Skin Concerns:Pigmentation

Skin concerns: Pigmentation edition.

Last week, a lady came in to show me her sun damage which she had treated at another clinic to ask if the healing process looked normal. The “sun damage” had been treated with Cryopen four months ago. It was now significantly darker in colour and had scarred, thickened and more noticeable. She asked if this was the healing process, and if would it eventually heal.

The trouble is, she didn’t have sun damage – she had melasma. This should not be treated with Cryopen, especially as she has a dark skin type. Melasma is very difficult to treat and cannot be treated as sun damage. (I repeat, not treated by us) I treat sun damage spots/pigmentation very easily and successfully on white skin, but the risk is too high on darker skin. It is important to know what type of pigmentation you are treating. I always suggest starting with skincare and only going to lasers, and peels if this hasn’t worked.  Always take the most gentle steps first.

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So… time for skin school…

Pigmentation is a common concern that brings clients in for treatment. So, what is it? And most importantly how can we avoid it?

Typically benign and mostly affects the person's confidence.

Melanin protects our skin from UV rays by absorbing them and scattering them. It acts as a potent anti-oxidant sweeping up free radicals. Pigmentation is the colouring of the skin which is determined by the presence of melanin.

Types of pigmentation or hyperpigmentation.

Melasma: irregular pigmented patches affect sun exposure areas. Hormonally driven. It is often symmetrical – think mummy mask.  

Age spots: can appear on the face and body and are caused by UV exposure. They are not symmetrical and will be a patch of brown like a freckle but larger.  

Post-inflammatory

Pigmentation from injury such as acne or burns. Appears as irregular dark-pigmented skin.

Causes of pigmentation:

UV radiation

Genetics

Hormones

Oxidative stress (pollution, ageing)

Medication.

For sun damage the best treatment is prevention! SPF50 on the face daily. If you are flying this year for a holiday, make sure you wear it during your flight as the UV rays are very intense at this altitude. This is the reason I treat so many flight attendants for sun damage. Broad-spectrum protects again UVA and UVB and is used all year round!

Treatment:

There is no single treatment and could be in combination with the following:

Oral treatment:

Tranexamic acid

Physical treatment:

Lasers:

Can be used to treat age spots in lighter skin types. This is an amazing treatment and we always get really good results. On average takes three treatments. The patch may look darker for about five days whilst it heals and will appear lighter after this stage. This is my favourite treatment for sun damage

Chemical peels

Glycolic acid and TCA peels are commonly used for pigmentation,

Microneedling:

Safest for darker skin types. This treatment stimulates the body to repair itself.

Topical treatments:

If I had pigmentation this would be my starting point before going to the above treatments.

Hydroquinone Gold standard for treating pigmentation. Significant side effects should be considered including irritation, redness and ochronosis in darker skin types. (Do not use over 4% to avoid this) I would never recommend this as a long-term treatment.

The EU has banned over 1% but this is still available at higher levels in different countries – use with care! There are more gentle treatments below.

Kojic Acid: Care with sun exposure. Do not use for a long time.

Azelaic acid: Good for melasma. Available over the counter – go for 20%

Vitamin A: Reduces oxidative stress and inhibits melanosome transfer.

Niacinamide: Go for 4%.

Vitamin C: Anti-inflammatory and good for treating pigmentation.

Ferulic Acid: Penetrates deep into the skin and is best combined with Vitamin C.

Alpha Hydroxy Acids: Help with skin turnover and enhance the above products to work better.

I hope this information is useful when selecting your skincare if you currently have pigmentation.

If you are not sure what type of pigmentation you have, please book in for a consultation or send us a photo.

Have a lovely weekend

Katie

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