Pigmentation Problems

Pigmentation Problems

Problems with skin pigmentation are extremely common.  Melasma, post inflammatory hyperpigmentation (PIH), vitiligo, photodamage or discoloration, brown patches on the face or upper lip area are due to melanocyte sensitivity.  A variety of influences from within and outside the body can influence the melanocytes to instigate a pigmentary disorder.

What is Melasma and What Causes It?

Melasma is a hormonal problem that causes a pigment disorder characterized by brown or dark macules or patches on the skin. You can develop melasma anywhere, but it favors the forehead, nose, cheeks and upper lip; usually in a symmetrical pattern.

While melasma can affect all races, it is most seen in darker Fitzpatrick skin types III-VI and is more common in women than men.  The depth of the deposition in the dermis determines the discoloration. The epidermal involvement appears as brown discoloration, whereas deeper dermal deposits appear blueish gray.

It is unknown yet as to why melanocytes become hyperactive, or why only some women develop it and others don’t even when exposed to the same factors.  Therefore, the precise cause of melasma remains up for debate.  There are some widely agreed upon causes in the increased synthesis of melanin in addition to a genetic predisposition.  Some trigger factors are ultraviolet light exposure, vascular factors, chronic inflammation and inflammatory disorders, the use of cosmetics and other products, phototoxic or photosensitizing agents, as well as some medications like antiseizure, blood pressure, antimalarial and tetracycline.  Sebum induced inflammatory conditions such as adults acne and rosacea can increase resistance to treatment and therefore better results are seen when using a topical and or laser genesis to reduce sebum production. Hormones might explain why melasma might occur and why it is seen in women taking birth control pills, hormones or after becoming pregnant.  Typically, epidermal melasma responds quickly to treatment but is known to reoccur.

UV rays, hot water (or yoga), continuous exposure to improperly used topical products can cause inflammation that can contribute to over production of melanin.  Melasma can worsen if improperly treated by patients self-treating with hydroquinone (for more than 5 months), or alpha hydroxy acids or kojic acid for more than 1 year. Melanocytes can develop resistance to these treatments and respond with an over production of tyrosinase which causes rebound hyperpigmentation.

The other half of the melasma question involves uneven uptake of melanin by surrounding keratinocytes.  36 surrounding keratinocytes are supplied with melanin from a melanocyte, but with melasma there are only a few keratinocytes uptake the melanin unevenly.  An increase on cell turnover induced by retinoids can equalize and restore even color tone without bleaching.  Treatments like Laser Genesis also help reduce inflammatory conditions caused by sebum, increase keratinocyte activity and induce a more even uptake of melanin.

Focal or generalized dyschromia that can occur as a result of an injury, disease or inflammation of the skin.  Sun exposure worsens PIH, in fact a sun tan can be categorized as a general form of PIH and clients who tan more evenly and easily are more prone to post inflammatory hyperpigmentation.  Racially diverse skin types are more sensitive to inflammation and dermatologic procedures.  Consequentially, they also tend to develop more profound and prolonged PIH.

What can you do to treat your melasma or post inflammatory hyperpigmentation?

The success of treatments are based on an individual’s tolerance and specific condition and depth of pigmentation.  Success also depends on an individual’s commitment to improving the condition and sticking to a specific regime and avoiding potential triggers.  It is important to note, that while the pigmentations can be reduced, clients need to be aware that often treatments will be required as maintenance to keep the pigmentation from returning.

Lifestyle changes include consistent use of sunscreen as well as physical UV blocks such as hats, sunglasses and choosing shade is your best defense.  Reducing your skin’s temperature is also choice to help manage melasma and PIH.  Saunas, hot yoga, sunbathing, hot tubs and steam rooms are all things that increase the skins’ internal temperature.

Long term topical application of tyrosinase inhibiting agents including but not limited to retinoids, azelaic acid, kojic acid, arbutin, licorice extract, and vitamin C.  These in addition to professional chemical peels and laser treatments can effectively reduce the amount of melanin and inflammation occurring in the skin and aid in the reduction of melasma and PIH.

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