Hyperpigmentation and Darker Skin TonesAlicia LarteyAs a consumer who has dealt with severe acne in the past, I found that my hyperpigmentation became a reminder of how I felt at the height of painful acne flare-ups. I began a personal journey of research to uncover effective ways to treat hyperpigmentation and hopefully educate my growing audience at the same time. As soon as I mention the word ‘hyperpigmentation’ on social media, I am always met with an influx of questions and experiences from my community. While hyperpigmentation is not a new topic, there always seems to be a lot of confusion around it. Let's take a dive into some background knowledge on the subject. Hyperpigmentation describes those pesky dark marks or areas we see on the skin which are usually the result of an inflammatory response. Excess pigmentation is caused by the overproduction of melanin by the melanocytes. This will occur after damage to the skin. The overstimulation of the melanocytes results in extra deposits of pigmentation appearing on the damaged area. The colour of the hyperpigmentation can give you an insight into the depth of the hyperpigmentation: grey hues indicate dermal melanosis, while brown indicates epidermal melanosis. Knowing how deep the lesion is will help guide you when choosing the correct treatment. During my research, I discovered how much information and misinformation about hyperpigmentation flooded skincare spaces. A lot of the information that was credible required a very deep understanding of scientific language and biological processes – which would be a lot of faffing for someone who just wanted to treat their skin. Something I noticed in my research is that the treatments I found useful for hyperpigmentation were not always the hyped-up treatments. One of the most popular products for treating hyperpigmentation is a Vitamin C serum. You cannot search hyperpigmentation without a Vitamin C serum popping up. Controversially, I do not find them useful for hyperpigmentation. I think this is because I saw how frustrated my community was becoming when trying to find the perfect Vitamin C serum and feeling like their hyperpigmentation would never reduce. As mentioned earlier, hyperpigmentation is caused by the overproduction of melanin and, therefore, people with deeper skin tones are more likely to get hyperpigmentation and require a more intensive treatment other than Vitamin C. The key to truly effective treatment is to use products that help with inflammation and inhibit tyrosinase. However, while vitamin C does have tyrosinase-inhibitor properties, it is not the gold-standard treatment. There are many efficacious tyrosinase inhibitors besides Vitamin C and that is a hill I am willing to die on! Alternatively to Vitamin C, I am a huge fan of azelaic acid and kojic acid which are both amazing tyrosinase inhibitors. Azelaic acid at 20% is wonderful for treating both acne and pigmentation. Kojic acid is a little harder to get your hands on, but I am such a huge fan! Kojic acid can usually be found in consumer products at 1%, but is available at a higher percentage in a professional treatment clinic. There is no way I could talk about hyperpigmentation without dispelling two of the most common myths. Myth 1: ‘People with deeper skin tones should not use AHAs as they can cause burning or bleaching’. This is super FALSE! Your skin tone does not dictate which ingredient you should use; your skin type (oily, dry, sensitive, normal) has more of an impact. I find this myth very damaging to a lot of people’s skincare journeys. Deeper skin tones can absolutely use AHAs, and I often recommend them. One tip I advise people to remember is that formulation of a product matters and you should not discount an ingredient based on one bad product experience (unless you are allergic to it). Myth 2: ‘Hydroquinone is dangerous and illegal in the UK’ Hydroquinone remains the gold-standard tyrosinase inhibitor and it is NOT illegal in the UK, but it is available by prescription only. The main danger with using hydroquinone is obtaining it from an unregulated source or improper use. The Pigmentation Box is a great example of treating hyperpigmentation in a multifaceted way and it is great for both pros and beginners to kick their pigmentation into line! Desai S. R. (2014). Hyperpigmentation therapy: a review. The Journal of clinical and aesthetic dermatology, 7(8), 13–17. https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.12048 Del Rosso J. Q. (2017). Azelaic Acid Topical Formulations: Differentiation of 15% Gel and 15% Foam. The Journal of clinical and aesthetic dermatology, 10(3), 37–40. Punchard, N. A., Whelan, C. J., & Adcock, I. (2004). The Journal of Inflammation. Journal of inflammation (London, England), 1(1), 1. https://doi.org/10.1186/1476-9255-1-1
Treating HyperpigmentationAndy MillwardHyperpigmentation is a broad umbrella term that covers any excessively pigmented (brown / black) marks of the skin. It can include sun damage (sometimes referred to as sun spots or liver spots), post-inflammatory hyperpigmentation, drug-induced hyperpigmentation and melasma (although the last one is a complex medical condition so I don’t advise trying to address this one on your own). In order to treat hyperpigmentation successfully, whether at home or in-clinic, there are a few things we need to understand first due to a couple of common misconceptions that I see a lot in-clinic, preventing people from getting results. Firstly, hyperpigmentation is always the result of something else i.e. it’s a secondary concern and only exists as a result of something else. Whether it’s prolonged sun damage, trauma or inflammation, medications or a hormonal imbalance. Jumping in and treating hyperpigmentation without first understanding the primary cause is like trying to empty the bathtub with both taps still running. You need to fix the problem that caused the hyperpigmentation in the first place, even if it's the pigment that bothers you the most. Secondly, hyperpigmentation is complex. It’s not just a simple staining of the skin. Unfortunately, you can’t just exfoliate the skin to get rid of the excess pigment granules. A key thing to understand about melanin (pigment) is that it’s one of our skin's defence mechanisms - like putting an umbrella up on a sunny day. A major factor that is often overlooked when treating hyperpigmentation is the melanocyte is inflamed (the cell that produces pigment). Therefore, a big part of treating hyperpigmentation must include a way of reducing inflammation and calming the melanocyte down. Another issue often overlooked when treating hyperpigmentation is the importance of skin barrier integrity. As a corneotherapist I put skin barrier health at the forefront of everything I do, but it can be overlooked in treating hyperpigmentation. The skin barrier becomes compromised cell-2-cell communication is broken down and inflammation increases, hence my emphasis on its importance. Yes, our cells really do speak to each other! This communication is vital for even pigment production and distribution within the epidermis. Every treatment programme, whether it be at-home with products or in-clinic with treatment, should incorporate some form of barrier repair process in the beginning to ensure optimal long-term results. Once the primary factors that caused the pigmentation are found and the skin barrier is being supported, it makes treating hyperpigmentation that much more effective and the skin will respond better to treatment. Treatments could include peels, microneedling, IPL (Intense Pulse Light Therapy) and laser treatments. Chemical Peels are a great option for treating hyperpigmentation, as they increase cell turnover and help remove excess pigment granules. I prefer combination peels rather than single-agent peels, as these include a combination of ingredients to not only peel the skin but also regulate pigment production such as Vitamin A and Vitamin C for example in combination with AHA’s (Alpha hydroxy acid) / BHA (Beta hydroxy acid). I personally like to use peels in combination with other treatment, such as LED light therapy or even microcurrent to help reduce inflammation and increase cellular energy, supporting the overall result. Microneedling is a great option for treating hyperpigmentation. The controlled trauma of the needles not only helps to break down pigment, increase cell turnover and renewal but also helps repair the communication between cells. Using a 0.5mm needle depth is ideal for most hyperpigmentation issues as it works down to the depth of skin where melanocyte lives. Microneedling can also be combined with growth factors and mesotherapy quality ingredients to address pigment. IPL and laser are light based treatment methods that induce heat into skin to break down pigment clusters. Although IPL and laser are different technologies, the principle is the same but energy deliverance is different. Melanin absorbs light energy, this energy is then transferred into heat. This heat causes controlled trauma to the skin and breaks down pigment granules to increase cell renewal. It can be highly effective in treating pigment and one of the fastest ways to see results, however, caution is needed on darker skin types. Heat trauma can instigate more pigment to be produced making IPL an unsuitable option for treating pigment in darker skin tones, but some laser technology is. A practitioner experienced in treating skin of colour is also essential, but it is possible to treat all skin types with laser. In terms of how long it takes and how many treatments are required, it really depends on many factors including what the primary cause was, how long the pigment has been there, the age of the client and what supporting home care is being used. Generally, I advise my clients to expect at least 3-6 months before seeing decent results, though in some cases this can be longer.
Spotlight On NIOD Re:PigmentNIODThe NIOD Re:Pigment, featured in The Pigmentation Box, is a superstar serum for people with pigmentation who want help in reducing the look of pigmentation on their skin.
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