Pigmentation Decoded

Pigmentation is the most complex skin condition but is very common in my clients. The biggest concern that my clients have are age spots, dark patches and discolouration. The expertise and corresponding treatment plan of a skincare professional are crucial to tackling pigmentation. Diagnosing pigmentation takes careful consultation to establish the cause. From my experience, treating pigmentation requires patience, the right treatments, topical and oral products, and lifestyle changes. Pigmentation/damage can be hidden for many years and can come up to the surface as we age. 

What is pigmentation and how does it happen?

All skins contain a brown pigment called melanin (it comes from the Greek word melanos, which means black). Melanin is responsible for differences in skin colouration. The function of melanin is to protect the skin against injury from ultraviolet radiation by absorbing UV rays. Melanin can also be produced by other stimuli internal and external. Certain triggers can result in increased activity of melanocytes (pigment-producing cells): meaning more melanin (pigment) is produced. 

Blue light can cause pigmentation, we are almost always exposed to blue light even in the shade. 

All causes of pigmentation are in conjunction with UVR exposure, and the main cause will be one of the following: trauma, medication, a chemical substance, hormonal, and vitamin A and C deficiency, but also essential fatty acid deficiency. Studies show that free radicals generated by pollution or lack of sleep can damage cell DNA and cause melanin production. 

Hormonal pigmentation is normally found in the centre of the face. Sun damage is often found in the outer areas of the face. Pigmentation caused by trauma is usually found in irregular shapes and unusual places. 

Types of pigmentation 

Melasma and chloasma

Both mean the same thing, hormonal pigmentation that can be caused by pregnancy, mild ovarian or thyroid dysfunction, the contraceptive pill and some photosensitising medication. 

If melasma occurs during pregnancy I refer to it as “the mask of pregnancy”. 

Melasma is seen as symmetric pigmented macules extending over large areas like the cheeks, upper lip, chin and forehead. Genetics (family history) and sun exposure are major factors in developing melasma.

Solar lentigines (liver spots, age spots)

Patches of darker skin caused by sun damage are most common at age over 40/50 but are also seen in younger individuals due to an increase in sun exposure and sunbeds. The marks appear all over the body, particularly face arms, decolletage and hands. These are pigmented flattened macules that rarely change in size or location and are an average of 1cm in diameter.

Freckles

Freckles can appear at any age as a result of short term exposure to the sun. They are not a sign of sun damage but indicate that an individual is more susceptible to UV damage, making sun protection vital.

Post-inflammatory pigmentation

This is pigmentation that's a result of an injury that has broken the skin. The inflammatory response and exposure to UVR during the first few days of healing can result in post-inflammatory pigmentation. This pigmentation always has a history of trauma. History can include infections, allergic reactions, mechanical injuries (picking acne spots) or reaction to a medication, burns, bruising and inflammatory skin diseases from eczema/dermatitis.

Hypopigmentation

This is when melanin (pigment) is missing in the skin, creating white or pale marks. This occurs when there is a decrease in pigment produced. Loss of pigment can be due to trauma, sun damage or inflammatory skin disorders. Genetics can also cause hypopigmentation including vitiligo and albinism.

My treatment suggestions: protection and persistence!

Pigmentation is often caused by years of damage and reversing it will not happen overnight. Improvements can only be made by a good treatment plan, the client’s commitment to that plan and patience. Oral and topical treatments should be combined in the treatment plan.

The first step is to protect your skin from sun exposure. A few minutes of UV or blue light can undo any progress made in pigmentation treatment. Practice good habits to protect your skin from sun and avoid sun exposure. I recommend Nimue Environmental Shield SPF50 which offers protection against the full light spectrum: UVA, UVB, infrared & high energy visible light (blue light emitted from screens).

From my experience, melasma can fade after pregnancy or when the contraceptive pill is discontinued. But melasma can return if you repeat excessive sun exposure, pregnancy or the contraceptive pill, therefore continued and complete sun protection is a must!

The slowest to respond to treatment, from my experience, is pigmentation due to trauma and chemicals because these are at “scar tissue” level. Loss of pigmentation can also be related to trauma or sun damage, that's why you should include essential fatty acids as a normal part of your home care for pigmentation. I recommend eating (flax, sesame, sunflower, pumpkin) daily. I recommend Skin Omegas+ or a vegan option Biocare Flaxseed Oil. 

The number one ingredient to incorporate is vitamin A in your skincare, as pigmentation starts with vitamin A deficiency.  Ensuring that the skin is rich in vitamin A will minimise the chances of pigmentation. Using topical and oral vitamin A creates optimum levels. I recommend an intense infusion of vitamin A with topical treatments like Retinal Active or Vitamin Rich Repair and an oral supplement of Skin Vit A+ or Skin Accumax™ if you are suffering from acne and would like to prevent post-inflammatory scarring. 

Vitamin C is a melanin (pigment) production inhibitor, so by inhibiting the formation, the pigmentation will be reduced. Studies have shown that taking vitamin C supplements have benefits greater than applying topical vitamin C. I recommend Skin Vit C.

Alpha hydroxy acids (otherwise known as AHAs) are vital in treating pigmentation as they are great for skin rejuvenation and lightening skin pigmentation by increasing cell turnover. Long term use can reduce pigmentation by encouraging the old discoloured skin cells to be removed, I recommend Nimue Cleansing Gel and Nimue Conditioner. Some of my clients think the stronger the acid the more beneficial it is, this is not the case. Harsh acids can cause post-inflammatory pigmentation or hypopigmentation. 

The antioxidant astaxanthin can reduce hyperpigmentation if taken orally. Find out more in the chapter in my journal Sun Damage: What should be your protection plan?. Niacinamide (vitamin B3) also helps to minimise pigmentation by promoting cell growth and renewal. 

Needling and Peels

How does microneedling work? Thousands of micro-channels are created in your skin using a Dermapen to promote a more balanced and normalised cellular function with regulated melanin (pigment) production. As melanocytes (pigment-producing cells) are directly targeted, a repair and corrective process encourages even skin tone for a smooth and radiant appearance. I believe regular microneedling combined with active ingredients can improve pigmentation.  

I also found peelings very effective on superficial pigmentation by removing the pigmentation in the epidermis (top layer of the skin). I use glycolic, salicylic acid or TCA peels to treat hyperpigmentation. 

Pigmentation is a lifelong problem that can not be cured but can be controlled. We need to take a holistic approach to improve pigmentation and by eliminating the triggers of pigmentation.