Hyperpigmentation is a common condition that makes some areas of the skin darker than others. “Hyper” means more, and “pigment” means color. Hyperpigmentation can appear as brown, black, gray, red or pink spots or patches. The three main types include age spots, melasma, and post-inflammatory trauma. Post-inflammatory trauma can result from an injury, sun exposure, or a skin condition, such as acne.
What is Melasma?
Melasma is a skin condition that causes patches and spots, usually on the face, which are darker than your natural skin tone. It is usually fairly symmetrical, patchy, ill defined and light or dark brown depending on recent sun exposure. Melasma is a common skin condition of adults mostly women, in which light to dark brown patchy pigmentation develops usually on the face. Although it can affect both genders secondary to excess ultraviolet irradiation it is more common in women. It occurs in pregnancy and also can be caused or exacerbated by the oestrogen in the oral contraceptive pill. Melasma is usually very noticeable during the summer months when the face can actually appear dirty and fades a lot during the winter months. It has no cancerous potential.
What causes Melasma?
The cause is not fully understood although it occurs quite frequently in pregnancy and in the majority the condition fades after the delivery. Some acquire it while taking oral contraceptives although it doesn’t always fade after discontinuation of these. All patients with melasma find that it is increased with increased exposure to UV light and this must indeed be the cause in males where oestrogen is not contributory.
What is PIH?
Post-inflammatory hyperpigmentation (PIH) is a common acquired disorder occurring after skin inflammation or injury. It is chronic and is more common and severe in darker-skinned individuals (Fitzpatrick skin types III–VI). PIH usually looks like a flat area of discoloration on the skin. It can appear white, pink, red, purple, brown, or black, depending on your skin tone and the depth of the discoloration. PIH can develop in all skin types. However, it tends to be more severe and longer-lasting for people with medium to dark complexions.
What causes PIH?
When your skin cells react to damage or irritation by making extra melanin, post-inflammatory hyperpigmentation is the result. This skin condition shows up as tan, brown, dark brown, or even blue-gray patches and spots on your skin. The most common causes are acne, eczema, and impetigo, but any type of trauma or irritation to the skin has the potential to cause PIH.
What are Age Spots?
Age spots are small, flat dark areas on the skin. They vary in size and usually appear on areas exposed to the sun, such as the face, hands, shoulders and arms. Age spots are also called sunspots, liver spots and solar lentigines.
What causes Age Spots?
Age spots are caused by overactive pigment cells. Ultraviolet (UV) light speeds up the production of melanin, a natural pigment that gives skin its color. On skin that has had years of sun exposure, age spots appear when melanin becomes clumped or is produced in high concentrations.
Treatment / Management
Explanation and solar protection are the most important as the condition is difficult to treat. Fair skinned individuals have the best prognosis and may recover completely after pregnancy or stopping the oral contraceptive pill.
Proper skin care is essential in melasma. Starting the day with either an AHA or BHA cleanser that wakes up the skin cells and makes them respond better to active products. Sunscreen daily is very important. REFORM Skincare SPF30 sunscreen is a once daily factor 30 application. It has titanium dioxide which gives a complete physical block. REFORM Skincare Vitamin C 20% is a very powerful anti-oxidant and offers additional sun protection and is a whitening agent. REFORM Skincare Retinol 1% is an excellent serum for pigmentation and anti-ageing also. It also improves fine lines, pigmentation and ageing, it is not to be used in pregnancy or breast feeding. If these products are combined with a home dermaroller there is increased penetration of about one thousand into the skin so results will be superior.
If the pigmentation is very severe or only improves moderately with the above, prescription products can be added in for a short period which again is excellent for increased pigmentation.
The products will usually need to be used long-term for maintenance but are excellent for skin anti-ageing. If the pigment still doesn’t clear to the patient’s satisfaction then at a review visit about 6 weeks after starting the products a peel can be performed. Peels can improve melasma but can also worsen it so caution is necessary. Several peels may be necessary.
Lasers can also be used including FRAXIS Co2 and Fractional RF with Needling.
An initial dermatology consultation is required to properly diagnose and recommend a treatment plan.
Our doctors are experts in the management of Skin Cancer, Melanoma, Acne, Psoriasis, Atopic Dermatitis (Eczema), Hidradenitis Suppurativa, Lupus, Contact Dermatitis and Hair Loss. They have access to and experience with advanced treatments and technologies that offer the most up to date and best possible care.
THE ADARE CLINIC
4 Clare Street, Dublin 2.
Tel: +353 (0)1 676 9810 Dublin
Adare, Co. Limerick, Ireland
Unit 2, Harvey’s Quay, Limerick
Tel: +353 (0)61 395410 Adare