The skinvestigation series: pigmentation 101

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The skinvestigation series: pigmentation 101

Written: May 2007. Updated: February 2008. 

Produced by melanocyte cells within the epidermal layer of the skin, melanin is the pigment created by our bodies to protect us from UV radiation. Dark complexions naturally have more melanin, light skins have less and both produce pigment when faced with skin trauma. 

When it comes to a complexion crisis, exposure to the sun is about as traumatic as it gets. The more you expose your skin to UV light, the harder your skin scrambles to protect itself by producing pigment. Exposure to the sun thus forces melanocytes into overdrive, producing dark, hyperpigmented blotches of discolouration.

“The damage is also accumulative over years of sun exposure so, as we age, it seems the problem heightens,” says Emma Hobson from the International Dermal Institute.

Sun spots

“Solar lentigos are areas of brown pigmentation which are one centimetre or more in diameter and appear after acute and chronic sun exposure,” explains Dr Gabrielle Caswell from the Cosmetic Physicians Society of Australia. “The face and the back of the hands are usually the most affected.”

Other types of hyperpigmentation are not directly caused by sun exposure, but all are exacerbated by UV light.

Chloasma

Caused by hormonal fluctuation, chloasma shows itself through brown (on light skin) or greyish (on dark skin) patches, often on the cheeks. It may be also be called a ‘butterfly mask’ or ‘the mask of pregnancy’ as it is common amongst expectant mothers. “It’s most commonly associated with pregnancy, but chloasma can also be caused by the contraceptive pill or a woman’s own oestrogen levels,” explains specialist dermatologist Dr Michael Rich. When not associated with pregnancy, this discolouration may be called melasma.

“Though traumatic for some to deal with, it is usually only a temporary change in skin pigmentation,” details Hobson. However, she also says melasma can be tricky when caused by contraception: “Not only does the birth control pill have chemicals that bind to the melanin, but the body also believes it’s in a state of pregnancy and is likely to be producing the hormones that cause the pigmentation.”

Post-inflammatory hyperpigmentation

Inflammation caused by injury, rashes, acne, allergies or even waxing can also leave its mark. “When inflammation is present the melanocyte is stimulated, resulting in a brown patch,” explains Hobson. “This is even more severe in dark skin and can result in a deeply pigmented area.”

Products and pigmentation

Some cosmetic products and medications can contribute to photosensitivity, which leaves the skin more susceptible to hyperpigmentation. “Such cosmetic ingredients include lime oil, bergamot, retinoic acid (Retin-A), Renova and, most commonly, artificial fragrance,” details Hobson. “It is common for both men and women to have uneven skin tone where perfume is applied or from skincare, haircare, cosmetics or shaving products.”

The list of photosensitising medications is long and includes some anti-cancer drugs, diuretics, anti-inflammatory agents and anti-malarials. Hobson recommends: “Whenever taking medications, ask your doctor or read the product disclosure to see if it can cause pigmentation. If the drugs can cause photosensitivity, wear and reapply sunblock every two to three hours – just choose one that does not contain artificial fragrance!” (Try: Hamilton Sensitive Cream SPF 30+, $12.95)

Fading away 

Topical treatments

There are myriad skin lightening and whitening lotions available, but Hobson offers a warning: “There are some excellent products in the marketplace and, equally, there are poor ones that do virtually nothing! There are very few ‘dangerous’ products available as we have great regulatory bodies in Australia… However, beware of buying products off the internet as they may come from abroad or from unknown sources and may not be at all ‘safe’ to use.”

Most anti-pigmentation treatments target the chemical chain that leads from the colour-stimulating enzyme in the bottom layers of the epidermis to the pigmented surface of the skin. Researched and well-recognised fading ingredients include:

Hydroquinone –  One of the most contentious skin lightening ingredients, hydroquinone is also widely credited as the most effective. Dr. Susan Taylor, director of the Skin Color Centre in New York and an assistant professor of dermatology at Colombia University told the Pittsburgh Post-Gazette in 2006: “Hydroquinone is the gold standard for treating pigmentation disorders and has been for many years. I consider it to be very safe and effective.”

Though most dermatologists seem convinced that hydroquinone is generally well tolerated when used as directed (e.g. avoiding other medicated products, especially those with benzoyl peroxide) and might only cause irritation in some users, health risks have been associated with hydroquinone and it is considered a potential carcinogenic by some. Most sources agree that hydroquinone should not be used throughout pregnancy or breastfeeding.

Arbutin –  Containing a form of hydroquinone derived from the leaves of plants like bearberry, cranberry and mulberry, “arbutin interferes with the conversion of pigment-forming enzymes, inhibiting the final synthesis of melanin,” describes Hobson. Products that contain this ingredient might not list it as such, highlighting the plant source instead.

Try:
Danne Montague-King Super Bright ($132) – contains arbutin
Ultraceuticals Even Skintone Serum ($75) – contains bearberry arbutin
Dermalogica Day Bright SPF15 ($84.50) – contains mulberry arbutin

Liquorice – The root of the glycyrrhiza glabra plant has long been used as an anti-inflammatory. Research now also suggests that it has pigmentation-fading potential.

Try:
Sothys Paris Double Lightening Serum ($125)
Palmer’s Skin Success Eventone Fade Cream ($14.95)     

Azelaic acid  – A natural acid found in wheat, rye and barley. Used in the treatment of acne and a notable antioxidant, azelaic acid has also shown itself to be an effective skin lightener, especially when used in concert with other fading agents.

Try:
Pevonia Botanica Radiance Lightening Gel ($85) – blends azelaic acid with mulberry-extracted arbutin.
Jan Marini Bioglycolic Bioclear Cream ($78)

Kojic acid – This comes from the fermentation process of Japanese rice wine. It is included in some eye creams to dispel dark circles and clinical results have also revealed kojic acid is effective against hyperpigmentation, especially in tandem with glycolic acid or hydroquinone. The trouble with this ingredient, however, can be that it is unstable in the presence of light and air.

Try:
Peter Thomas Roth Potent Botanical Skin Brightening Gel Complex ($69) – blends kojic acid with  bearberry and mulberry and also comes in a pump pack impervious to light.

Tretinoin creams – Available upon prescription only, tretinoin fights sun damage and premature ageing and it has shown itself effective against minor discolouration too, particularly when used with azelaic acid or hydroquinone. Tretinoin can cause some irritation and photosensitivity and is not recommended for use during pregnancy.

Professional and home peels

Hyperpigmentation  is often effectively tackled with a multi-pronged approach, including at-home skincare, DIY peels and professional peels.  “If the pigment is mainly epidermal (light), you may benefit from a series of doctor-strength glycolic peels. Jessner peels also do a very good job on superficial pigmentary problems, including freckles,” says Dr Caswell. Deeper trichloroacetic acid (TCA) peels are used on more significant hyperpigmentation.

What about down time? “Glycolics often have very little healing time, Jessner peels take about two weeks and TCA peels two to four weeks,” Dr Caswell highlights. Removing layers also leaves your skin extra susceptible sunlight, so post-peel SPF is crucial.

Lasers, IPL and LED

Dr Rich uses both laser and IPL (intense pulsed light) technology in his Melbourne clinic, but says that, because treating patches of pigmentation can lead to further discoloration if not spot on, he prefers laser. “Lasers selectively apply light and heat to destroy an intended target without damaging the areas around it.

“Lasers are very specific, using only one type of light at a time, and [the way we apply] modern lasers is very specific too,” he explains.

 “IPL emits a wider spectrum of energy and is less specific to the one thing that you’re trying to treat,” says Dr Rich.

Dr Rich recommends that, if you do choose to use IPL, you should visit a dermatologist. “Some would say I have a bias, but I don’t believe that beauticians should use IPL machines. Like lasers, IPL machines should only be operated by doctors because they are too risky, in my opinion, otherwise. For example, if you cause trauma to dark skin surrounding a patch of chloasma, you’ll create a brown mark in that surrounding area too.”

One other type of light-based therapy making waves in skincare circles is LED (light emitting diode) photorejuvenation. LED treatments, such as Omnilux, might take longer to achieve results than laser or IPL (two sessions a week for four to five weeks is usual) but they do have advantages.

“Laser and IPL are photodestructive… LED Omnilux is not thermal like laser or IPL and does not create damage,” explains Dr Glen Calderhead, international research co-ordinator at the Japan Phototherapy Laboratory in Tokyo. Omnilux selects a single, pure colour of light to target particular conditions and “help cells do what they do normally, but do it better,” he says.

Nicola Wood, a beauty therapist from Thaspa in Sydney, uses Omnilux Revive (red light) on her clients and  believes “it can make a remarkable difference”.

“I had one Indian-Fijian client with dark skin who had pigmentation from waxing along her jaw line,” she tells. “After four weeks of using the Omnilux, it was completely gone and there was no discolouration in the surrounding skin. She was thrilled.”

Another attraction is that Omnilux is gentle, relaxing to experience and requires no healing time.  “It doesn’t even leave you any more sensitive to sunlight than before, unless you’re having it in conjunction with a peel, though you should always use a sunscreen anyway,” Wood explains.

Yes, it all comes back to sun smarts

Without diligent sun protection, any hyperpigmentation treatment becomes far less effective – or useless. Dr Rich details that melanocytes in pigmented patches have a “memory that will cause them to make more melanin in those areas.

“So even if you do manage to fade hyperpigmentation, it will just come back with sun exposure. Avoiding the sun is the most important part,” he reiterates.

– Tracey Withers

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