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Pigmentation

Pigmentation of skin

If you have pigmentation, or more correctly hyperpigmentation, of the skin, you know how stubborn can be. It can be very difficult to develop an effective skin care routine  to improve the appearance of the pigmentation and, in particular, prevent further occurrences.

Pigmentation is not a particular skin condition, but rather a catch-all term used to refer to a number of different skin conditions: solar lentigines (often called sun spots, age spots or liver spots), melasma and post-inflammatory pigmentation. Anyone can be affected by pigmentation, however Asian, African and Mediterranean skin tones are more prone to it. And it is more frequently seen in older people.

The best approach to dealing with pigmentation is to take steps early to address the causes and to follow the right skin care routine to minimise its appearance. If the pigmentation is allowed to become darker and larger, it becomes even more difficult to tackle.

Causes of pigmentation

Pigmentation is caused when there is an increase in the natural pigment that is present in our bodies and gives our skin, hair and eyes their colour. This pigment is melanin. Melanin is produced by the melanocytes in our skin and is present to block out the sun’s harmful UV rays, which can lead to skin cancer.

The melanocytes are activated to produce melanin when inflammation occurs. This all starts with an enzyme called tyrosinase, which turns the amino acid tyrosine into melanin. Once produced, this melanin transfers into other skin cells and thereby creates more melanin, which becomes visible as pigmentation.

Most people have the same number of melanocytes, but the size and distribution of the melanosomes in their skin are different, and these determine the extent of the pigmentation.
Those with larger and more clustered melanosomes will  not only have more pigmentation spots, but also darker pigmentation spots.

You cannot influence or control the number or melanosomes you have,
however you can reduce melanin production and decrease the activation
of these cells.

An increase in melanin production can be caused by a number of different factors, including:

  • injury to the skin, such as squeezing or picking
  • sun damage
  • hormonal changes
  • heredity factors
  • certain medications (anti-seizure drugs, antibiotics, hormone treatments, diuretics, blood pressure, oral contraceptives)
  • acid peels, IPL or laser treatments

Some people may experience hormonal pigmentation, which could be caused by birth control or hormone replacement therapy medication. Pigmentation is also associated with various diseases and conditions. Most commonly, though, pigmentation occurs if you spend a lot of time in the sun before the age 18, without a sunscreen, or use tanning beds.

Types of pigmentation

Solar lentigines

Even though they are often referred to as liver spots, they are not caused by the liver but rather exposure to the sun, smoking and environmental triggers, such as pollution. They become more obvious and increase in number and size as we age, and they are particularly evident on areas that are repeatedly exposed to the sun, such as hands and face. Additionally, they are larger than freckles and more difficult to treat.

Even if you have success treating these spots, remember that protection is crucial, as they can easily return or darken.

Melasma

Hormonal pigmentation is triggered by oestrogen and can be challenging to manage. As with solar lentigines, you must ensure full protection when exposed to the sun to prevent it darkening or worsening.

Post-inflammatory pigmentation

Pigmentation also can be caused when the surface of the skin is damaged, presenting as darker or reddish patches. The most common type of post-inflammatory pigmentation is caused by acne, breakouts and keratosis pilaris. Usually it fades over time, however if the skin has been damaged through aggressive treatments, squeezing or damaging the skin, it can linger or become permanent.

Pigmentation and hydroquinone

Hydroquinone is the fastest and most effective topical treatment for pigmentation, however it can cause serious irritation or even allergic reactions. In some people, it can even result in hypopigmentation, or a permanent lightening resulting in patches of skin that are lighter than surrounding skin. Despite new evidence about its safety, some concerns remain.

The percentage used in over-the-counter products is limited to 2% in Australia, however higher strengths are available with a prescription. Strengths of 4-8% have been found to be more effective, however they are more likely to cause skin issues. Reactions to Hydroquinone have been found to be linked to the strength of the formulation and the length of time it is used.

The use of Hydroquinone has been restricted in Europe, Japan and the US, but it is still available over-the-counter in Australia. Pregnant women should not use Hydroquinone. If you would like to use Hydroquinone cream, please consider all the benefits and risks or talk to your doctor or dermatologist to ensure it is right for you.

Many people prefer not to use Hydroquinone to treat their pigmentation and instead look to less controversial ingredients, typically based on combination formulas that use chemical and plant extracts that work synergistically together. Many people, though, do not find they get as significant an effect as they would like. There is some research showing positive results, however typically alternatives to Hydroquinone formulas work best when peels or AHAs are also used.

Not only is pigmentation difficult to treat, it is also difficult to prevent from recurring, given it can be reactivated.

What helps with pigmentation?

There are hundreds of products out there that claim to “dramatically” improve your pigmentation. However, unless backed up by clinical results, they should be treated with a good dose of realism. Despite some research studies showing encouraging results for certain ingredients, we have not found any one ingredient or product that delivers the type of result most of us are really looking for.

Hydroquinone remains the gold standard to tackle pigmentation, however it needs to be used in a high enough dose and carries some risks, which is why is should be used under medical supervision.

If you are happy to achieve a brightening of your skin and a little improvement in the appearance of your pigmentation, there are many skin care products available that can potentially do this. Keep in mind they work best when used in addition to a Glycolic Acid or other AHA.

We have seen a lot of claims for IPL in the treatment of solar lentigines, however consider this carefully and ensure you go to a reputable clinic as it could also further activate the melanocytes and cause a worsening of the pigmentation.

To reduce the appearance of pigmentation and prevent further pigmentation, a multi-pronged approach will deliver the best results:

  1. meticulous sun protection and application of sunscreen every day
  2. exfoliation
  3. use of topical antioxidants
  4. use of brightening serums and creams
  5. use of a retinoid

Sun protection

Protecting your skin from the sun will help prevent solar-induced pigmentation, and is likely more effective than trying to treat it once it has developed. Use a high SPF broad-spectrum sunscreen and reapply it regularly to ensure maximum protection.

An SPF30 blocks, at best, 97% of the sun’s UVB rays. Topical antioxidants work by preventing free radical damage from the small percentage of UVB rays that penetrate the skin and by reducing inflammation, which triggers melanin production and often contributes to the formation of dark spots. Antioxidants also help counter the damage done by the UVA rays that penetrate our skin more deeply than UVB rays and support the skin’s repair function. Some plant oils also have been found to have antioxidant and anti-inflammatory benefits for the skin, and possibly even have anti-carcinogenic properties. A strong barrier function is equally important, so it is imperative to build the skin’s moisture barrier and lock in hydration.

Exfoliation

Some people find that the use of Alpha Hydroxy Acids, in combination with a brightening serum, helps to improve the appearance of their pigmentation. Expect this to be a long, slow process, and keep your expectations reasonable. Alpha Hydroxy Acids will remove dead skin cells and stimulate the generation of new ones to come to the surface. Leave-in products get the job done faster and leave your skin looking younger and fresher, but they are best used in the short term to avoid overly thinning out your skin and making it even more sensitive to the sun and prone to further pigmentation. When using any product that removes the topmost protective later of skin, you must be meticulous about your sun protection every day.

Skin peels and microdermabrasion give more dramatic results, especially when done in clinic. It is always best not to do chemical peels yourself at home. To maximise your results and minimise any potential harm, have these done by a qualified professional. You certainly would not want to cause additional injury to your skin and trigger post-inflammatory pigmentation!

Antioxidants and brightening ingredients

There are many ingredients used as alternatives to Hydroquinone to improve the appearance of pigmentation, including Arbutin, Bearberry, Glutathione, Kojic Acid, Liquorice Root, Niacinamide, Resorcinol, Tranexamic Acid and Vitamin C. They are usually used in various combinations, together or with other ingredients, to intensify the effect.

Antioxidants hep to protect the skin from UV damage by counteracting cell damage and supporting the skin to repair itself. They also can enhance the effectiveness of sunscreens. While they are not sunscreens in themselves and should not be relied on to provide UV protection, they are nonetheless important to include in your daily skin care routine.

There are many natural alternatives to Hydroquinone that are commonly used to tackle pigmentation, although expect more of a brightening effect. Formulations that approach the problem from multiple angles will give you better results. Look for ingredients that exfoliate the skin, reduce the appearance of the pigmentation and dampen down melanin production.

Ensure your expectations are realistic. It could take many months before you see an improvement in the appearance of your pigmentation, not the two to four weeks so many brands like to claim! And unfortunately, some pigmentation does not respond at all. Do not be completely disheartened, though, as preventing new pigmentation or discouraging the darkening of current pigmentation is an equally important goal.

Some helpful antioxidants and brightening ingredients commonly used in skin care products to target pigmentation include:

  • Liquorice Root Extract
    Liquorice root contains glabridin, which inhibits tyrosinase activity in the skin.
  • Vitamin E
    This antioxidant helps counteracts free radical damage from UV exposure. It works well alongside Vitamin C and enhances the effectiveness of the Vitamin C. Vitamin E, though, is usually used in its synthetic form, D-Alpha Tocopherol. Unlike natural Vitamin E, it only contains Alpha Tocopherol. Research is emerging that suggests Gamma Tocopherol is the form that is of most benefit to the skin.
  • Vitamin C
    Vitamin C is a powerhouse antioxidant that counteracts free radical damage from UV exposure, builds collagen and improves skin tone.
  • Niacinamide
    Niacinamide works to stop melanosomes transferring melanin to surrounding skin cells, while also increasing skin’s moisture and enhancing its barrier function.
  • Kojic Acid
    This ingredient suppresses melanocyte activity and helps other topical treatments penetrate more deeply. Derived from fungus, it works in a similar way to Hydroquinone by reducing the appearance of pigmentation and slowing the production of melanin in the skin.
  • Arbutin
    Arbutin, which comes from the bearberry plant, inhibits melanocyte activity and helps reduce the appearance of pigmentation. It breaks down into Hydroquinone in the skin, but is not as potent or as irritating as Hydroquinone.
  • Green tea
    Green tea extract is another great ingredient that is often used in skin care products for its antioxidant powers and ability to fight free radicals.
  • Pomegranate
    Pomegranate rind extract is anti-inflammatory and has been demonstrated to decrease melanin due to tyrosinase inhibition and decrease erythema (redness) in the skin.
  • Ginger Root Extract
    Ginger root extract is an antioxidant that is anti-inflammatory, inhibits melanocyte activity and may help to even out areas of skin that have lost their pigment, known as hypopigmentation.

Retinol and other retinoids

Retinol  is widely recommended for it many anti-ageing skin benefits, including pigmentation. Retinol is a Vitamin A derivative that is used in skin care. This ingredient encourages old skin cells to shed and stimulates new ones to develop, thereby speeding up the process and encouraging the new cells to form correctly. Additionally, it reduces the transfer of melanosomes and allows for increased penetration of active ingredients.

Retinol is not as transformative as prescription Tretinoin (Retin-A), however it is also not as irritating either and therefore better tolerated. It comes in a range of strengths and formulations.

You can read all about Vitamin A derivatives in our indepth blog article What Are Retinoids?

Laser treatment

Some cosmetic dermatologists may recommend laser treatment or cryotherpay followed by laser therapy, however there is not universal agreement around the effectiveness of laser treatment given the potential risk of recurrence and hypopigmentation. Melasma occurs much deeper in the skin than other types of pigmentation and, due to this, is extremely difficult to treat safely.

Other measures

Chemical peels and microneedling are also used to improve pigmentation. These are usually used in combination with a specific skin care routine and products, to give faster results. A number of treatments are required.

More invasive or aggressive skin treatments always need to be considered carefully as they sometimes can be counter-productive and cause inflammation and post-inflammatory pigmentation. These types of treatments should be done by trusted, reputable professionals rather than at home.

Do not overlook the need to maintain a healthy immune function and a balanced, nutritious diet that includes high levels of antioxidant-rich foods. There are some more holistic dermatologists who even recommend taking oral supplements as well, specifically Green Tea or Polypodium Leucotomos, an antioxidant from a tropical fern that has some science showing it is photo-protective.

If you are seriously affected by your pigmentation and your home skin care routine is not delivering the results you want, talk to a medical or cosmetic professional. And always make sure that any suspicious or changing skin spots are checked out as early as possible.