Skin Pigmentation Disorders
Skin pigmentation problems go by many names: age spots, sun spots, freckles, hyperpigmentation, sun damage, post-inflammatory hyperpigmentation, seborrheic keratoses… and more! While these conditions are not normally painful, they can make people feel self-conscious. If you suffer from a skin pigmentation disorder, there are many treatment options to consider. Principal among them are sun protection and skin care.
What is Pigmentation?
While some conditions are genetically programmed, most forms of facial pigmentation are a result of exposure to sun, and the overproduction of melanin in our skin.
What is Melanin?
Melanin is produced by melanocytes as a way of protecting our skin from the sun’s ultraviolet and visible light rays, which can damage skin. We all have melanin in our skin, but some of us have more of it than others, which is determined by our genetics. In addition, sun, hormones, and inflammation send signals to produce melanin in our skin, which can appear as uneven complexion ranging from mild to severe.
Both forms of ultraviolet light (UVA and UVB) and even visible and artificial light can stimulate the production of extra pigment in our skin, as well as turn off our skin’s ability to remove excess pigment.
The Emotional Side of Pigmentation
Hyperpigmentation can have profound psychological implications, particularly in societies where dark skin is a cause for stigmatization. Melasma can prevent individuals from participating in recreational (such as swimming) activities, social or work activities, and can instill deep feelings of inadequacy, specifically, not being attractive. Post-pregnancy melasma can contribute negatively to postpartum depression.
The Key Forms of Pigmentation We Treat
1. Sun Damage
The browning of skin can occur from both UVA and UVB exposure. UVA causes the release of already-existing melanin within the melanocytes to combine with oxygen (oxidize) and redistribute (but not total increase in quantity) melanin throughout the epidermis to create the rapid browning (tan) in the skin.
Freckles, or ephileds, are the localized laydown of extra melanin in response to sun, and are an additional expression of skin injury from sun, heralding the damage occurring on a deeper level.
Melasma is genetically based and is the laydown of patches of pigmentation in varying degrees within the epidermis and dermis layers of the skin.
Melasma has a variety of triggers: sun exposure (UVA, especially), hormones (there is a marked female predisposition to melasma, and it occurs for some people during pregnancy, when using hormonal birth control, and during menopause), steroids, certain foods, certain internal health issues, some photosensitizing cosmetics or medications, skin treatments such as laser or chemical peel treatments, or even stressful events.
While melasma can occur in all skin types, certain ethnic groups have higher predisposition to the expression of melasma, particularly those with light natural pigment to the skin, such as Mediterraneans, certain Hispanics, Asians, Middle Easterners, SE Asians, and Africans.
Melasma occurs predominantly on the face, particularly the upper lip, chin, forehead, and cheeks, but can also occur on the sun-exposed parts of the neck, chest, and arms. Melasma never occurs in completely sun-protected areas.
4. Post Inflammatory Hyperpigmentation
After inflammation on the skin (a burn, acne lesion, bug bite or the like), the skin that was red or pink will later turn brown as part of the healing process. These brown spots can be almost as annoying as the red or pink spots, and last many months before fading. The degree of brown discoloration will depend on both the native pigment in skin (those with darker skin will get darker brown spots) and amount of sun exposure. Treatment involves sun protection and well designed products to release pigment from skin.
5. Sebhorraic Kerotosis
Other forms of acquired skin pigmentation can come from medications such as minocycline, amiodarone, gold, silver, phenytoin, antimalarials, and many more. These medications variably produce pigmentation on skin, ranging from a brown to bluish or gray appearance of the skin or in patches, and can be permanent.
First Things First
Block and Release!
- 1. Use a broad spectrum sunscreen containing high zinc levels (over 8 percent) Regardless of the weather apply every day, and reapply.
- 2. Use a well-designed skin care program to help release skin pigmentation
- 3. Be patient! Releasing unwanted pigment from skin can be a very gradual process.
4. If you have changing moles, skin cancerous lesions, or seborrheic keratoses, make sure to see a doctor that provides biopsies, as these conditions may need to have additional diagnostic testing.
Use the ABC's with a Broad Spectrum Suncreen
Now that you're preventing further pigmentation problems, use the ABC's to release pigment from your skin.
- Retinoids: Vitamin A. These topical skin forms of vitamin A come in prescription and non-prescription varieties, and help combat pigmentation—as well as multiple other skin issues—at a genetic level. Retinoids are widely considered the most important reparative molecules for skin.
- Niacinamide: Vitamin B. A derivative of niacin, also known as B3, this powerful molecule not only helps to diminish pigment and brighten skin, but also strengthens the skin barrier and protects it from the damaging effects of ultraviolet light.
- Vitamin C. This key vitamin for skin is important for interrupting melanin formation, as well as a multitude of other benefits for skin health.
Pigmentation Problems Are Complex
There are many classes of medications used to treat pigmentation. This is because facial pigmentation itself is very complicated, and different medications work on different aspects of the pigment laydown process.
Medication failure plagues pigmentation sufferers, either due to ineffectiveness, non tolerance, side effects, or lack of proper instruction. Many older topical medications used for treating pigmentation, such as outdated formulations of vitamin C, UVB-only focused formulations of sunblock, topical steroids, and low-dose monotherapy hydroquinone, are no longer effective.
Dr. Kenner’s philosophy has always been to use leading edge ingredients, blended together in elegant base formulas to “attack” the complexities of pigmentation from multiple angles. Understanding and planning for the complexities of facial pigmentation is the basis for successful treatment.
More Pigment Releasers
- Hydroquinone blocks melanocyte production. it is often used as a powerful, short term treatment for challenging pigmentation such as melasma
- Physicians recommend taking periodic breaks when using hydroquinone, particularly at higher levels, to prevent a rare, but dramatic side effect called ochronosis. When blended with other ingredients, this rare side effect is dramatically reduced.
Alpha and beta hydroxy acids (AHA and BHA)
- These natural botanical and milk acids can gently remove surface skin and are particularly helpful in combination with pigment-releasing skin products.
- Used at low doses, these acids can be used at home as a wash, or on a weekly basis as a “home peel” to provide added encouragement to the (often) long and slow process of encouraging pigmentation to release from the skin.
Other Treatments Include:
- Resorcinol, a bezenediol derivative, is a peeling agent, and acts in a similar way as the hydroxy acids to gently exfoliate and remove pigmented surface skin cells.
- Azelaic Acid: a byproduct of a natural yeast occurring on the skin. Similar to hydroquinone, azelaic acid blocks active melanocytes and prevents melanin transfer and distribution.
- Tranexamic Acid: This molecule has been used for years to prevent excess bleeding, and has more recently been shown to have benefit on treating excess skin pigmentation in conditions such as melasma.
- Kojic Acid: a natural skin-lightening agent derived from fungi that inhibits excess melanin production. It has been safely used for many years to treat melasma, often in combination with other pigment-blocking agents.
“In addition to choosing and blending the right leading edge ingredients, Dr. Kenner takes great care to write down explicit instructions on use, and gives tips and expectations throughout the treatment course.”
Clinical Treatments For Pigmentation
In addition to a medical diagnosis and treatment plan, the following clinical services can help rosacea.
Medical Grade Facials (Hydrafacials)
The Hydrafacial MD is a professional level facial treatment using vortex extraction of surface dead skin, blackhead plugs, and dirt/pollution buildup, followed by infusion of therapeutic and rejuvenating serums.
Pigmentation: Before and After
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