BEAUTY: LIGHTEN UP!
We get some advice from the experts on how to alleviate dark spots and pigmentation
Whether it’s a dark mark left behind by a long-gone pimple, sudden blotches brought on by pregnancy or freckles deepening in colour, hyperpigmentation is a part of life for many us. But there are ways to avoid the spots and speckling, or – if that ship has sailed – improve their appearance. We’re here to help!
Yes, we know. Hyperpigmentation isn’t exactly lifethreatening, but it affects the way you look. And according to a study published in the Journal of Clinical and Aesthetic Dermatology, this can have a negative psychological impact and cause emotional distress.
Simply put, hyperpigmentation is a condition that causes your skin to darken. Because the dark melanin pigment sits in the dermis, it absorbs light, explains dermatologist and founder of Dermastore, Dr Ian Webster. ‘It’s because of this light absorption that the skin looks dull.’
Post-inflammatory hyperpigmentation (PIH) is most likely to affect women of colour because they have more melanocytes (melaninproducing cells), but other types of hyperpigmentation that are more hormonal in nature don’t discriminate. Whether it’s a freckle that has graduated to full-blown age spot or a dark flare-up on your cheeks during pregnancy, it all falls under the same umbrella: hyperpigmentation.
Before you spend a fortune on skincare, you’ll need to understand the underlying cause of the hyperpigmentation – there is no one-size-fits-all treatment.
It is always best to consult a dermatologist for some expert help. But in the meantime, we’ve compiled a cheat sheet to get you started down the right path.
POST-INFLAMMATORY HYPERPIGMENTATION
‘Any trauma to the skin, especially among patients with a darker complexion, can result in PIH,’ explains Dr Webster. ‘Trauma may include acne, insect bites, burns or any form of physical injury to the skin.’ This results in an overproduction of melanin or an irregular dispersion of pigment, and usually manifests as dark patches at the site of the inflammation or trauma.
The severity of PIH or depth of the excess pigment within the layers of the skin will determine the colour of the patches, writes Dr Erica Davis in the Journal of Clinical and Aesthetic Dermatology.
The deeper under the skin the pigment is, the tougher it is to treat. If the patches are tan, brown or dark brown in colour, this means the excess melanin is located in the epidermal layer of the skin. It can take anywhere from months to years to resolve without treatment. Hyperpigmentation within the dermis, on the other hand, has a blue-grey appearance and may either be permanent or resolve over an unusually long period if left untreated.
Exposure to harmful UV rays without the proper protection can make it almost impossible to improve the appearance of PIH.
TREATMENT
Dr Webster’s advice? Consult a medical professional who has experience in this area. ‘The correct product recommendations can then be made; these should be medical-grade products backed by clinical trial,’ he cautions. ‘Brands I generally recommend for this condition are PCA Skin, SkinCeuticals and Dermaceutic.
‘I would not recommend any in-office treatments [at doctor’s rooms or spas] for PIH. In most cases, if you use a high-factor broad-spectrum sunscreen that is appropriate for your skin type and do little else, the PIH will slowly improve with time,’ he adds. ‘It is important to keep the underlying cause under control to try to avoid PIH. For example, if the underlying cause is acne, it is better to first treat the acne properly before using more aggressive treatments.’
In-office treatments, he says, can often exacerbate PIH if the person performing the treatment does not have a full understanding of the triggers and its underlying pathology.
Dr Ean Smit, dermatologist and founder of the Cape Town Cosmetic Dermatology Centre, agrees. But there are also other ways to treat PIH. ‘Some over-the-counter creams don’t really work because they don’t penetrate the skin deeply enough,’ he says. ‘There is an option to enhance penetration through the use of microdermabrasion and non-ablative fractional laser [more about this on page 80].’ But Dr Smit is cautious about recommending laser therapy.
‘Before I recommend laser treatment, I look at the severity of the PIH, whether the skin is in need of rejuvenation and if all other options have been exhausted.’ He stresses that a dermatologist with extensive experience must perform these treatments. ‘I recently saw a patient who underwent cryotherapy [cold therapy] to treat their melasma, and it had actually made the condition worse. You need to be very careful.’
MELASMA
This form of hyperpigmentation is in a league of its own. It is more commonly seen in women, and is thought to be triggered by UV exposure as well as hormonal influences; it is also (rather ominously) known as ‘the mask of pregnancy’.
It may appear after starting birth control or other hormonal treatments. ‘Any oral contraceptive pill that contains the female hormone oestrogen can lead to melasma,’ says Dr Webster. ‘The higher the concentration of oestrogen in the contraceptive pill, the more likely that the person will develop melasma.’
Dr Smit says melasma typically appears in the form of blotchy, hyperpigmented patches on the face. ‘It’s usually on the cheeks, bridge of the nose, forehead, chin and upper lip,’ he says. ‘It does affect men as well, but that’s very uncommon. I can’t really confirm whether or not it is caused by hormonal fluctuations because there is very little conclusive research on the exact cause.’
The sun is also a trigger. ‘Underlying factors such as hormonal changes may not manifest until a person goes on vacation to a warm location,’ said Dr Shadi Kourosh in Harvard
Women’s Health Watch.
‘The sun is the major exacerbating factor whatever the underlying cause.’ Melasma can be caused by the sun’s rays as well as by heat and visible light, so a strong SPF may not be sufficient to prevent it.
The potential hormonal influence also makes melasma tougher to treat. ‘Initially, the pigmentation is in the top layer of the skin, which is known as epidermal melasma, but with time, the pigment falls through the basement membrane into the dermis, resulting in dermal melasma, which is more difficult to treat,’ says Dr Webster. ‘Most patients with melasma have a mixed form: a mixture of epidermal and dermal types.’
TREATMENT
Dr Webster recommends using a good-quality, high-factor, broadspectrum sunscreen EVERY DAY. ‘Preferably use one that not only protects against UV radiation but also high-energy visible light and infrared radiation,’ he says.
Dr Smit agrees, adding that hydroquinone, a skin-bleaching agent used to block melanin production, can be a good option for dermal melasma. ‘Hydroquinone needs to be carefully monitored and controlled, though,’ he says. ‘It should be used only on the darkened areas.’
Other recommended treatments
include light chemical peels, fractional laser treatments and Dermapen, says Dr Webster. ‘These can help by breaking up the melanin over time with multiple treatments. Combined with a good-quality sunscreen and targeted corrective active ingredients, these treatments can help reduce melasma.’
Dr Smit adds: ‘When it comes to these procedures you have to be very cautious. The risk of postinflammatory hyperpigmentation is high, so save yourself some time and money by seeing a dermatologist.’
SUN SPOTS
Sun spots, or solar lentigines, are patches of dark skin that result from exposure to the sun, says Dr Smit. ‘Some people think they’re common only in people older than 40, but they’re also very common in younger people.’ Sun spots can also be caused by bruising that leaves blood pigment behind.
A sun spot is round and
irregular in shape, and the colour varies from tan to dark brown or black. They tend to look similar to freckles, but sun spots are larger and typically develop later in life.
They are more common in people with fair skin, and on areas frequently exposed to the sun. Pigment changes are commonly seen on the hands, face, back, arms, feet and shoulders.
‘Before I can even recommend treatment, I usually take a skin sample to determine whether it could be skin cancer – melanoma,’ explains Dr Smit. Look out for a slowly growing patch of discoloured skin, which at first resembles a freckle or sun spot but then becomes more distinct and atypical – this may be lentigo maligna, which is a precursor to melanoma. It occurs in sun damaged skin, so it is generally found around the face and neck.
It is therefore essential to have your dark spots monitored by a dermatologist.
Avoid sun spots by limiting your time in the sun and by wearing sunscreen that protects you from both UVA and UVB rays.
TREATMENT
‘Try to find skincare ingredients with tyrosinase inhibitors, because they control how fast your skin produces melanin,’ says Dr Smit. ‘I recommend hydroquinone, even though it has quite a bad reputation. But that is why you need to see a professional who can monitor your treatment.’
If topical treatments aren’t for you, cryotherapy may be an option. Some dermatologists freeze the sun spot off with a liquid nitrogen solution. Nitrous oxide may be used to treat superficial dark spots. ‘Other options include pigment laser treatments
or, if you’re looking for homogenous improvement over a larger area, I would use energybased treatments like intense pulsed light (IPL).’ IPL uses pulses of light energy to target sun spots on the skin. It does this by heating and destroying melanin to remove discoloured spots.’
LOTIONS AND POTIONS
Ingredients that could help the appearance of hyperpigmentation are retinol, tranexamic acid, azelaic acid, kojic acid, ascorbic acid, arbutin, niacinamide or liquorice extract.
Ascorbic acid is known by many names, including L-ascorbic acid or vitamin C. It is a skin-brightening agent that is considered safe for all skin tones.
Azelaic acid is well known for its anti-inflammatory benefits and is often recommended for those dealing with both active acne and hyperpigmentation.
Kojic acid is another natural bleaching agent and works best on brown-coloured PIH.
Niacinamide (vitamin B-3) is usually found in anti-ageing products because of its waterretention abilities. It is both useful in combating wrinkles and PIH. It most likely won’t treat PIH on its own and works best when used in combination with other ingredients.
Retinol, the king of the skincare world, is made from vitamin A and works by deeply penetrating the skin to even out skin tone and texture.
• Kalahari Skin Brightening Gel, R354
• The Body Shop Drops of Light, R304
• SKNLogic Multi Active Lotion, R295
• Dermaceutic DD Derma Defense Daily Defense Cream SPF50, R520
• Eucerin Even Pigment Perfector
Dual Serum, R599,99
• Lamelle Vita C 30, R945
• SkinCeuticals Ultra Facial Defense SPF50, R510
• Elizabeth Arden Vitamin C Ceramide capsules, R1 025
• Environ Radiance+ Mela-Fade Serums A and B, R990
• Theravine Melanovine Brightening C+ Daily Mattifier, R656
• Avène D-Pigment Brightening Serum, R399,95
• Eucerin Even Pigment Perfector Day Cream SPF30, R449,99
• Eucerin Even Pigment Perfector Night Cream, R449,99
• Vichy ProEven Brightening Cleansing Foam, R200
• Dermalogica C-12 Pure Bright Serum, R1 579
• SkinCeuticals CE Ferulic drops, R2 385
• La Roche-Posay Pigmentclar Even Skin Tone Daily Moisturiser UV SPF30, R355 • Lamelle Correctives Brighter Concentrate, R1 100
• PCA Skin Pigment Gel, R1 185 • Neoretin Serum Booster Fluid, R1 042 • Clarins Sun Care Lotion Spray SPF50, R460 • Exuviance OptiLight Tone Corrector, R552
Avoid sun spots by wearing sunscreen that protects you from UVA and UVB rays