The ins and outs of hyper-pigmentation and skin blemishes
We’d all love to have a spotless, peaches-and-cream complexion, but pigmentation, sun spots, and freckles can spoil the plan. Our skin gets its colour from melanin, which is made by the body and determines the colour of our skin, hair and eyes. Over-production of melanin shows up as brown patches and spots.
Melanin is formed by cells in the epidermis (the topmost layer of the skin) known as melanocytes, and some of us are darker because we have higher concentrations of melanin. After sun exposure or tanning, the skin increases melanin production as a form of defence against ultraviolet (UV) rays. This can lead to sun damage and sun spots, or freckles, which are brown spots – usually on the face and the back of the hands.
The main causes of hyper-pigmentation are:
• Sun damage: Brown spots or dark patches appear from too much melanin being made and coming to the skin’s surface as a protective mechanism. Tan, lentigenes, and freckles are the pigmentations we commonly see because of UV rays, either from the sun or another source of light. Use sunscreen to protect your skin from UV damage, both indoors and outdoors.
• Hormonal changes: Pregnancy, menopause and oral contraceptive pills can all cause pigmentation side effects.
• Melasma: This very common condition is frequently seen during or after pregnancy, or with the use of oral contraceptives. Melasma usually looks like a patch, commonly on the cheeks, forehead and chin.
ontributing factors include hormonal changes and sun exposure. Melasma can be very deep and reach the second layer of the skin (dermis); if so, it can be more difficult to treat.
• Post-inflammatory hyper-pigmentation: The body’s response to injury is inflammation, which triggers melanin production. The results are brown spots and patches. Some examples of PIH are acne scars, insect bites, or cuts or abrasions following laser treatments, peels, or fixed drug reaction.
The first step in treatment is to consult a dermatologist to identify the condition through visual examination and relevant medical history. Pigmentation most frequently affects only one’s outward appearance, and is not indicative of any underlying health risks. However, prevention is better than cure. Start using an effective sunscreen daily, before it’s too late – this is the key to preventing and minimising the formation of brown spots. Apply sunscreen 15 minutes before sun exposure; wash and reapply every two to three hours, as the protection only lasts for a limited time.
If you’re really committed to boosting your skin’s health and appearance, use the correct products with the right ingredients. It’s better to use dermatologist-recommended products with the correct strength of active ingredients, rather than lower-strength, over-the-counter products. A variety of creams are available to treat pigmentation. These agents tend to block the formation of melanin; hydroquinone is the most commonly used de-pigmenting agent used to treat melasma for an initial eight to ten weeks. Other non-hydroquinone lightening agents include kojic acid, arbutin and azelaic acid.
In addition to the lightening agent, your doctor may also prescribe creams containing glycolic acid (an alpha hydroxyl acid, or AHA), tretinoin (a form of vitamin A), and mild steroids to enhance the skin-lightening effect of the treatment. These are solutions applied to the face, causing gentle exfoliation of the superficial layers of the skin. This stimulates skin regeneration, helps lighten pigmentation and improves texture.
Peels used to treat pigmentation include glycolic acid, lactic acid, trichloroacetic acid, and phytic acid peels. Newer peels use a combination of multiple agents in gel vehicles to treat pigment concerns gently yet effectively. Five or six sessions may be required to see an improvement, and maintenance sessions will be required thereafter.
Microdermabrasion is a procedure in which the outermost layer of dead skin cells is mechanically exfoliated, carrying with it some of the pigment-containing cells. It also improves the penetration of topical medications prescribed to treat pigmentation. About eight to ten sessions may be needed bi-monthly.
The Q-switched NdYag laser targets pigment in the epidermis of the skin, effectively lightening it. There is minimal discomfort and no downtime. Multiple sessions are needed, and treatment intervals may vary from one to four weeks. It is the only treatment for birthmarks like the Nevus of Ota. Q-switched NdYag lasers are effective, new-world technologies that treat all types of hyper-pigmentation. This laser is also used to treat birthmarks and remove tattoos – a very popular treatment because it is painless, short in duration (you can complete it during your lunch hour), and brings marked improvement in just a few sessions. This treatment is effective for all ages, and works on men and women alike.
Fractional lasers are used as adjuncts in the treatment of melasma, and are FDA-approved. The laser generates microbeams that create channels in the skin, through which melanin-containing debris is extracted. Treatments are given at four- to six-week intervals under topical anesthesia.
Mesotherapy is the injection of medication directly in the middle layer of the skin (mesoderm). This achieves high concentrations of actives at the site where it is needed. A cocktail of medications that cause skin lightening is commonly used – for example: glutathione, vitamin C, and peptides. Five or six treatments at three- to four-week intervals are needed for optimum results A healthy diet and regular exercise are the mainstays of healthy, glowing skin. Don’t believe in quick fixes; spend at least 15 minutes in the morning and evening on skin care, using good products to maintain flawless skin.
Dr. Padmavathi Surapaneni, dermatologist and cosmetologist
Pragna Skin and Laser Clinic