If you've ever been pregnant, chances are you're intimately familiar with pigmentation. And even if you haven't, living under the Australian sun means pigmentation is almost inevitable (quick, pass the sunscreen!)
Luckily, Douglas Pereira knows skin. As a leading clinical skin specialist in Sydney, with a cult namesake clinic and skincare line, Douglas believes that you can have amazing skin at any age (phew).
Douglas shares the down-low on pigmentation, what it is, and what you can do about it.
If you have ever noticed uneven spots, acne scars or sun damage on your skin, these are all examples of hyperpigmentation. Hyperpigmentation can occur for a variety of reasons, including injuries, sun exposure, hormonal changes and medications. While the signs can be unwelcome, there are many ways to reduce and prevent hyperpigmentation.
To understand hyperpigmentation, you must understand what gives skin its colour in the first place: melanin. Typically, the more melanin present, the darker the affected part of the body.
In a person without hyperpigmentation, the skin’s pigment is healthy and consistent across the body. In hyperpigmentation, certain areas of a person’s skin overproduce melanin. As a result, those portions of the person’s skin appear darker than his or her natural skin tone. The condition can affect any part of the skin but is most often seen on the face, hands and neck.
Causes of Hyperpigmentation
Hyperpigmentation comes about when one of two things occur: 1) the concentration of melanocytes, the cells that produce melanin, is unusually high, or 2) the melanocytes are abnormally active in producing melanin. The causes of hyperpigmentation can include UV exposure, pregnancy, birth control, hereditary factors, hormonal changes, heat, certain medications, inflammation or injury to the skin, or Addison’s disease (when the adrenal gland doesn’t function properly).
Forms of Hyperpigmentation
Hyperpigmentation can manifest in a variety of forms, from the innocuous smattering of freckles on your nose in the summer to melasma, known as “the mask of pregnancy.” The most common forms of the condition include:
- Lentigo/lentigenes. A form of freckle or pigmented spot, usually called a sun or age spot, that is tan, brown, or black and darker than the rest of the skin. These most commonly appear on the face and the backs of the hands and are caused by sun exposure.
- Melasma. This form of hyperpigmentation causes a raccoon-like mask around the eyes and mouth. About 31% of women with melasma have a family history of the condition, and 50-70% of pregnant women develop melasma.
- Post-inflammatory hyperpigmentation (PIH). The darkening of the skin following an injury. PIH is different from traditional hyperpigmentation in that it is the body’s natural response to inflammation or injury. Acne, burns, psoriasis, friction, or surgery can cause that injury. PIH will fade as the skin begins to regenerate, so hyperpigmentation in the epidermis often goes away in six months to a year. However, if PIH affects the dermis, the deeper layer of skin under the epidermis, the pigmentation could last for years. On the bright side, PIH usually responds quickly to treatment.
While treatment options for hyperpigmentation abound, it can take a lot of time to reduce signs of hyperpigmentation – especially severe cases. The easiest and most effective approach to the condition is simply to avoid it in the first place. Here are some preventive measures you can take to keep your skin tone even and bright:
- Avoid the sun. If you must go outside, cover your head and face with a wide-brimmed hat and wear shirts with long sleeves.
- Wear sunscreen. Wearing at least SPF 30 sunscreen every day is a crucial step in preventing and treating hyperpigmentation, then make sure you reapply.
- Exfoliate regularly. Slough off dead skin cells to reveal the vibrant, newer skin underneath. Depending on your skin type, aim to exfoliate one to three times per week.
- Use an antioxidant or vitamin C serum. Worn daily, vitamin C and other antioxidants can help combat sun damage.
Whether you prefer to treat your hyperpigmentation at home or want to consult a professional, your treatment options are many.
Generally, products containing alpha hydroxy acids (AHAs), such as glycolic and lactic acids, can help lighten dark spots. AHAs help break up the dead skin cells stained with pigment on the epidermis. Keep in mind, though, that some skin types and medications may prevent you from using AHAs safely, so always consult your doctor first.
Other treatment options include the Cosmelan depigmentation peel by Mesoestetic. This is my treatment solution of choice, as the Cosmelan depigmentation peel is a unique, muilti-ingredient treatment designed to reduce areas of skin discolouration and hyperpigmentation, chloasma from UV damage, post-inflammatory hyperpigmentation from acne and skin trauma and hormonal imbalances and changes. The treatments do not use harsh ingredients such as hydroquinone and is suitable for all skin types, ethnicities and ages. They work by decreasing the skin’s natural melanin production (which cause hyperpigmentation) by inhibiting an enzyme deep within the skin. They also improve cell turnover, which “pushes” pigment cells to the surface where they are sloughed away. Rather than harsh hydroquinone, which is often used for melanin reduction, Cosmelan used a variety of acids, which kill bacteria on the surface and boosts new skin production, as well kojic acid to inhibit melanin production.
We can also look at the Dermamelan depigmentation peel by Mesoestetic, tyrosinase inhibitors, Intense pulsed light (IPL) (a 30-minute procedure that exposes the skin to intense pulses of light, however it is worth noting that in some skin tones, IPL can make pigmentation worse) and exfoliation, including retinol.
Hyperpigmentation typically presents itself in a brownish-grey undertone. To neutralise that shade, look for a colour-correcting foundation or concealer in a deep orange-brown colour. If you’re using concealer, apply it to all the affected areas after you’ve applied foundation. Make sure you choose a foundation that is not too light for your skin; it will make your dark spots appear more grey. Finally, set your makeup with a powder, focusing on your problem areas.
More to Know About Corrective Procedures
Some more intensive procedures can benefit people with hyperpigmentation. On the other hand, some of these procedures can also make hyperpigmentation worse or even cause it in the first place. Further treatment options include:
- Microdermabrasion. For only very mild cases of hyperpigmentation.
- Chemical peel. A trichloracetic acid (TCA) peel or more intensive phenol peel can also treat hyperpigmentation. When TCA is applied to the skin, the top layers of the skin dry up and peel off over the course of a few days to a week. Once the old skin is gone, you’ll see a new, undamaged layer of skin. Chemical peels can be more effective at treating melasma than laser treatments.
- Fraxel pigment laser (FPL). This is a pigment-erasing laser that uses a wavelength, known as Thulium, that specifically and quickly lifts hyperpigmentation. FPL can treat melasma, PIH, sun hyperpigmentation, and acne-related pigmentation. Patients see results in about seven days, which is the treatment’s primary appeal. I personally have challenges with this method for the use of depigmentation in Australia, due to the intense sun exposure we receive in Australia. And over my many years of treating skin I have seen laser treatments to not be so effective long term. As well, laser can induce inflammation in the skin that can create pigmentation.
- Micro needling. This procedure uses a tool called a Dermapen, which holds a group of small needles to create a controlled injury to the skin. The needling stimulates collagen production and growth factors to help the skin repair and rejuvenate itself. Usually, patients see results fairly quickly but often experience dryness and peeling in the days after the procedure.
Of course, one of the best preventives and product is use is SPF 30+ – 50+ sun protection. Another thing to keep mind, if your pigmentation is hormonal, is to seek the advice of a doctor or naturopath who can target and treat the hormonal issues within your body.