Hyperpigmentation (too much pigmentation) is a major skin issue that we encounter daily in South Africa, in all ages and races. But before we can tackle how to treat hyperpigmentation, we asked Dr Wade Merchant to share his expertise on what causes hyperpigmentation and the different types of hyperpigmentation we should be aware of!
What is normal pigmentation?
Special cells called melanocytyes are responsible for producing melanin , the natural pigment that makes our skin look the way it does. These "pigment factories" are found in equal quantities in all skin types - from darkest of the dark to the lightest of the light. The difference is that in darker skin types these pigment factories are highly active, producing much more pigment and are able to disperse pigment further into the surrounding skin, allowing for a darker complexion.
Besides a beautiful skin tone, Melanin has several essential protective functions. It helps the skin defend against the harmful effects of UV light (like your body’s own built-in sunscreen) and combats free radicals, helping to prevent against photoageing and cancer formation.
What is Hyperpigmentation?
When our skin has abnormal a stress applied to it e.g. uv light, it become inflamed. In genetically at risk people, this inflammation causes the “pigment factories” to become over-stimulated and they start to release too much pigment into the surrounding tissue in a disorganised and erratic manner. This pigment can be dispersed to a shallow depth (epidermal pigmentation) or deeper (dermal) or both. As a result, patches of too much pigment appear on the skin. Pigmentation is normal and protective, while hyperpigmentation is a side effect of skin inflammation.
Triggers of Hyperpigmentation:
There are several causes that can trigger or aggrevate hyperpigmentation that you should be aware of, including:
- Sun exposure - UV light as well as visible light like electronic screens and indoor lighting
- Hormones – including pregnancy, menopause and oral contraceptive pills/injections etc.
- Stress - emotional and physical
- Medications - certain antibiotics
- Heat - hot days, saunas and steam rooms
- Inflammation - acne or other skin conditions trauma
Types of Hyperpigmentation
It is also important to disiinguish between the three main types of hyperpigmentation, as this plays a major role in our treatment approach:
1. Sun induced
Most types of hyperpigmentation you can think of, freckles, sun spots and age spots, are caused by sun exposure and it can occur at any age.
This chronic skin condition is caused by any kind of hormonal influence or change e.g. pregnancy, menopause, birth control etc. It appears as patches of dark discolouration often with a symmetrical pattern, typically found on your cheeks, forehead or upper lip. It is more common in women with olive or darker skin tones and tends to be more stubborn and difficult to treat.
3. Post Inflammatory Hyperpigmentation (PIH)
This type of hyperpigmentation usually occurs after some type of injury or trauma to the skin, usually from acne or other skin conditions. It can also appear after aggressive skin treatments e.g. waxing or incorrect treatment with chemical peels or laser.
So now that you understand what hyperpigmentation is and where it comes from, lets discuss how best to treat it.
5 Steps to Successful Pigmentation Correction
There are so many pigmentation products and treatment options available, it difficult to know where to start! Dr Wade recommends you follow these 5 steps:
Step 1: Professional skin consultation
Start with a professional skin consultation by a trained therapist at Legs eleven, who will analyse your skin with a special UV light and assess the causes, extent, type and depth of your hyperpigmentation - This is a critical first step as it will determine which treatments are best for you. You'll then receive a personalised treatment plan - according to your skin tone, skin history, type, extent and location of hyperpigmentation, age, other skin concerns,treatment timeline and budget etc.
Step 2: Avoiding sun exposure and managing your triggers
As we’ve already mentioned, UV radiation is the main cause of hyperpigmentation and aggravates existing hyperpigmentation – so direct sun exposure must be avoided. It is also important to manage any underlying causes / triggers for your hyperpigmentation that have been identified e.g. heat, stress, acne or hormones. This may require your Doctor to prescribe oral therapies, for example Lamelle Research Laboratories Ovelle D3 Supplement, which is taken for Hormonal-induced Melasma.
Step 3.Home Skin Care Products
The next step is to treat your skin at home, with the appropriate skin care products, starting at least 2-6 weeks before any in office pigmentation treatments. This includes the daily use of a broadspectrum daily SPF 30+, which is absolutely essential to treat any kind of pigmentation and prevent reoccurance. Also important is the use of pigment supressing products containing active ingredients that specifically block pigment production, such as decabutin, arbutin, ascorbic acid, nicatinamide, and brightening peptides etc. Exfoliating products that accelerate the removal of pigment e.g. retinol and salicylic acid, are also recommended.
Using a home skin care regimen with well-researched, clinically proven ingredients will help lighten and prevent future hyperpigmentation.
Step 4: In-office ‘Depigmentation’ Treatments
Once you have prepared your skin at home, the next step is to remove any existing hyperpigmentation with the appropropriate depigmentation treatment combinations, recommended in your individuaiised treatment plan. In office treatment options may include chemical peels, IPL skin rejuvenation, Brightening dermapen and / or redermallization. To read more about these different treatment options, click HERE to read part 2 of our blog.
Step 5: Long-term Maintenance Plan!
The last but probably the most important step is having a dedicated maintenance plan - there is absolutely no point in starting a treatment if you are not going to protect your results by avoiding sun exposure and using the correct sun protection and pigment suppressing products to prevent hyperpigmentation from reoccuring. Maintenance in-office depigmentation treatments may also be recommended every 3-6 months to keep your hyperpigmentation at bay. Remember in most cases, hyperpigmentation is a long-term condition.that requires a lifestyle change and ongoing management.
In part 2 of our “Perfect Pigment” Blog series Dr. Wade Merchant will discuss treatment options with a special focus on the newer, novel depigmentation treatments – Brightening dermapen and redermalization