Irregular Pigmentation

Hyperpigmentation is caused by an increase in the production of melanin, the substance that gives your skin its colour. There are a wide range of causes (and some medical conditions) which may boost your body’s production of melanin:

• Excessive or repeated sun exposure
• Aggressive skin treatments
• Hot working environments
• Acne or skin injury
• Reaction to chemicals and fragrances
• Genetics
• Hormonal changes, often caused by pregnancy or the combined contraceptive pill
• Endocrine diseases such as Addison’s disease or Thyroid disease
• Certain medications such as antibiotics, anti-epileptics and hormone treatments

While anyone can develop hyperpigmentation, the condition tends to be more severe in individuals who tan easily or have naturally brown skin.

Hyperpigmentation can come in several different forms. The most common include:

• Melasma: Melasma appears as patches of brown pigmentation on areas that are chronically exposed to the sun. It most often arises on the face, typically on the forehead, cheeks, nose, upper lip and chin. Melasma can also affect the arms and the back. Women are more likely to develop melasma than men. Those who tan well or naturally have a darker skin tone are also more prone to developing melasma and melasma is driven by hormonal changes during pregnancy or if taking the combined oral contraceptive pill. Though the condition does not affect an individual’s health, melasma can be a source of embarrassment or anxiety about one’s appearance.
• Sunspots (Solar lentigo): These yellow, light or dark brown areas on your skin are caused by excessive sun exposure over a prolonged period. They most commonly occur on the face and hands and lower legs in people with fair skin.
• Post-inflammatory hyperpigmentation (PIH): This condition occurs due to a prior skin injury or skin inflammation. PIH is more common in darker skin types.

Melasma is categorised into three primary types:

• Epidermal: Epidermal melasma is characterised by the presence of excess melanin in the outermost layers (epidermis) of the skin. The pigmentation is brown with well-defined borders. Epidermal melasma is typically more responsive to treatment.
• Dermal: Dermal melasma is identified by the presence of cells that ingest melanin, called melanophages, in the middle layer (dermis) of the skin. The pigmentation is brown, blue or grey with poorly defined borders. Dermal melasma is harder to treat.
• Mixed: Mixed melasma includes both the epidermal and the dermal type. The pigmentation is brown-grey in colour. Treating mixed melasma can be difficult but some improvement can be achieved.

During your consultation we will use a specialised light called a Wood’s lamp to determine the location of the pigment and the type of melasma.

There is no true cure for hyperpigmentation since the problem can be reactivated by sun exposure. Instead, the goal is to manage and control the condition by lightening the appearance of the skin in the affected region.

Depending on the type of pigmentation and goals, Dr. Hughes may recommend one of the following hyperpigmentation treatments:

• General Measures: Photoprotection, avoid oral contraceptive pill if possible, avoiding extreme heat and energy from devices
• Topical Therapy Regimen with Peels: tyrosinase inhibition is a key factor in management and treatments include:
• In Pregnancy: tailored skin products containing kojic acid, liquorice, mulberry, azelaic acid, vitamin C, glycolic acid
• Not Pregnant: an at-home prescription program containing hydroquinone, retinoid, exfoliant to help suppress the development of new pigmentation and lift existing excess pigmentation and periodic in-office peels to lift and shed excess pigmentation (all under supervision of doctor). Vitamin C is a useful adjunct for mild to moderate pigmentation. Prescription azelaic acid (20%) applied twice daily may help superficial melasma. Tranexamic acid tablets may be prescribed for those unresponsive to hydroquinone (must have no history of venous thromboembolism).
• Plexus Fractional Photofacial: Suitable for age spots and post-inflammatory hyperpigmentation (not for melasma). An intense broadband light treatment for the improvement of both red and brown areas on the face, chest, and arms. Bonus – improved skin quality.

For melasma we do not recommend microneedling, microdermabrasion or any laser treatments except for Picosure in the hands of a dermatologist in cases of melasma that are resistant to treatment with tyrosinase inhibitors.

Sun Protection – Critical Factor #1

Using sunscreen with SPF 30 or higher is crucial for controlling pigmentary activity whenever you’re in the sun. We can’t over-stress the need for consistent sunscreen use.

Timing: Sunscreens (those without physical sunscreens: zinc or titanium oxide) take about 30 minutes to become effective. Sunblocks with physical sun screens are effective immediately. Although one complaint of zinc-based sunblocks is the white cast, several good options come tinted. You can also tint your own with a small dab of darker colour makeup.  We recommend Obagi Mineral Sunscreen as a good physical only sunscreen and Heliocare is an excellent full range of sunscreens with an option for every skin type, having one in particular for pigmented skin

Please contact the clinic on 087 4223492 or use our online booking system to schedule your hyperpigmentation treatment consultation.