I have a complicated relationship with summer: I love feeling the warmth of the sun on my skin, but I don’t love the unevenness with which it marks my complexion.
With summer’s seasonal return, I’ve learned that the sun usually kisses and tells. This can be concerning to those affected by pigmentation problems, so let us look at common factors that may worsen your excess pigmentation and follow our tips to help you with this challenging condition.
Why treat pigmentation?
I’ve treated many patients with pigmentary disturbance. I’ve seen their frustration at having to cover up a condition they wish they could rather spend time improving medically. I’ve witnessed the anxiety they face at the idea of going make-up free. I’ve come to understand the difficulties they face in terms of lowered self-esteem and how self-conscious they feel following the onset of unexpected pigmentary alterations.
Pigmentary disturbance remains a challenging condition to treat. There are over 152 genes that regulate pigment production! This has an impact on how individuals respond to topical treatments, and finding the correct treatment is a process. It is important to understand that there is no quick fix. I do, however, believe that if dermatologists work closely with our patients, we may embark on a pathway to improvement.
The skin complexion we inherit is influenced by
South Africa is amongst the sunniest countries in the world and sun-induced pigmentation ranks first as both cause and aggravator of many pigmentary disturbances. We all understand that ultraviolet UVA and UVB rays cause photoaging (sun-induced ageing) and increased pigment production. But we also realise now that the visible light spectrum and infrared radiation play a significant role in contributing to skin damage and uneven skin tone through generation of reactive oxygen species (free radicals) within the skin.
Sun exposure may lead to a general increase in pigmentation where skin is exposed, as well as a darkening of pre-existing freckles and the appearance of sun spots.
Heat Waves and Close Shaves
Heat itself from any external source or trauma to the skin may stimulate increased activity of melanocytes (pigment-producing cells in the skin.)
Melasma (hormonal hyperpigmentation) is a common form of pigmentary disturbance. It frequently occurs during pregnancy or when a susceptible person starts using a combined oral contraceptive pill. The increase in oestrogen concentration stimulates melanocyte activity, increasing the production of melanin. This increased pigmentation is commonly found on cheekbones, forehead, nose and occasionally around the mouth.
The aftermath of inflammation
During the active phase of many inflammatory skin disorders – such as acne, eczema and lichen planus – inflammation in the skin may activate pigment production pathways. When the skin is healed, there may be an increase in pigmentation, called post-inflammatory hyperpigmentation (PIH).
Certain types of medication may lead to pigmentary disturbance. These include non-steroidal anti-inflammatories used for pain relief, the combined oral contraceptive pill, antihypertensive (blood pressure), antimalarial, antibiotic and anti-epileptic medications. Telltale signs that you may have drug-induced pigmentation include darkening of your nails and mucosa (lining of the mouth, etc.).
Should you treat pigmentation in summer? Yes!
Treatment of pigmentation has two arms:
One: use one or a combination of treatment agents that effectively decrease pigment production and,
Two: prevent further worsening of pigmentation from continued sun exposure.
The most important aspect of treating pigmentation over sun-exposed sites is to ensure that you protect vigilantly from the sun.
- This includes avoiding peak-intensity sunlight hours between 10 am and 3pm outdoors.
- When you’re outdoors, wear protective clothing in the form of sun hats, scarves and long sleeves,
- Always remember to apply a broad-spectrum sunscreen with both UV, visible light and infrared radiation protection, such as Bioderma Photoderm range
What treatment should you use?
Here are your A, B, Cs for treatment of excess pigmentation in the summer months:
Always use sun-protection. A broad-spectrum sunscreen should be applied daily in appropriate quantities (a R5 coin amount for your face alone). Re-apply every couple of hours if you are spending time outdoors. Remember, no sunscreen lasts the entire day.
Always remove pigmentation-stimulating agents, such as exacerbating drugs. Speak to your doctor about changing medication, if possible.
Dermatologists may use the following in-clinic treatments to reduce pigmentation:
Chemical peels containing alpha-hydroxy acids like glycolic acid. The strength of the peel will depend on what is clinically suitable for your skin type to minimise inflammation, especially in those with darker skin types. Peels should gently encourage exfoliation of the uppermost layer of the skin, lifting epidermal pigmentation and helping active brightening ingredients from skin care products to penetrate the skin.
Dermafrac is a newer treatment combining microdermabrasion, micro-needling, simultaneous deep tissue serum infusion, and light emitting diode (LED) therapy. In addition to stimulating skin rejuvenation, the procedure also helps with uneven skin tone and hyperpigmentation through delivery of select ingredients into the dermal layer to damp down pigment-producing pathways. This procedure is particularly recommended for those with darker skin types. where stimulation of inflammation through more aggressive treatments may actually worsen pre-existing pigmentary disturbances.
Laser therapy should only be carried out under the care of trained medical professionals. The selection of laser is dependent on the cause of the pigmentation, with careful consideration given to the skin type of the patient.
Care at home
In cases of chronic hyperpigmentation, a more intense acute phase of therapy is often followed by a tailored, safe long-term management programme. Treatment in the acute phase may include ingredients like hydroquinone that are prescribed for a short period under supervision of your dermatologist.
Due to side-effects with continued hydroquinone use, a switch to a non-hydroquinone- based ingredient or combination of ingredients is advised.
Skin brightening agents work on various different pigment activities:
- they may block the formation of melanin,
- inhibit the transfer of melanin from the melanocyte to other skin cells,
- suppress melanocyte activity
- limit inflammation and
- enhance skin cell turnover
Systemic skin-lightening agents have become increasingly popular in recent years. Fernbloc has proven safety and efficacy, but we strongly advise against using other agents such as intravenous glutathione because of severe side-effects, which include renal and liver impairment as well as documented life-threatening adverse drug reactions including Steven Johnson Syndrome.
My recommendations for home care treatment of pigmentation and sun protection
- Essential: Sunscreen with a broad- spectrum UVA and UVB cover, as well as cover for visible light. I recommend Bioderma’s Photoderm M if you have been diagnosed with hormonal melasma as it effectively extends cover to this visible spectrum range. Sun protection is especially important if you have had in-clinic treatments and are using active ingredients such as hydroquinone, retinol, AHA, etc.
- Noreva Trio White depigmenting range is a combination of reductol (a phytonutrient that protects keratinocytes), as well as vitamin C and arbutane that limit melanin production
- Esthederm’s Esthewhite range: a combination of murine exopolysaccharise that enhances skin cell turnover, glucosamine and glabridine that regulate melanin production, and vitamin C with added anti-oxidant benefit.
- Topical retinoid at night: For first-time retinoid (vitamin A) users, I start with Esthederm’s Intense Retinol Serum – a 0.3% retinol preparation combined with papyrus and apricot oils rich in omega 3, 6 and 9, which improve tolerance of the retinoid. As you develop tolerance, and should added strength be required, I upscale treatment to a prescription-grade retinoid.
Find out more about the Esthederm range here.
Here’s wishing you happy summer days,