• acne
• acne scarring
• birthmarks - brown
• birthmarks - port wine stains (red)
• facial volume loss
• fat deposit reduction
• freckles
• gynaecomastia / man boobs
• hand rejuvenation
• injectable lip enhancement
• keloid / hypertrophic scarring
• laser hair removal
• laser tattoo removal
• leg veins / spider veins
• neck rejuvenation
• non surgical facial shaping
• rosacea and facial capillaries/redness
• skin analysis
• skin pigmentation
• sweating - excessive
• wrinkles

• anaesthesia/analgesia for procedures
• anti-wrinkle injections
• chemical peels
• dermal fillers
• laser - apogee
• laser - gemini
• laser - medlite
• laser - ruby
• lipodissolve
• make-up - dermacolour
• make-up - glo minerals
• microdermabrasion
• photodynamic therapy
• plasma skin regeneration
• retinoids - topical
• sclerotherapy
• skin care - asap
• skin care - cosmedix
• skin care - rationale
• skin needling

Skin Pigmentation Treatment

What is skin pigmentation?

Skin pigmentation is result of abnormal production and deposition of melanin by the melanocytes. Melanocytes are pigment-producing cells. The number of melanocytes present in our skin will determine our skin colour. Production of melanin is dependent on UV or sun exposure, and is a natural protective mechanism of the skin.

What causes skin pigmentation?

Reasons for skin pigmentation problems are;

• In most cases, especially in an area of high UV levels like Australia, this is caused by excessive UV or sun exposure (most common)
• Hormonal, as seen in melasma or chloasma that is a type of pigmentation usually caused by pregnancy or the pill (common)
• A response to some drugs, and some medical causes such as liver disease or haemochromatosis (uncommon)
• Trauma to the skin. This can be a result of physical trauma to the skin, chemical peels, laser treatments, or acne. This is known as post-inflammatory hyperpigmentation (common).
• Birthmarks and acquired pigmentation - skin pigmentation can be present at birth (birthmarks), appear in childhood, or adulthood. Examples of these include; congenital melanocytic naevus, cafe au lait spots, spilus naevus, hori's macules, and naevus of ota.
  
  

What are my options for treating skin pigmentation?

Sunspots/Solar lentigos

Post-inflammatory hyperpigmentation

Melasma/Chloasma

Case study 1

This patient presents with melasma over her cheeks, chin, and forehead. She also has some acne present. Normally, she wears sunscreen daily, and is careful to avoid excessive sun exposure. The 'after' photos are the result of one month's treatment with Kligman's formula. Note the improvement in the melasma/pigmentation in all areas. Also of note is the improvement in acne, which is most likely due to the retinol present in Kligman's formula. Retinols help exfoliate the skin and improve acne.

Case study 2

This is a before and after picture of a female with melasma on her upper lip that was treated for 6 months with Kligman's formula only.

Case study 3

This was a 40 year old female of indian origin who presented with melasma affecting both cheeks. She was treated for 2 months with Kligman's formula and weekly Medlite laser treatments at 1064nm. There was considerable improvement in the pigmentation, and she also experienced an improvment in the skin texture and smoothness as a result of the laser treatments.

Freckles, brown birthmarks, and epidermal (superficial) pigmented lesions

Dermal (deeper) pigmented lesions

Tattoo pigments

How can skin pigmentation be treated with lasers?

Lasers can be used for the treatment of skin pigmentation yet leave normal skin intact. Selective photothermolysis­ is a term that describes how pigmentation selectively takes up the energy given out from the laser in preference to that of the normal skin. This allows the laser to selectively disrupt the pigment with minimal or no damage to surrounding skin. Two types of laser that treat pigmentation are listed below. They are both effective in treating pigmentation, and have pros and cons to each.

One type of laser for treating pigmentation are quasi-continuous pulse width lasers. These lasers emit pulses of light that are attracted to the melanin in the pigment, and this selectively disrupts the pigment by thermally heating it. The length of each pulse in this case is in the millisecond range, and although this sounds short, it is actually a long time in this instance. An example of this laser is the Gemini Laser.

Another type of laser for treating pigmentation are q-switched lasers. These lasers emit extremely short pulses of light that are attracted to the melanin in the pigment. They also selectively heat the pigment to disrupt it, but as the pulses are much shorter, they also have a photomechanical effect ie. they shatter/shock the pigment causing it to breakdown. It is this effect that also allows these lasers to treat tattoo pigment as well. Generally the advantage of these lasers is that they require fewer treatments to treat pigmentation. It is a more aggressive and effective treatment, and therefore also has more side effects such as a longer recovery time as well as an increased chance of post-inflammatory hyperpigmentation. Examples of these lasers include the Sinon Ruby laser and the Medlite laser.

How can skin pigmentation be treated with topical agents?

The first method of treating skin pigmentation is to prevent its appearance or worsening by daily application of sunscreen. UV exposure from sunlight or sun beds will invariably worsen any existing pigmentation and promote further pigmentation to arise. The risk of skin cancers also rises with increasing exposure to UV.

At The Victorian Cosmetic Institute, we recommend physical sunscreens as opposed to chemical sunscreens. Physical sunscreens contain titanium dioxide and zinc oxide. These are not absorbed by the skin and provide long lasting protection through the day. Chemical sunscreens such as Para-aminobenzoic acid, are absorbed into the skin and need reapplication after two hours. Studies have found that these chemicals are absorbed by the skin and found in the liver soon after application.

All sunscreens should be applied twice, ten minutes apart, to ensure an even coat. Furthermore, sunscreen should be applied everyday, even if it is cloudy, or overcast, as UV light is still present. It is also important to avoid direct sunlight, especially during the middle hours of the day, seek shade when possible, and wear a hat and protective clothing.

At The Victorian Cosmetic Institute, we recommend sunscreen from our two ranges, Cosmedix and ASAP . These are physical sunscreens that are not comedogenic or acne forming.

Once sun protection has been implemented, it is now possible to treat the skin pigmentation.

Common lightening agents include;

Hydroquinone - This is the most widely and successfully used skin lightening agent. It can be used for melasma or chloasma, post-inflammatory hyperpigmentation, and other disorders of pigmentation. Over the counter strengths can go up to 2%, but concentrations higher than this require a script. It can also be compounded with some of the other agents listed below by a compounding chemist. Hydroquinone can be quite irritating to the skin and cause redness or contact dermatitis when used in higher concentrations. There is also the rare risk of developing ochronosis, which is a paradoxical reaction to the hydroquinone in the treated area leading to an increase in pigmentation. This appears to occur in darker individuals after prolonged use. Alternating use of hydroquinone with other lightening agents every four months can help prevent this.

Kojic acid -  This is derived from fungus such as Aspergillus and Penicillium. It can be used in concentrations between 1% and 4% and can be compounded with other agents. Again, irritation can occur with use. It is not as effective as hydroquinone, but has no chance of rebound pigmentation or ochronosis.

Arbutin - originating from bearberry, arbutin helps to lighten the skin by inhibition of the enzymes that help produce melanin. It has less irritation than kojic acid and hydroquinone. Available as L-arbutin in Cosmedix products.

Vitamin C - Topical vitamin C also helps interfere with pigment production. An additional benefit of vitamin C is the anti-oxidant effect it has, so it will help prevent skin from environmental damage. Also stimulates the production of collagen. Stability of vitamin C is the main problem of most vitamin C products. Cosmedix provides vitamin C in the form of L-ascorbic acid and is highly stable in this form.

Glycolic acid -  is an alpha-hydroxy acid (AHA) that can has a discohesive effect on the epidermis, or top layer of skin, to help desquamate (exfoliate) the pigmented skin cells. By doing so, it speeds skin turnover and pigment is lost more rapidly. Glycolic acid is found in varying concentrations in ASAP skin care products.

Retinoids - Retinoids are derived from vitamin A. Retinoids work in a number of ways to help reduce pigmentation. The actual mechanism of action is not clear, but it is thought that their depigmenting properties arise from inhibition of the enzymes causing pigmentation, dispersion of pigment granules in the top layer of skin, and also by accelerating skin turnover to help pigmented skin cells shed more quickly. It is also this final property that helps retinoids smooth skin, reduce wrinkles, and active acne. L-retinol, a type of retinoid, is found in various Cosmedix products. Retinoids can be irritating to the skin and may need to be commenced slowly.

Why should I choose The Victorian Cosmetic Institute to treat my pigmentation?

At The Victorian Cosmetic Institute, our doctors will carefully assess your pigmentation problem and carefully formulate a treatment plan for you. We have a wide range of treatment options including a large number of topical agents and lasers, and this will ensure that you will get the treatment most suited to your pigmentation.

Our doctors are also highly experienced in laser treatments, and will be able to give you the best advice for your treatment.

The first step is simply contacting us for your initial consultation, where we will discuss with you what is a realistic and achievable outcome, and what to expect from your laser treatment.

Making that first phone call about any cosmetic procedure can be a confronting task - many of our patients have preferred filling out our online enquiry form. We can then contact you with an understanding of the results you are hopeful of achieving and ensure the treatment is appropriate.