19 September, 2023

Hyperpigmentation

Hyperpigmentation is such a common skin problem. When we have an uneven skin tone or sun ageing spots, it can be distracting and affect the overall look of our skin. The skin texture can be perfect but if the tone is not even, the texture also appears to be uneven.  
 
Before we look at how to treat hyperpigmentation , we first have to understand where hyperpigmentation comes from and why it occurs. 
 
Pigmentation starts  in the melanocytes in the skin’s epidermis, in the basal (bottom) layer.
When melanocytes are triggered they transfer melanin-containing units to the keratinocytes (cells in the upper layer of the skin) which causes skin colour changes when melanin is released. 
 
Hyperpigmentation happens when a chemical reaction occurs where tyrosine is converted to melanin by the enzyme tyrosinase. 
 
Hyperpigmentation occurs when there is a change in melanin production and or its distribution. 
 
Melanocytes always responds to a trigger and is part of the skin’s barrier defense system.
Triggers and genetic predisposition include
1.     UV radiation/sunburn
2.     Hormone fluctuation
3.     Inflammation
4.     Injury to the skin
5.     Skin barrier defects: decreased acidity/ thickened stratum corneum
 
There are different types of hyperpigmentation so let us look at the four most common types. 
 
1.      Melasma “mask of pregnancy”. This form of hyperpigmentation affects 90%  of pregnant woman. 
It looks like hyperpigmented patches (macules) usually bilateral  and symmetrical on the upper lip, cheeks  or forehead. 
This happens due to high levels of estrogen and progesterone that stimulate melanogenesis. 
Other causes of melasma include combined oral contraceptives, pregnancy, hormone therapy, genetics and sun exposure. 
 
2. Post inflammatory hyperpigmentation
This form can occur after an  injury or a process of inflammation such as acne or eczema.  
Causes include acne, atopic dermatitis, incorrect waxing of facial hair, injury caused by cosmetic procedures such as microneedling, laser , chemical peels, microdermabrasion or picking by the patient. 
When these areas heal, it leaves darker patches  (macules or spots) over the area where previous ongoing inflammation occurred. 
 
3. Maturational hyperpigmentation
This is darkening of sun exposed areas that worsens with age. It looks like small patches of brown spots that mostly occurs on the hands, face, chest and feet: wherever the sun exposed the patient. This is common in those ladies who tanned a lot in their younger days and never used sunscreen.
 
4. Freckles
These are small fine dark spots that forms when you we have a genetic predisposition and spend time in the sun. 
 
Treatment for hyperpigmentation always requiresdiligence, chronic care, home based care as well as professional treatments. 
It should be seen as a chronic skin condition that needs maintenance. 
 
The sun is the most important modifiable factor. 
 
So how do we treat hyperpigmentation?
It’s best to see a professional to create a proper individualized treatment plan for each patient’s needs. 
 
For homecare, the following ingredients are all very important in treating all types of hyperpigmentation. 
 
1.     Sunscreen is needed to prevent further hyperpigmentation. Ideally we need an SPF  of at least 50  and it should protect us against UVA, UVB and IF rays. The best sunscreen is the one you will use every single day. 
2.     For anti-Inflammatory and anti-oxidant properties ascorbic acid (vitamin C) is important. It inhibits tyrosinase but also prevents sun damage and oxidative stress from the environment. 
3.     Tyrosinase inhibitors include kojic acid, hydroquinone, arbutin, , azelaic acid
4.     Vitamin A is important to increase cellular turnover and to lighten pigmentation
5.     Alpha- and beta hydroxy acids  which includes glycolic acid, lactic acid, mandelic acid have exfoliating properties which increases the cellular turnover. This decreases the time that the melanocytes can deliver their pigment into the top layer of the skin. 
6.     Tranexamic acid is one of the latest inventions for hyperpigmentation specifically for melasma. It has anti- inflammatory properties and acts as a tyrosinase inhibitor. 
7.     Niacinamide (vit b 3) and NAG (n-acetyl glucosamine) both slows down the transfer of melanin from the basal membrane to the keratinocytes. 
 
Although homecare is extremely important for hyperpigmentation, professional treatments will be the mainstay of treatment for optimal results. 
 
1.     On our Harmony XL Pro laser system we have the best laser technology for treating hyperpigmentation. 
We have the option of treating either the underlying inflammatory redness that feeds the brown pigment called the DyeVL laser. This laser is wonderful for melasma( hormonal pigmentation) and post inflammatory hyperpigmentation. Or we can treat the sunspots, freckles, brown spots with our AFT laser.  
2.     Chemical  and laser peels also forms part of pigmentation treatment and can be used depending on the type of pigmentation. 
 
For such a common skin concern , we have all the products you need for home care as well as the top professional treatment modalities .