Non Surgical Treatments

What Are The Main Causes Of Pigmentation?

Hyper pigmentation may either be due to increased melanin deposition in the epidermis or dermis.

• Melasma: Otherwise known as "the mask of pregnancy". Seen as brown patches on the face, often in a symmetrical pattern. It is more commonly seen in females. It occurs due to hormonal changes in the body. The pigmentation increases on exposure to the sun.
• Freckles and Lentigenes: These are tiny brown spots on the face and are genetic in origin.
• Solar lentigo spots, often called ‘sun spots’. This is increased pigmentation due to sun exposure. The pigmentation occurs on exposed skin, commonly on the face, neck and the back like large brown freckles.  

• Post Inflammatory Hyper Pigmentation (PIHP) : It may be seen in the following cases:
• Seen after healing has occurred, like in acne, eczemas, contact dermatitis, burns etc.
• Drug induced pigmentation.
• Pigmentation due to cosmetics especially those containing fragrance.

 

• Nevus or 'Birth mark': Usually seen at birth but may also appear at a later age.
• Peri-orbital Melanosis: Also known as 'dark circles' and may be hereditary or due to stress or eye strain.

Who Is Prone To Pigmentation?

Unfortunately, you can't tell in advance if you will get melasma, although according to the American Academy of Dermatology, if someone in your family had it, you have a 30 percent chance of getting it. In general, melasma occurs in 50 to 70 percent of pregnant women and 5 to 34 percent of women taking birth control pills. The condition usually strikes women between the ages of 20 and 39. Melasma is more common in dark-skinned persons, and is worsened if the skin is exposed to sun.
Solar lentigo is a skin condition caused by chronic exposure to the sun.
Although post inflammatory hyper pigmentation can occur in all skin types, it is more common in people of darker skin types and Asians.

What Is The Best Way To Get Rid Of Pigmentation?

Topical vitamin A creams such as Zorac will stimulate cell turnover and reduce existing pigmentation. Using an effective sunscreen with both UVA and UVB protection will help prevent further sun damage and subsequent pigmentation from reoccurring.

Prescription medications and phototherapy, such as the Sciton BBL or laser treatment, should be combined with Rationale to achieve best results.

Hydroquinone (HQ) is most commonly used prescription medication .It is a strong inhibitor of melanin production but its effects are slow and can take months.  Evidence of improvement with HQ is usually observed at 4-6 weeks, with improvement appearing to plateau at approximately 4 months. Efficacy is directly linked to concentration, but the incidence of adverse effects also increases with concentration. Retinoids (Stieva A) improve the effectiveness of HQ.  At COSMOS we commonly prescribe Stieva A with 4% hydroquinone for melasma and Post Inflammatory Hyperpigmentation (PIHP). The patient is advised to use HQ and Stieva A for 4-6months to ‘turbo start’ the treatment before moving the patient onto over the counter preparations like Kojic Acid,  Vitamin C, Vitamin B3, AHAs and Vitamin A.

Azelaic acid, available as a 20% cream-based formulation called Finacea, appears to be as effective as 4% HQ and superior to 2% HQ in the treatment of melasma. The mechanism of action is not fully understood. Unlike HQ, Azelaic Acid seems to target only hyperactive melanocytes and thus will not lighten skin with normally functioning melanocytes. The primary side effect is skin irritation which is higher than that experienced with HQ. Regardless, Azelaic Acid is definitely a consideration for skin lightening if you have had problems using hydroquinone.

Other de-pigmenting agents that have been studied in the treatment of melasma are Kojic Acid, Ascorbic Acid/Vitamin C, 4-N-butylresorcinol, Phenolic-thioether, 4-isopropylcatechol.

Avoiding the sun between 10am and 4pm, when the sun's rays are most intense. A broad spectrum sunscreen with UV A and UV B protection is essential. Cessation of the pill is also factor that can cause melasma.

Light based treatments with lasers can help with freckles, sun spots and may help superficial cases of melasma and PIHP.

To remove a large number of freckles in one single setting, a medium depth chemical peel with trichloroacetic acid is performed. Patients require 5-7 days downtime.

Once Skin Has Desired Result, Is It Necessary To Keep Up The Brightening Regimen?

It is essential to keep up the suppression of the melanin via inhibiting the tyrosinase enzyme. A number of skin whitening agents which inhibit this enzyme include Vitamin C, Vitamin B3, Kojic Acid, Arbutin, Mulberry, Licorice and Melanostat.

The use of Retinoids and AHA should also advisable

How Can You Prevent Brown Spots Long Term?

Regardless of the treatments used, all will fail if sunlight is not strictly avoided. Prudent measures to avoid sun exposure include hats and other forms of shade combined with the application of a broad-spectrum sunscreen at least daily. Seek shade between 10am and 4pm, when the sun's rays are most intense.

Wear light-coloured, tightly woven, protective clothing and wide-brimmed (three-inch) hats.

Sun protection should begin in childhood because it is estimated that 80 percent of lifetime sun exposure occurs before age 18.

What Ingredients Should You Look For To Achieve UVA Protection?