermis. This transfer process involves the extension of melanocyte dendrites into the surrounding keratinocytes.
5. Melanin distribution
Within keratinocytes, melanosomes are distributed throughout the cytoplasm, forming a protective cap over the nucleus. This melanin cap helps to shield the DNA from harmful UV radiation.
Pigmentation treatments
Prescribed medication
There are a number of prescribed pigmentation treatments available, however each has its own benefits and risks.
Dermatologists have various on-script and off-script options, however, due to side effects the pigmentation requires correct diagnosis, dosage determination and ongoing oversight, especially Hydroquinone.
Here are a few of the most commonly prescribed treatments for pigmentation:
Hydroquinone is not only the gold-standard but the recommended first line of treatment when it comes to dark spots and melasma. Hydroquinone inhibits the production of melanin and is toxic to the melanoctyes that produce melanin. It can be prescribed in various strengths and used alone or in combination with other actives. The effectiveness of Hydroquinone depends on your individual skin and the severity of the pigmentation. Hydroquinone can be used only for limited periods to prevent complications and ochronosis.
Triple therapy involves the combination of Hydroquinone, Retinoic Acid and a steroid. This combination approach has been found to be effective in treating melasma and other forms of pigmentation. The Retinoic Acid speeds cell turnover and the steroid reduces inflammation. Triple therapy is typically used for a limited period to avoid potential side effects associated with long-term use.
Tranexamic Acid is an oral medication that helps reduce pigmentation by interrupting a number of the pathways involved in the production and transfer of melanin. It’s particularly beneficial for treating melasma and is often used with topical treatments. Oral Tranexamic Acid needs to be used under medical supervision to ensure safety and efficacy.
Clinical procedures
In-clinic pigment treatments are available when prescribed medication has not worked or is not suitable.
Chemical peels involve the application of a chemical solution to the skin, which helps to remove the outermost layers of skin. This process encourages the growth of new skin cells, resulting in a more even complexion. Depending on the severity of your pigmentation, different types of chemical peels may be recommended, such as glycolic acid, salicylic acid or TCA peels. The peels can be superficial, medium or deep, and each involves varying levels of downtime and risk. Deeper peels need to be carefully performed to avoid serious side effects.
Laser therapy is another powerful tool for treating pigmentation. It works by targeting melanin in the affected areas. The laser emits intense pulses of light that are absorbed by the melanin, breaking it down and stimulating the body’s natural healing process. Multiple sessions are usually required to achieve results, and it’s crucial to follow post-treatment care instructions. Choosing the right practitioner and most suitable laser are crucial as some treatments can make the pigment darker or harder to remove later. There is the risk of recurrence or rebound pigmentation.
IPL/BBL works by emitting broad-spectrum light that targets specific wavelengths associated with melanin, the pigment that gives skin its colour. It uses selective photothermolysis, which involves targeting specific chromophores (melanin) without damaging surrounding tissues. When the IPL is absorbed by the melanin, it generates heat and the heat causes the melanin to break down. But the heat can also cause post-inflammatory hyperpigmentation (PIH) and this treatment is not suitable for those with darker skin or prone to PIH. There is a high risk of recurrence or rebound pigmentation.
Dermabrasion is a mechanical exfoliation technique that involves using a specialised instrument to gently remove the outer layers of skin. This process helps to diminish the appearance of pigmentation by promoting cell turnover and revealing fresh, healthy skin. Dermabrasion is often used for more severe epidermal pigmentation and textural issues. This treatment can cause inflammation and darkening of the skin, especially in those with a darker skin tone.
Some treatments require multiples sessions and can be very expensive, such as picosecond laser, nano laser and TCA peels.
At-home topicals
Medical protocols stipulate that topical pigmentation treatments should be the first-line treatment for hyperpigmentation, and Hydroquinone remains the most recommended topical..
Hydroquinone: This controversial ingredient is available at a concentration of up to 2% over the counter in Australia but is restricted in some countries. It inhibits tyrosinase, the enzyme needed for the production of melanin in the skin. By blocking this enzyme, Hydroquinone prevents the formation of new melanin pigment. It also works by helping to disperse existing melanin in the skin, making dark spots less noticeable. Hydroquinone is toxic to melanocytes and can have serious side effects.
Alpha Arbutin: This natural ingredient, derived from bearberry plants, has gained popularity for its ability to inhibit the production of melanin. Alpha Arbutin is considered a gentler and safer alternative to Hydroquinone. Regular use can help fade the look of pigmentation and promote a more even skin tone.
Alpha Hydroxy Acids: AHAs, such as Glycolic Acid and Lactic Acid, gently exfoliate the skin’s surface, aiding in the removal of dead skin cells and revealing a brighter complexion. Regular use of AHAs can help to visibly fade pigmentation and improve skin texture. Start with low percentages and gradually increase over time to minimise the risk of irritation.
Azelaic Acid: Azelaic Acid is a multi-tasking ingredient that helps with pigmentation, acne and rosacea. It works by inhibiting the production of melanin, making it an excellent choice for those dealing with hyperpigmentation issues. Azelaic acid also inhibits tyrosinase, but also regulates cellular processes, thereby preventing transfer of melanosomes, organelles containing melanin, to keratinocytes. At the same time, it’s anti-inflammatory.
Kojic Acid: Derived from fungi, Kojic Acid is a potent brightening agent that inhibits the production of melanin. It’s particularly effective in reducing pigmentation caused by sun damage or melasma. Incorporating products with Kojic Acid into your skin care may help you achieve a more uniform complexion. Unfortunately, some people find Kojic Acid quite irritating and develop contact dermatitis.
Liquorice: Liquorice Extract contains a compound called glabridin, which has been shown to have skin-brightening properties. Regular use of products with Liquorice Extract can help improve the look of pigmentation and overall skin tone.
Niacinamide: This active works in multiple ways. Like Vitamin C, Niacinamide is a tyrosinase inhibitor, but it also reduces melanocyte activity, regulates cellular processes involved in the transfer of melanosomes and it reduces inflammation, which is what stimulates melanocytes to produce more melanin.
Retinol: Widely regarded as a holy grail ingredient in skin care, retinol boasts numerous benefits, including reducing pigmentation. As a derivative of Vitamin A, Retinol accelerates cell turnover, promotes the growth of new, healthy skin cells and fades the look of pigmented areas. Incorporating retinol, or other retinoid, into your night-time skincare routine can help improve overall skin texture and tone.
Tetrapeptide-30: This is a synthetic peptide containing the amino acids proline, glutamic acid, and lysine. It interrupts the pathways that lead to the appearance of discolourations and uneven skin tone.
Vitamin C: This powerful antioxidant not only brightens the skin but also improves tone. L-Ascorbic Acid is the queen of Cs and has the most potent effects, but it’s not the only form that helps with pigmentation. Vitamin C can help to fade the look of pigmentation spots and PIH. Vitamin C is a potent inhibitor of tyrosinase, an enzyme that’s needed by the skin to form melanin.
Sunscreen: The most overlooked protection against dark spots and patches on the skin. Look for a sunscreen that contains filters that protects against UVA, UVB and IR-A.
Others: There are other ingredients, including some that are patented or exclusively licensed by the certain brands. Some have very promising but limited research. For example, Eucerin uses Thiamidol and Medik8 uses Oxy-Resveratrol.
Skin care routine
There are also many topical pigmentation treatments that are available to use to use at home, however you need to take a multi-pronged approach and remain consistent to see results.
A specialised skin care routine can help by reducing the looking existing discolourations, reduce the recurrence their recurrence and prevent new ones.
Your skin care routine should include products that cover all the following six bases. Some serums and creams combine a number of these effective ingredients in one.
- an exfoliant to remove dead skin cells and pigment from skin’s surface
- an effective antioxidant to protect against oxidative stress
- a tyrosinase inhibitor to prevent excess formation of melanin
- a melanogenesis disruptor to prevent transfer of melanin pigment
- a retinoid to speed cell turnover and improve tone and function of skin cells
- a high SPF UVA/UVB/IR-A sunscreen to prevent pigmentation being triggered
Also ensure you wear protective clothing, including a hat.
If you have dermal pigment, the above actives can be helpful too but you should consult a dermatologist as you may need prescription pigmentation treatments.
Lifestyle changes
Lifestyle changes are also important adjunct to pigmentation treatments, with strict sun protection every day being essential.
Most people rely on SPF as their sole form of protection, but sunscreen doesn’t necessarily provide complete protection or complete continued protection. Protective clothing and a hat are essential for avoiding darks spots and patches of discolouration.
There are also lifestyle factors that should be considered. Ensure you follow a balanced diet rich in antioxidants, manage stress levels to reduce cortisol and get adequate sleep to allow proper cell repair and renewal.
Long-term commitment
The human body is an amazing tour de force. Like many other things that happen in the body, the formation of pigmentation involves complex processes that we don’t completely understand yet.
Pigmentation treatments come in many forms and often need to be combined to be effective. There is no one treatment that will permanently rid you of discolourations. But there are many things that you can do that can get you closer to your goal.
The right skin care routine, the right combination of actives and meticulous sun protection can help you achieve a brighter and more even-toned complexion.
Patience, persistence and prevention are required in equal measure. In many causes, the pigment you see took years or even decades to reveal itself and it’s also going to take many months of effort to reduce the damage.
If you need help putting together the right skin care routine to help with your pigmentation treatments, call us for free advice or book a skin consultation and get a personalised skin care plan.
Yours truly in better skin
Anna Marie has long had a love of things skin care starting with her first job working in a beauty clinic. She has developed her own skin care products and studied dermatology and integrative at AACDS. Anna Marie has multiple degrees, including a BA, several Grad Dips and a Master’s.
