Dr. Smita Ramanadham

Dr. Smita Ramanadham

May 13, 2020

Let’s talk pigment!

Sunspots, melasma, scarring, and inflammation can all cause hyperpigmentation or dark discoloration in our skin. It can be localized and present as spots or can be in patches and take up a majority of our facial skin. Regardless of its cause or presentation, it can be quite frustrating and difficult to treat.

Let’s start by understanding why our skin darkens when it becomes irritated. Melanin is pigment within our skin. It gives us all our skin color and is protective against UV rays. Fun fact, this protective nature is one of the reasons why certain ethnicities, based on their location in respect to the equator, may generally have more melanin than others. For example, South Asian Indians, typically have more melanin than other ethnicities. Okay, back to the science. Melanin is produced by cells named melanocytes that are in the basal layer of the epidermis of our skin. (Yes, our skin has different layers!) While the number of melanocytes is generally the same regardless of skin color, the amount of melanin produced, through a process called melanogenesis, is different. This process is initiated by UV radiation (the sun!) as a means to protect our skin from the damaging effects of UV rays. More sun à more UV radiation à more production of melanin à darker skin. So why do we develop dark pigment from acne or scars as well? It’s because these inflammatory processes can also stimulate melanocytes causing an increase in melanin.

Now that we have the science out of the way, the best treatment for pigment is prevention. Sunlight stimulates melanin production, so by wearing appropriate sunscreen (SPF of at least 30 as recommended by the ADA), you can stop the process from the get-go. Aside from this, there are other treatments that may help that range anywhere from skin care to chemical peels or laser treatments.

Skin care: Skin products that contain brightening agents can help improve hyperpigmentation. These include vitamin C, kojic acid, azelaic acid, or niacinamide. Hydroquinone is another more powerful medication used to treat pigment. It’s typically found in medical-grade products or can be obtained with a prescription. This works by inhibiting an enzyme (tyrosinase) that is needed to make melanin. It’s important that you have close follow up with a medical provider when using this as rebound hyperpigmentation can occur if not used properly.

Chemical peels: Peels help improve pigment as well. Chemical peels vary in how deep they penetrate the skin. By using acids that penetrate the layers of the skin in which the pigment is located, the discoloration can be treated and improved as these layers shed off. Chemical peels are good for an overall improvement in tone and brightness.

Lasers: Lasers are one of the best ways to treat discoloration. A laser works by targeting a specific chromophore. Chromophores can include water, hemoglobin, or melanin. Various lasers or IPL’s exist that can be used to treat this and should be discussed during your consultation. The important thing to remember is that a laser does not differentiate between melanin in melasma, sunspots, or scars from the melanin that is in your normal skin. If used inappropriately, hypopigmentation or hyperpigmentation can result.

Pigment problems are tricky and require continued care. While there is, unfortunately, no magic bullet, the methods above can ameliorate and improve some of these issues. Most importantly, wear sunscreen and protect yourself from the sun from the start.