Uneven pigmentation: so many of us get it at some point in our lives. There are so many ways to treat pigmentation, but successful treatment depends on understanding the type of pigmentation you have and treating it accordingly.
Hyperpigmentation is a broad term that refers to all types of pigmentation, or patches of darkened skin. It’s usually caused by trauma to the skin, such as sun baking, burns, friction or inflammation. This type of pigmentation is usually treatable once the cause is removed and the skin is allowed to relax.
Melasma is a specific type of hyperpigmentation that belongs to a league of its own (more on this below).
Although hyperpigmentation can have many different causes, the effects are all similar; overactive melanocytes.
Melanocytes are the cells responsible for creating pigment as a protective measure for your skin. For example, when you sit in the sun for a short time, melanocytes create the pigmentation that gives you a tan. When the melanocytes are damaged, threatened by potential dangers like UV or inflammation, or when they’re disrupted by hormonal changes, they can create too much pigment or put pigment in layers of skin where it doesn’t belong. The result is dark patches of skin that do not fade on their own.
Melasma is also known as hormonal pigmentation because it forms when melanocytes are stimulated by hormonal changes in the body.
It’s also been dubbed “the mask of pregnancy” because of its prevalence in pregnant women. According to the International Dermal Institute, melasma occurs in 10-15% of women during pregnancy, and up to 25% of women who are taking oral contraceptives. It can also occur during menopause or other times of life that bring about hormonal changes.
Melasma is believed to be a genetic condition that is dormant until triggered, most often by hormonal changes, sun exposure, stress or a combination therein.
Unlike other forms of pigmentation which appear as dark spots or uneven skin tone, melasma appears as dark patches of skin that cover larger areas of the face. The pigmented patches are often uniform in colour. They can also sometimes appear on the arms or other parts of the body.
In a few lucky cases, melasma fades about a year after hormonal changes have stopped (as in delivery or after contraceptives are discontinued). In most cases however, melasma is constant and reoccurring. The good news is that it can be successfully treated with patience, caution and understanding.
Treatments for Melasma and Hyperpigmentation
Before you can treat pigmentation, you have to know which type you’re working with. As a side note, dark spots that may look like freckles or moles can be a sign of skin cancer, so you should go for regular skin cancer checks regardless of your pigmentation and skin tone.
Most forms of benign pigmentation, including melasma, can be treated with pigment inhibiting serums, the right laser treatments and prevention of further pigment forming in the future. In our clinical practice, we find that a multifaceted approach is often the most effective.
Pigment Inhibiting Serums
Pigment inhibiting serums work by inhibiting tyrosinase, the enzyme responsible for pigment synthesis in your skin. Tyrosinase oxidises the melanin in your skin and turns it into dark-coloured pigment. A good pigment inhibiting serum should contain tyrosinase inhibitors (such as Symwhite or D-Acetyl Glucosamine) as well as antioxidants or natural anti-inflammatories (like vitamin B). You can also add a product with Vitamin C to your skincare routine as it can help even out your skin tone. It’s a common ingredient in day creams, but you can also find specific vitamin C serums. These products are generally safe for use with melasma.
Remember to also apply sunscreen and wear a hat outdoors. Most forms of pigmentation are triggered by UV exposure, so a pigment inhibitor is not going to make much difference if you’re still exposed to the sun.
A pigment inhibiting serum will also decrease the risk of adverse effects if you choose to try laser treatments for pigmentation. Although rare, there is a small risk of developing post-inflammatory hyperpigmentation (PIH) from the heat created by lasers. If you don’t use the right type of laser on melasma, there is risk of triggering a melasma break-out. In most cases, these effects can be avoided by following proper safety protocols and using the right laser settings for your skin type.
We cannot stress this enough; make sure you discuss your pigmentation with a Clinician and ask them to recommend a laser treatment for your condition and skin type. Certain types of laser are excellent for reducing sun damage but not very good for treating melasma. With IPL, for example, you can actually risk making melasma worse.
Laser treatments use highly-focussed energy to shatter pigmentation trapped beneath your skin. Once shattered, your immune system naturally carries the particles away. Most people need a few treatments before they get a satisfying result, but you should notice the pigmentation fading in the few weeks after your course of treatments.
Many types of laser use light energy which also involves heat. While these lasers can be effective at treating sun damage and other forms of pigmentation, the heat can trigger a melasma breakout. For melasma, you need a different type of laser.
The newest model of Pico laser uses vibrational energy, so there’s much less heat involved. This makes it much safer for use with melasma and PIH. It can also be used with darker skin types more safely and effectively.
We should note that these treatments reduce pigmentation, but there is no outright “cure.” You can reduce the appearance of pigmentation to even out your skin tone, but there’s a chance that it could come back one day in the future with exposure to your triggers (whether they be hormones or UV exposure). Continued use of a pigment inhibiting serum and good sun protection will help you prevent this from happening, and help you maintain your clear, even-toned results.