What to do about pigmentation?

In New Zealand, pigmentation is one of the leading skin concerns, and one that we see a LOT of in clinic. It tends to come with a lot of questions: What is it? Why do I have it? What can I do about it? Will it ever go away?

Like many skin concerns and conditions, the term “Pigmentation” is an umbrella term used to describe irregular melanocyte activity within the skin, causing visible ‘darkening’ in the skin. Pigmentation can look very different on each of us and our aim in clinic is to determine what type of pigmentation are we looking at, where in the skin is this pigment sitting and is it stimulated by internal or external triggers.

The number one trigger of pigmentation conditions within the skin is the SUN! The UV rays trigger a response from our melanocytes (pigment producing cells in the skin) and they create a patch of darkened skin as a form of protection. It’s like your body’s way of creating its own defence from the sun! 

The sun doesn’t have to be shining for our skin to receive damage from these harsh UV rays, so as we head into the warmer months, don’t just wait for the sunny days to be applying your sun protection! This should be a non negotiable part of your every day routine.

Different types of pigmentation we often see or get asked about:

• Solar lentigine (often referred to as ’sun spots’ or ‘age spots’)
• Post inflammatory hyperpigmentation 
• Melasma
• Freckles
• Dermatosis Papulosa Nigra

Solar Lentigos

• This is pigmentation that generally sits in the epidermis (superficial) layer of the skin and is caused by UV ray damage. In most people, this type of pigmentation takes years to show and the damage is generally created prior to the age of 18. 
• The most effective way to treat this type of pigment is through the use of a tyrosinaise inhibiting serum, and a retinol at home. SPF use is non-negotiable and the skin must NEVER be exposed to UV without sufficient protection as this pigment resurfaces and darkens very quickly.
• Peels and microneedling treatments in clinic are super beneficial at lightening solar pigmentation - ideal time to treat is once summer is over.

Post inflammatory Hyperpigmentation

• Most commonly seen in darker skin types (from Fitzpatrick 4 onwards), post inflammatory hyperpigmentation occurs when inflammation within the skin is exposed to UV rays and triggers melanocyte activity as a protective mechanism. 
• This can occur post acne, or any type of trauma to the skin that causes inflammation.
• Home-care for this type of pigmentation would include a suitable retinol for your skin type, a tyrosinaise inhibiting serum and SPF applied and re-applied daily. 
• It is so important to not pick or pop breakouts as this is generally what worsens the inflammation to the point of stimulating the melanocytes.
• Peels and microneedling are the most effective treatments for treating this type of pigmentation.

Melasma

• Melasma is an inflammatory skin condition most often seen in women. It is generally caused by significant hormonal events such as pregnancy/breastfeeding, contraception or menopause. It has also been noted to be a genetic condition.
• Although it is mainly triggered by hormonal changes, UV and heat exposure are known to exacerbate and worsen the condition.
• Treatment for melasma is unique - any treatments that are heat based can worsen the condition so laser treatments are not recommended. 
• Specialised peels for melasma such as Cosmelan are a great way to effectively reduce the appearance of Melasma - note that this will not shut down the melanocyte activity within the skin and ongoing maintenance is required to upkeep the results.
• Lifestyle changes are required to reduce chance of melasma worsening over time - avoid ALL heat to the face, sunblock alone is not enough as the heat from the sun is enough to worsen melasma. 
• Regular activities that cause the skin to flush or heat up are not recommended: eg. Hot showers, spas, saunas, exposure to heat while cooking, intensive exercise. These can all worsen the condition.

Freckles and Dermatosis Papulosa Nigra

• Pigmentation conditions such as freckles and dermatosis papulosa nigra are genetically pre-disposed. This means that you were born with melanocytes in place to produce this pigmentation, and they can pop up anywhere from childhood right through to our latest years in life.
• Freckles will show up as small, flat pigment clusters and each individual freckle is generally circular in shape.
• DPN are raised, dark "freckles" that can also appear to look like very small skin tags. They are often seen on the cheeks of people with tan to dark skin tones.
• In regards to freckles they can be lightened with strict homeware and regular treatments, however this fix is only temporary and they will return with continued exposure to UV.
• DPN can be removed by a DR and are not treatable by aestheticians or beauty therapists. Be cautious that if you are prone to these, they are likely to continue to pop up and return even after removal.

The most effective ways to reduce pigmentation and prevent it from worsening are:

• Wear your SPF every single day. No exceptions!
• A tyrosinaise inhibiting serum will reduce the melanocyte activity and can help to fade present pigment.
• Retinol/vitamin a will help to lighten and reduce pigment.
• Avoid direct sun and heat exposure
• Treatments such as peels and micro needling can help to dramatically improve pigmentation

If you notice pigmentation coming up that seems irregular, is causing issues and is textured or painful, it's a good idea to have it checked by a dermatologist.

If you have any questions about pigmentation, or you are wondering what to do about yours, feel free to send us a message or book in for a consultation.

xx