Pigmentation is one of the most common yet complex skin conditions skincare professionals encounter, and it is an increasing focus for clients. So far in 2021, searches for “hyperpigmentation” have soared by 140% as individuals seek out advice on tackling concerns such as age spots, dark patches and discolouration.
Visible signs of pigmentation can be an emotional issue, and tackling the concern requires a smart and sensitive approach. Research suggests hyperpigmentation and melasma are frequently associated with negative psychological effects, including anxiety or depression.
Delivering tangible results for clients dealing with these issues takes time and requires the expertise and treatment advice of knowledgeable skincare professionals. Numerous complex mechanisms govern the process of pigmentation, and damage can be hidden in skin for years before pigmentation appears on the surface. Easing pigmentation requires a careful combination treatments, active ingredients in oral and topical products, home care and lifestyle changes.
What is pigmentation and how does it happen?
All skin contains some level of the pigment melanin and the variety in our natural production of this molecule is what determines our individual skin tone. Melanin is also produced to protect skin cells from damage, for example when exposed to UV light. It is also produced in response to other stimuli, both internal and external, some of which can lead to excess melanin production.
Melanin is produced by cells called melanocytes, which are scattered through the basal layer (stratum basale) of the epidermis. When these cells are stimulated by specific melanocyte stimulating hormones, a reaction occurs wherein the enzyme tyrosinase facilitates the synthesis of melanin. There are two types of melanin: phaeomelanin, a red, brown pigment produced in people with lighter skin tones, and eumelanin, a dark brown or black pigment produced in people with darker skin tones.
Pigmentation becomes visible as marks or spots when melanin deposits build up in the upper layers of skin cells, which happens as keratinocytes move up the layers of the skin. The activity of the melanocytes in our skin determines how much pigment is produced and certain triggers can result in increased melanocyte activity: meaning more melanin, and increased pigmentation.
What causes pigmentation?
The causes of pigmentation are incredibly varied and highly individual. “Genetics play an important role but excessive sun exposure, hormones and stress appear to be the main triggers for the development of excess melanin,” explains Dr Des Fernandes, founder of Environ Skincare. “It seems the melanocytes are stimulated to become “rogue” and start over-producing melanin.”
UV and sunlight are the most pervasive triggers, causing swiftly-seen changes and long-term damage. “When keratinocytes are exposed to UV, damage to their cellular DNA stimulates an increase in the production of melanocyte stimulating hormones. This increases the amount of melanin produced to protect the keratinocytes,” explains Dr Gaby Prinsloo, medical director at the iiaa. “UV radiation also increases oxidative stress in melanocyte DNA, which directly increases tyrosinase activity, further increasing melanin production.”
Melanin protects cells, but extended sun exposure and cumulative damage can trigger abnormal melanocyte activity, leading to excess melanin production and in some cases, cancer.
In addition to UV, blue light can also lead to pigmentation. Blue light is a high energy, high frequency component of the natural light spectrum. The highest levels occur in sunlight, with electronic screens and LED lights as an additional source.
Alongside external stimuli, hormones play a crucial role, particularly for women. The reproductive hormone oestrogen can stimulate the overproduction of melanin when skin is exposed to sunlight. This contributes to a specific type of hyperpigmentation: melasma. The “mask of pregnancy” is melasma brought on by hormonal shifts during pregnancy.
Scientists continue to uncover additional causes of pigmentation. The endocrine stress response can trigger the production of melanocyte stimulating hormones. Studies suggest free radicals generated by the response to stressors such as pollution or a lack of sleep can damage cell DNA and cause melanin production.
Types of pigmentation:
Melasma is a specific type of hyperpigmentation caused by hormonal change and exacerbated by UV damage. It is more common in women, particularly pregnant or menopausal women or those taking hormonal contraceptive pills. People with darker skin tones (Fitzpatrick skin types III-V) are also more likely to experience melasma.
Melasma has a distinctive appearance. Usually symmetrical across the face, distribution is most commonly centrofacial (on the cheeks, nose, forehead, top lip and chin) and can also be malar (on the nose and cheeks) or mandibular (on the jaw and chin).
Post-inflammatory hyperpigmentation (PIH)
Inflammation in the epidermis stimulates the melanocytes to increase melanin synthesis, which leads to excess pigmentation. PIH often appears in the wake of inflammatory skin conditions such as acne or dermatitis, leaving a darker patch skin where flare-ups have healed. The concern is more common in darker skin tones, particularly Fitzpatrick skin types IV through VI.
PIH also occurs if skin is severely damaged by an external aggressor. Chemical burns, overly aggressive facial peels or lasers can all trigger PIH.
Age spots, liver spots, sun-spots or senile freckles are all solar lentigines: patches of darker skin caused by sun damage and most common in those aged over 40. The marks appear all over the body, particularly on the face, arms and hands.
Each spot, or lentigo, contains a higher density of melanocytes than the surrounding skin, leading to a subsequent accumulation of melanin. Spots can be scaly in appearance and can become inflamed.
“Irreversible damage to melanocytes accumulates over time, and pigmentation will develop later in life once a critical point is reached,” explains Dr Gaby.
Another type of lentigo, freckles appear at any age, and result from the short-term response of melanocytes when exposed to sunlight. In freckles, the amount of pigment produced by melanocytes increases, but the number of melanocytes within the skin remains the same. Freckles are not a sign of severe skin damage, but indicate an individual is susceptible to UV damage, making sun protection particularly crucial.
Visibly the opposite of hyperpigmentation – hypopigmentation creates white, or pale marks on the skin due to an absence of melanin.
Hypopigmentation occurs when there is a decrease in the number of melanocytes or a decrease in the amount of melanin produced, this leaves light or unpigmented marks on the skin. Several genetic conditions, including vitiligo and albinism, cause hypopigmentation, and it is also caused by skin damage, for example sun damage, inflammatory skin disorders, or burns.
Hypopigmentation is common and manifests as small, unpigmented flecks on the arms or legs – places where sun care may have been less rigorous.
Treating pigmentation: protection and persistence
Improving pigmentation is challenging for therapists and clients alike. Pigmentation is often caused by years of damage and reversing this will not happen overnight. However, significant improvements can be made with smart treatment, client commitment and, crucially, time.
“Pigmentary blemishes are one of the most difficult skin concerns to target successfully,” explains Dr Des Fernandes. “There are many important factors that need to be addressed, and there is no one magic ingredient that can do it all. Pigmentary blemishes are a life-long problem which cannot be “cured” but can be controlled to various degrees.”
A holistic approach is vital. “There are numerous triggers for pigmentation, and the more you target the more effective you can be,” explains Dr Gaby. “It is important to take a synergistic approach.”
She adds that clients and therapists must be patient, as results take time to appear. “Melanocytes are in the lowest layer of the epidermis. The melanin produced is deposited in the keratinocytes also in the lower epidermis. As the keratinocytes mature and grow, they move upwards through the skin. Once they reach the upper layers of the epidermis, we see visible pigmentation,” she explains. “The same is true in reverse. When we normalise melanin production, the new, healthy keratinocytes will take time to work their way up to the visible surface of the skin.”
Sun care comes first.
“Protection against sun exposure should be the first and main focus of any treatment plan,” stresses Dr Des Fernandes. The close relationship between UV and blue light exposure and abnormal pigmentation necessitates a strict, sensible approach to sun. “A few minutes of unprotected direct or indirect UV or blue light can immediately undo any beneficial effects from skin care and treatments,” adds Dr Des.
The ingredients to incorporate:
Think of vitamin A as creating a foundation of healthy skin: ensuring skin is rich in vitamin A is the most effective way to minimise the chances of pigmentation. Skin rich in vitamin A provides a strong platform for ingredients that target the mechanisms of pigmentation. Using topical and oral vitamin A in combination ensures optimum levels within the body to create this foundation.
“The ideal treatment approach is to first normalise the cell functioning with vitamin A and antioxidants. We do not want to destroy or render melanocytes ineffective, but rather get them to behave in a normal, healthy way. Start by soothing irritated keratinocytes and melanocytes with the use of vitamin A.”
As a powerful antioxidant, vitamin C helps counteract the reactive oxidative stress that triggers melanin synthesis. Molecules of vitamin C bind to reactive oxygen species that would drive melanin production in the skin, meaning pigmentation is limited. Vitamin C also has a normalising effect on melanocytes.
Dr Des Fernandes explains that vitamin C in the form of ascorbic acid acts as a tyrosinase inhibitor. “It inhibits tyrosinase at two places in the metabolism of tyrosine into melanin,” he says. “Tyrosinase is essential for the formation of melanin, so if it is inhibited, the production of pigmentation is reduced.”
Additionally, oral supplements of vitamin C have been shown to be extremely effective in combatting pigmentation such as brown spots. One study has even suggested that the benefits of nutritional vitamin C can be greater than topical vitamin C when it came to skin concerns.
In addition to its role in encouraging skin rejuvenation, lactic acid directly acts on mechanisms behind pigmentation. Studies show lactic acid accelerates epidermal cell turnover and “directly inhibits tyrosinase activity”, reducing the amount of melanin formed in melanocytes. This minimises existing pigmentation while preventing new pigmentation. Lactic acid synergises well with vitamin C and other tyrosinase inhibitors in the body.
Gentle lactic acid peels can be beneficial within a pigmentation treatment programme. When applied correctly, they stimulate regeneration without causing damage. However, when it comes to acids, caution and care is necessary.
Pycnogenol (French Maritime Pine Bark extract)
French maritime pine bark extract, or pycnogenol, is an emerging ingredient and supplement at the frontier of pigmentation treatment. Researchers describe it as exhibiting “anti-melanogenic activity” due to its antioxidant properties, noting that it appears to inhibit tyrosinase and suppress melanin synthesis.
Oral pycnogenol reduces hyperpigmentation and melasma when taken as a supplement. One study found that when combined with sun protection, oral pycnogenol supplementation improved melasma in 94.4% of participants. Additional studies report that supplementation improves age-related pigmentation, reducing the density and size of solar lentigines.
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