Pigmentation
We all have come across many media advertisements that are constantly talking about miracle creams that work on pigmentation and dark spots. This has made everyone very well aware and conscious of ‘pigmentation’. Over the years, this awareness has translated to patients coming early to halt pigmentation, or even just prevent it. It's great that a lot of us now think about skin care rather than just seeking cure when a skin problem occurs.
The most common skin concern in my daily clinical practice has been Pigmentation or to be technically correct hyperpigmentation. Simply put, it is an increase in melanin content making the skin darker than it is.
How does it occur?
Our skin is in constant interaction with the external environment as well as our internal body. There are many factors which influence our skin color. Also, our skin melanin is dynamic, it increases in response to triggers and decreases when these triggers resolve.
Types of pigmentation
1. Dull uneven skin
The lack of uniform color makes the skin look less radiant.
2. Tanning
Can be due to a recent holiday or/and be cumulated over the years due to the time spent in both direct and indirect sun.
3. Aging
As compared to Caucasians or Americans where fine lines and wrinkles set in earlier during the aging process, Indians pigment earlier.
4. Freckles
Small scattered round specks on face, body - these are genetic and seen more commonly in lighter skin.
5. Post-inflammatory hyperpigmentation (PIH) -
These are spots left behind after the initial healing of pimples, infections or eczema’s.
6. Acanthosis nigricans
Darkening and thickening of skin most commonly on temples, nape, underarms and other body folds. Associated with weight gain, hormonal imbalances such as PCOD.
7. Skin tags
Medically called as DPNs these can be raised stuck on darker growths on the face, neck.
The most common causes of hyperpigmentation are:
1. Sun
Both direct and indirect sunlight will jumpstart the production of melanin. We all have different tendencies to tan, some of us tan quickly over a few minutes, and the other blessed few are more tolerant to skin tanning and pigmentation. It’s years of time spent in and out of the sun that ultimately affects pigmentation. Most of us underestimate the sun and equate it to heat and scorching days. The truth is Ultraviolet light can penetrate clouds, window glasses etc. making us prone to damage even on those pleasant ‘non-sunny’ days.
2. Smoking
Harmful effects of smoking are well known on the entire body. Besides being bad for our heart and lungs, it is equally damaging for the skin. Smoking created oxidant damage reduces skin repair leading to skin darkening as well as premature aging.
3. Sugar
Think before you guzzle down your next sugary iced tea on a sunny day. Presence of excessive simple carbohydrates like sugar and refined flour abundantly in convenient packaged foods, desserts, aerated sugary drinks lead to a condition called insulin resistance. This not only makes us prone to obesity, diabetes, hormonal imbalances like polycystic ovaries (PCOD) in women, but also to skin darkening.
4. Genetics
Conditions like melasma, freckles etc. can have a genetic predisposition.
5. Hormones
Skin mirrors internal organs and health. Hormones control all our bodily functions and imbalances between these crucial hormones like thyroid, insulin, stress hormones etc. can also cause skin pigmentation among other concerns.
6. Inflammation
Skin disorders like eczema, acne etc. can heal with darkening of the skin.
How to treat pigmentation?
During your initial detailed consultation we need to identify the type of pigmentation and any underlying causes.
The treatment plan is incomplete without an end to end approach consisting of:
1. PREVENT
Lifestyle changes - avoidance of sun, smoking, sugars.
2. PROTECT & REPAIR
Customised supportive skin care home regime consisting of products best suiting ones skin.
3. TARGET
Scientific dermatological treatments ranging from medifacials, exfoliating peels, high end pigment lasers
4. DEPT OF ACTION
Products & medifacials work on the outermost layers of epidermis. These help to prevent and treat the melanin on the outermost layers.
Exfoliating peels work up to the mid epidermal layers. These help to exfoliate dead cells, promoting rapid cell regeneration.
Fractional Q switched lasers works on lower epidermal and upper dermal layers. The laser safely and effectively targets melanin clumps and helps to break these down, so that it can be effectively filtered by body.
Always remember…..
It is never too late to treat pigmentation!
Few causes of darkening of the skin such as PIH after acne and skin tags can be permanently treated.
However, most other causes will need repeated sessions to achieve desirable results and long-term maintenance to prevent recurrence of pigmentation.
Melasma and freckles are permanent in nature and notoriously flare up after episodes of sun exposure.
The ABC of effective treatment are sunscreen, sunscreen and more sunscreen!
Using a sunscreen is not enough - make sure you are using an ‘effective’ sunscreen, ‘regularly’, ‘in adequate amounts’ and ensure ‘reapplication’.
Strictly avoid unsupervised and prolonged use of creams containing Hydroquinone or cortisones.
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