Pigmentation is a very common skin concern which becomes more prominent as we age due to sun damage. In my experience, its easier addressing lines and wrinkles than dealing with pigmentation. So how do we prevent it in the first place and how do we clear existing pigmentation?.
The main causes of pigmentation include sun damage, scarring due to injury or acne and hormone-related conditions such as melasma in pregnancy. However, It can also be caused by some medications such as amiodarone, contraception and hormonal drugs as well as medical conditions such as hypothyroidism and Addison’s disease. An inflammatory response to eczema or poorly performed skincare treatments such as chemical peels, laser and microneedling can also cause Post-Inflammatory Hyperpigmentation (PIH). Stress can also make pigmentation worse by affecting the hormonal balance of our body. It is therefore important to manage this and ensure that you eat and sleep well.
Prevention is always better than cure and the best way to prevent pigmentation is with the regular use of a good quality sunscreen as well as following sun safety advice because sunscreens are not 100% effective. However, buying the right sunscreen is a challenge in itself as the cosmetic industry is flooded with a massive selection of sunscreens, some which are not as good as others, unfortunately. Also, there is a myth that sun protection found in make-up and moisturizers is sufficient to address UV damage but this is not true as most of the make-up and moisturisers only offer very low sun protection of SPF 15 to 20, which is will not prevent pigmentation or ageing.
Physical sunscreens are noted to be more effective and better tolerated than chemical sunscreens. However, they are more expensive due to the nature of active ingredients. It’s therefore tempting to buy the cheaper chemical sunscreen however these as less effective and work by absorbing heat but can also cause skin irritation. This can sometimes make pigmentation worse, especially in patients with sensitive skins. Given this, I always recommend that individuals with pigmentation invest in good quality physical sunscreen. Find out more about sunscreens and how to select a good one here.
The challenges of treating pigmentation are less of an issue in lighter skins ( Fitzpatrick 1-3) than darker skins (Fitzpatrick 4-6). This is because lighter skin is more resilient to pigmentation as it produces less melanin, which is the colour producing pigment in our skin. On the other hand, darker skin produces more melanin in response to sunlight hence displays deeper and more problematic pigmentation.
Treatment is usually determined based on how superficial or deep the pigmentation is. In most cases, superficial pigmentation can be addressed with superficial to medium depth chemical peels and active medical-grade skincare. However deeper pigmentation requires extensive resurfacing using deeper chemical peels, laser, microneedling and microdermabrasion in addition to active medical-grade skincare. PIH is always a risk in such cases and the skin should always be conditioned with active skincare before initiating any treatment to reduce this risk as much as possible.
Often active skincare ingredients such as topical corticosteroids. hydroquinone, L-ascorbic acid, arbutin, retinoids, alpha-hydroxy acids such as glycolic acid, lactic acid, mandelic acid, salicylic acid as well as kojic acid, tranexamic acid, azelaic acid and niacinamide are used to treat pigmentation. Skin-lightening creams combining two or more of these ingredients are more effective than using one ingredient in isolation. Similarly, different treatments may need to be used synergistically to produce a clinically significant result such as combining skincare with chemical peels and adding other treatment modalities such as micro-needling and laser. It can take 6 to12 months or even longer sometimes to treat pigmentation depending on its cause and severity and patience is key.
Sometimes even after several interventions, there is no cure for some forms of pigmentations. In such cases, you can only manage it by continuing to use preventive measures and by use of camouflage makeup. You should consider seeing your GP or a dermatologist for a proper assessment if Over-The-Counter treatments (OTC) or medical-grade skincare treatments have not been successful or if you suffer from severe or worsening pigmentation. It is also very important to get any mole-like presentations checked out to rule out melanoma, a form of skin cancer.