Dr Ian Webster is an expert on pigmentation and answers some frequently asked questions:
Are there different kinds of Pigmentation?
There are various types of pigmentation. You can get Hyperpigmentation where there is increased pigmentation in the skin and you can also get Hypopigmentation where there is loss of pigment in the skin. Melanin is the pigment in skin that is produced by cells called melanocytes. If melanin production is faulty it produces too much or too little melanin. Melanin is triggered by tyrosinase, an enzyme that determines the colour of our skin.. Too much melanin causes Hyperpigmentation and too little melanin causes Hypopigmentation.
Is there a difference between Pigmentation and Hyperpigmentation?
No, they are one and the same condition.
What is Hyperpigmentation?
There are various sub-types of Hyperpigmentation:
The small discreet round, dark areas commonly found on the face, décolletage and back of the hands are what we call Solar Lentignes or sun freckles.
The other more distressing type of Hyperpigmentation is what we call Melasma and this is a more diffuse type of pigmentation that is commonly seen in woman, often over the forehead, cheeks and upper lip.
Melasma is more difficult to treat and the specialist help of a Dermatologist is often required to make the diagnosis and to oversee the treatment with hydroquinone before the patient is started on a maintenance treatment.
What is Melasma?
This tends to occur in people with a more olive or darker skin. Hormonal factors such as pregnancy and taking a contraceptive pill containing oestrogen can trigger this condition. It is also aggravated by sun exposure.
One essentially gets two types of Melasma:
Epidermal Melasma: This is where the pigment cells are found in the epidermis, the top layer of the skin. This often occurs in pregnancy and if treated early with the proper use of sunscreens it can settle down spontaneously.
Dermal Melasma: If the Epidermal Melasma is not treated properly, the pigment falls from the epidermis into the deeper layer of the skin, the dermis. Once the pigment is in the dermis it is far more difficult to treat. However, many patients have a combined form of Epidermal Melasma as well as Dermal Melasma.
What can I do about Melasma?
Ideally all patients who have hyperpigmentation should have a proper assessment done by a Dermatologist. They will assess the patient’s hormonal status and it may be necessary to stop or change hormonal treatments such as the contraceptive pill.
If the Melasma is severe and has been present for some time a Dermatologist will often prescribe a mixture of a fluid or cream that contains hydroquinone of various concentrations. This will lighten the pigmentation but it does not always clear it completely. Once the pigmentation has improved the Dermatologist will prescribe a maintenance regimen which includes non-hydroquinone skin products with ingredients that specifically target melanin production and of great importance a daily sunscreen.
Why Does the Sun make Pigmentation Worse?
Just one day in the sun without a proper sunscreen and the hyperpigmentation will take you back to square one – it is guaranteed to make your pigmentation worse. The sun is a trigger for pigmentation and your skin should never, ever be unprotected when you are outdoors. Always apply your sunscreen half an hour before sun exposure and re-apply regularly and especially after swimming and sweating. Your Dermatologist will always recommend a good quality, broad-spectrum sunscreen to be used strictly on a daily basis.
Recommended Sunscreen: ISDIN FotoUltra 100 Spot Prevent Fusion Fluid
What other Treatments will help my Hyperpigmentation?
Chemical peels that have been specially formulated to treat pigmentation. These peels should be performed by a Dermatologist or an experienced skin therapist because if a harsh peel is applied to the face it can leave Post-Inflammatory Hyperpigmentation, which means the peel will make the pigmentation worse. Sun freckles can be lightened and reduced with regular peels.
Intense Pulsed Dye (IPL) is recommended for Superficial Hyperpigmentation – sun freckles respond extremely well to this treatment. It cannot be used to treat Melasma.
Cryotherapy (Liquid Nitrogen) is another treatment for sun freckles but not for Melasma.
Dermapen Micro-Needling can help break up and reduce more superficial hyperpigmentation.
I have been performing skin laser surgery for approximately 25 years and I have not found any form of laser that is really beneficial for treating Melasma.
Will my Melasma ever go Away?
Unfortunately in many patients with Melasma it tends to be a chronic condition. There are many treatments that will improve and lighten the pigmentation but often the patients will have to use some form of treatment for many years.
What is the Most Important Advice you can give someone with Hyperpigmentation?
Never miss a day without sunscreen even on overcast days.
Never, ever use hydroquinone in an over-the-counter preparation. You should only use hydroquinone if you are under the care of a Dermatologist or medical doctor who understands pigmentation.