This is probably one of the most distressing problems for both the patient and the doctor. People with darker skin tones are more prone to pigmentation because they have more melanin. Melanin is the pigment in the skin which gives us colour, it is produced by cells called melanocytes.
If melanin production is faulty it produces too much or too little melanin. Too much melanin causes hyperpigmentation. The top 3 causes of pigmentation I see in my practice are Melasma, Post Inflammatory Hyperpigmentation (PIH) and Solar Lentigines or Sun Freckles.
What is Melasma /Chloasma?
This is a more diffuse type of pigmentation that is commonly seen in women. It presents as blotchy patches often over the forehead, cheeks and upper lip.
What causes Melasma?
It is triggered by hormonal influences such as pregnancy and use of a contraceptive pill containing oestrogen. It is also aggravated by sun exposure.
What can I do about it?
Ideally, all patients who have hyperpigmentation should have a proper assessment done by a Dermatologist. They will assess the depth of the condition and determine any exacerbating factors.
Severe forms of Melasma may require hydroquinone. This will lighten the pigmentation but it does not always clear it completely. Once the pigmentation has improved a maintenance regimen is required which includes non-hydroquinone skin products with ingredients that specifically target melanin production like Retinol, Azelaic Acid, Kojic Acid, Ascorbic Acid, Arbutin and Liquorice extract amongst others.
Chemical peels that have been specially formulated to treat pigmentation can also be used with caution under specialist supervision because if a harsh peel is applied to the face it can worsen the condition.
What is the one important thing about pigmentation?
The sun is a trigger for pigmentation and your skin should never, ever be unprotected when you are outdoors.
Just one day in the sun without proper sun protection you are back to square one – it is guaranteed to make your pigmentation worse.
No matter what expensive products you buy or treatments you undergo, if you don’t protect your skin from sunlight it is counter-productive.
Will it ever go away?
Unfortunately, in many patients, it tends to be a chronic condition. There are many treatments that will improve and lighten the pigmentation but often the patients will have to use some form of treatment for many years to maintain the results.
Post Inflammatory Hyperpigmentation (PIH)
This type of pigmentation can be caused by sun damage, any trauma or inflammation that occurs on the skin. One of the most common causes of (PIH) is Acne.
This will often leave discolouration and brown marks which can cause much distress.
Solar Lentigines or Sun freckles
These are caused by chronic sun exposure. They usually present with fairly small, discreet round brown patches on the face. These are usually best prevented by sun protection.
Most Important Advice I can give someone with Hyperpigmentation?
• Never miss a day without sunscreen even on overcast days
• Never, ever use hydroquinone in an over-the-counter preparation. You should only use hydroquinone if you are
under the care of a Dermatologist or medical doctor who understands pigmentation.
• Treatment needs commitment and a budget because effective products don’t come cheap.