Normal skin colour is composed of a mixture of four elements:
- Blue: reduced haemoglobin
- Red: oxyhemoglobin
- Yellow: carotenoids
- Brown: melanin
Hyperpigmentation is a skin condition related to an excess of melanin production.
Melanin is a natural pigment found in the skin, hair and the iris of the eye. Its main function in humans is to provide protection against the harmful effects of ultraviolet (UV) sunlight in the cell nucleus. It is a filter that absorbs solar radiation. The name derives from the Greek word “melanos” meaning “dark”. It is found in different colours and concentrations, resulting in different skin tones.
Melanogenesis is the process of melanin synthesis. It starts from an essential amino acid, tyrosine, which is transformed into melanin by tyrosinase enzyme action. The pigmentation is fully related to the amount of epidermal melanocytes and tyrosinase activation by means of UV rays.
Hyperpigmentation is the disruption of this physiological process, either by the production of too much melanin or for the unevenly distribution of that very same melanin over the skin. This is manifested by patches of varying sizes, more or less dark, which are set in the most exposed areas of the body.
If you are over thirty you are likely to show signs of premature aging due to sun damage. With the Cynosure Elite laser and the Revlite Q-switched Nd:YAG we can now treat sun spots and pigmented lesions.
There are many types of hyperpigmentation but the most common are:
- Melasma: it is a dysfunction in the synthesis of melanin, usually due to female hormonal changes such as pregnancy, etc. This kind of hyperpigmentation is not always automatically regulates when the normal levels of hormone in the body are restored. it has an uneven appearance. Unfortunately this type of pigmentation is incurable; treatment can only improve the appearance of the pigmentation and prevent it from spreading.
- Lentigos or lentigines: Formed by small brown spots and misnamed as age spots as they are not due to ageing but sun damage, appear as small rounded-plates in areas of the body permanently subjected to the action of ultraviolet rays. These skin discolorations are typically brown and flat. They appear on areas of the skin commonly exposed to the sun such as the backs of the hands, the forearms, neck, chest and face.
- Post inflammatory hyper pigmentation: this form of pigmentation is caused by trauma to the skin after inflammation. The more recent the trauma to the skin the better the chance to improve appearance of the pigmentation.
- Overexposure to the sun
- Picking at the skin
- Hormonal changes
- Certain medications such as antibiotics, hormone treatments, and anti-seizure drugs
- Inflammation and skin injuries such as acne vulgaris
As in all kind of skin condition, prevention is always the best medicine. It is essential the use of an opaque sunblock containing titanium dioxide and zinc oxide with high SPF.
1. Laser treatment:
- Revlite: Q-switched Nd:Yag laser: It is a non-ablative laser. This means that there is no break in skin tissue continuity during the treatment. It is designed to target pigment cells. This type of laser is absorbed preferentially by melanin and the resultant heat will cause damage to the cells containing pigment. These damaged cells will then be cleared from the site resulting in lightening of the pigmented area
- Alexandrite laser: This treatment works by directing a beam of laser light to the target chromophore which is the dark pigment (melanin) within the age spot. This removes the abnormality without scarring or damage, resulting in improved skin texture and reduced signs of aging.
2. Topical application:
- Hydroquinone. This topical application is the most commonly used, and it’s the only skin lightening treatment approved by the FDA.
- Kojic acid. This acid is derived from a fungus and works similarly to hydroquinone.
- Azelaic acid. Developed to treat acne, this has been found to be an effective treatment for hyperpigmentation as well.
- Mandelic acid. Derived from almonds, this type of acid is used to treat all types of hyperpigmentation.
3. Chemical peels:
Chemical Peels are another method for treating hyper-pigmentation. There are several types of chemical peels with different and multiple chemicals in them. Chemical peels vary in depth and strength as well.