What is pigmentation and how to reduce its appearance

How to treat and manage hyper-pigmentation. The best way to achieve a clearer complexion for longer.

It’s that time of the year when I hear these familiar words – “I have irregular skin pigmentation” “my skin tone is so uneven” “what are these dark spots/patches on my skin?”

And the reason for my client’s concern is not because hyper-pigmentation causes discomfort but because aesthetically it just does not look good. In fact, hyper-pigmentation only appears due to other issues created by the body.

Hyper-pigmentation affects around 90% of adults worldwide and because of its displeasing aesthetics, it can have quite a damaging effect on one’s confidence, which is the main reason why people especially women seek treatment, myself included.

When it comes to treating, or as I would like to say, “managing” this condition, there are many factors for the client to consider.

Preparation is key

Before we start tackling the main culprit such as hyper-pigmentation, we need to first look at the general health of the skin, making sure my client's barrier function is strong, hydration levels are optimal and a consistent at-home skincare regime is carried out and maintained. Only then we can begin to help treat the pigmentation.

When you have a healthier and stronger barrier function, skin cells will respond better to treatment, and there is less chance of any unexpected reactions during treatments.

Melanin in a nutshell

We all have melanin, it’s there to protect us, it’s what gives our skin its colour, but for most of us our wonderful melanocytes the cell where our melanin is produced decides to have a party because something has triggered it to do so (more of that later) and so, that party gets a little out of hand causing excessive production of melanin, resulting in darkening, or staining on various parts of the skin, therefore making the skin’s complexion irregular.

So, what’s triggering your pigmentation?

Of course, there is no point in going any further if we do not know what the cause or the trigger could be. Until we understand this, we will not be able to manage the condition.

Here are some questions you need to ask yourself if you are to consider treating your pigmentation, bearing in mind the various factors.

Internal factors –

• Hormonal changes. This has a huge effect on pigmentation and can occur in both men and women. A fine example is pregnancies, commonly known as “mask of pregnancy” or melasma.

• Post-inflammatory hyperpigmentation (PIH) bought on by past or existing acne, trauma to the skin due to surgery or following poor healing of the skin, constant picking of the skin. PIH is especially common in Asian and darker skin types.

• Photosensitising medication. Are you currently or have been taking certain antibiotics, HRT (hormone replacement therapy), contraceptive pills, natural remedies such as St John’s wort and burgundy?

• Medical conditions such as diabetes

• Genetic tendencies causing ephelides (freckles) – this is not necessarily a problem for some.

• Natural ageing of the skin can result in an accumulation of hyper-pigmentation over the years, referred to as senile lentigo or age spots.

External factors –

• Sun damage due to unprotected sun exposure. This is one of the biggest factors. This not only instigates hyper-pigmentation but also darkens existing pigmentation at certain times of the year. What is your relationship with the sun? Do you use sun protection daily? do you love sunbathing or using sunbeds? Do you work indoors or outdoors? Excessive sun exposure causes extensive hyper-pigmentation and discolouration of the skin.

• Frequent use of topical cosmetics and fragrances or constant exposure to chemicals. Where are you dabbing your favourite perfume or oils?

• Exposure to extreme heat. Heat has proven to also worsen the condition, especially melasma. Are you constantly in a hot kitchen opening oven doors or spending lots of time in saunas and steam rooms?

If any of the above applies, then you now need to make some serious changes. Obviously, some of them cannot be possible but at least you are now aware of your triggers and so managing the condition will be that much easier.

Pigmentation… the tip of the iceberg

Oh yes, what you see on the surface of the skin generally is just the tip of an iceberg, because pigmentation originates at the bottom of the epidermis (top layer of the skin) which simply means that the problem also originates from there.

As a skin professional, I need to be able to look deeper within the skin and I can do that with the help of a skin analysis machine. By shining various lights onto the skin it helps me identify a range of things such as the type of pigmentation present, it also helps me identify whether it is deep or very superficial, mild, or severe.

All this information helps me compile the best treatment plan for my client. This amazing tool is also great for my clients to see how the treatment is progressing, so you don’t just take my word for it!

The only way for pigmentation....is up

We already know that pigmentation originates at the bottom of the epidermis, and once melanin is formed, the only way for it is up. In-clinic treatments combined with high-performance products help bring the pigment to the surface quickly and lift the pigment from the skin efficiently as well as fade dark spots.

Treatments such as organic skin peels, micro-needling, IPL/laser to name a few. But most

importantly we need to treat the source, we need to re-educate the cells to stop them from partying too hard, how do we do that?

It’s all in the ingredients of the products and treatments we use. Familiarise yourself with this word, inhibitors, essential to treating or managing hyper-pigmentation, and here is a list of the most common ones.

Does any of your products include any of these ingredients?

• Tranexamic acid

• Cysteamine

• Kojic acid

• Arbutin

What to expect when treating hyper/pigmentation.

Your pigmentation during treatment may look worse before it looks better, in some cases pigmentation will become darker before it becomes lighter and there may be a time when there seem be more of it.

Don’t panic! because the pigmentation that has been lying dormant below the surface of the skin has now made its way to the top of the skin and this process may continue to do so for a while depending on the severity of your condition and the treatment used.

So, hang on in there, this is not the time to give up!

Once we have achieved our goal, we now need to maintain a clear complexion, my advice is to continue to do the following, consistently:

• Always be aware of your triggers

• Use topical antioxidants and SPF daily to help minimise damage.

• Always use a product containing any of the above inhibitors, this will help to keep the party under control if subjected to any unexpected trigger. You can adjust usage according to the severity of the condition.

• Retinol, help increase exfoliation and to bring the pigmentation to the surface quickly.

• And finally, do visit a skin professional to help maintain a clear complexion and optimal skin health.

Here are two excellent de-pigmenting treatments used by me in the clinic with great results.

Cyspera

Cosmelan.