Skin Pigmentation Treatment

Quick Facts

  • Excessive skin pigmentation can be from a number of causes including UV exposure, hormones, skin trauma, and congenital.
  • Pigmentation can be treated with lasers and lightening creams.
  • The mode of treatment used will be dependent on the type of pigmentation, patient preference, and patient risk tolerance.
  • Pigmentation can be classified into epidermal (superficial), dermal (deep), and mixed.
  • Different lasers are used for different types of skin pigmentation and skin types
  • UV protection/sunscreen is paramount in the treatment of pigmentation 







What is skin pigmentation?

Excessive skin pigmentation is a 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.

Hyperpigmentation, or areas that are darker than the rest of the skin, result from excess melanin production and deposition.
This page will discuss skin pigmentation and its treatment. This discussion will only encompass pigmentation that is in the skin, and will not involve discussion of raised pigmented lesions, moles, or skin cancers.
Hypopigmentation is the loss of skin pigmentation. This will not be discussed here.

 

What causes excessive skin pigmentation?

Excess skin pigmentation or hyperpigmentation is usually caused by an overwhelming of the melanin-protective system. This leads to excess production and clumping of melanin, and the appearance of brown or darker spots of pigmentation in the skin.

Reasons for skin pigmentation problems are;

  • UV radiation - in most cases, especially in  areas of high UV radiation levels like Australia, skin pigmentation problems can be 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)
  • 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 excessive skin pigmentation?

Essentially, hyperpigmentation can be treated with topical lightening agents (creams) or lasers. The main difference between the two is that lasers can produce a faster and more effective result in most cases. Topical lightening agents usually only fade pigmentation rather than remove it completely. There are however, more risks with the use of lasers as opposed to lightening agents, and these risks include worsening of the pigmentation, loss of normal skin pigmentation (hypopigmentation) or scarring of the skin (rare). Also, with laser treatment there is usually a period of recovery post-treatment. The mode of treatment used will depend on patient preference, patient risk tolerance, and the type of pigmentation treated. Pigmentation can be treated on any part of the face or body, including the neck, decolletage, back, and back of hands.







How can skin pigmentation be treated with lasers?

Some lasers can be used for the treatment of skin pigmentation and have minimal or no impact on normal skin. This is possible due to the process of  selective photothermolysis. This is a term that describes how a particular laser wavelength is attracted to pigmented lesions, and only minimally to the normal skin to allow selective removal of a lesion. This allows the laser to selectively disrupt the pigment with minimal or no damage to surrounding skin. Generally, the wavelengths that are attracted to the melanin in pigmented lesions range from 532 nanometers(nm) to 1064nm. 

One type of laser for treating pigmentation are millisecond 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 (1 millisecond = 1/1000th of a second), and although this sounds short, it is actually a long time in this instance. An example of this laser is the Gemini Laser or the Candela V-beam pulsed dye laser.

Another type of laser for treating pigmentation are q-switched lasers. These lasers emit nanosecond pulses (1 nanosecond = 1 billionth of a second) of light that are attracted to the melanin in the pigmented skin. 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 remove tattoo pigment as well. Generally the advantage of these lasers is that they require fewer treatments to treat pigmentation than the millisecond lasers. 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 (see below). Examples of these lasers include the Sinon Ruby laser and the Medlite laser.








Video: The patient in this video is one of the doctors at The Victorian Cosmetic Institute. She is having her pigmentation treated with the Medlite laser.

How can skin pigmentation be treated with topical lightening 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 with two coats. Like painting a wall spots are often missed with only one 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. For more information on sunscreens, click here.

Topical lightening agents can be used in conjunction to help reduce skin pigmentation. Topical lightening agents help to reduce pigmentation by inhibiting enzymes that produce melanin (skin pigment) and by increasing the turnover of the skin to flush out exisiting pigmentation. Common lightening agents include; hydroquinone, kojic acid, paper mulberry bark extract, retinoids, and glycolic acid. For more information on topical lightening agents click here.




Categorising skin pigmentation types

Skin pigmentation can be categorised into either;
  • Epidermal (superficial) pigmentation - these pigmentation types are usually close to the surface of the skin and are induced by sun exposure and include solar lentigos, freckles, and cafe-au-lait macules
  • Dermal (deep) pigmentation - these pigmentation types are usually found in the dermal layers, and include hori's macules, and naevus of ota
  • Mixed dermal/epidermal pigmentation - These pigmentation types traverse through both the superficial and deeper layers of the skin. Melasma is an example of this.
The following are examples of the types of pigmentation:

Solar lentigos or sun spots (epidermal)

The most common forms of pigmentation are due to sun exposure. Solar lentigos, colloquially known as 'sun spots' are an example of this. Solar lentigos are not cancerous, and appear as flat brown 'muddy' patches on the areas of skin that are more exposed to the sun. They commonly occur on the cheeks, forehead, and back of hands.

For those wanting to treat this type of pigmentation, the Medlite q-switched laser and the Sinon Ruby laser are usually the most effective. The Gemini laser does have some use in the treatment of solar lentigos, and tends to work well for lesions on the back of hands and for those with olive/darker skin types. The Gemini laser has a built in cooling tip that can help reduce trauma to the skin which is useful to reduce complications when treating the back of hands and olive/darker skin types.

Case study: This female presented to The Victorian Cosmetic Institute with a large solar lentigo on her face with surrounding smaller ones on her cheek. She underwent treatment with the Ruby laser  and achieved the result seen in the after photo after one treatment. The total downtime/recovery period was approximately one week, where the pigmented spots became darker and then fell off.

Post-inflammatory hyperpigmentation (mixed dermal/epidermal)

Post-inflammatory hyperpigmentation is due to trauma to the skin, resulting in inflammation and pigmentation. Causes include; acne, laser, laser hair removal, IPL, chemical peels, and physical trauma. In the case of post-inflammatory hyperpigmentation, it is important to note that treatment of this type of pigmentation can be worsened if the treatment further irritates the skin. In particular, laser treatments aggravate and irritate post-inflammatory hyperpigmentation and commonly make it worse. At The Victorian Cosmetic Institute, our doctors recommend the use of topical agents for post-inflammatory hyperpigmentation rather than lasers. The doctors at The Victorian Cosmetic Institute often prescribe a combination of hydroquinone, tretinoin, hydrocortisone, and kojic acid (Kligman's formula) for post-inflammatory hyperpigmentation.
 

Case study: This patient presents to The Victorian Cosmetic Institute with a history of facial acne. The before picture depics some active acne as well as post-inflammatory hyperpigmentation as a result of previous acne lesions. The after photo was taken after 6 months of treatment for active acne as well as the use of Kligman's formula for the treatment of post-inflammatory hyperpigmentation.

Melasma/Chloasma (mixed dermal/epidermal)

Melasma or chloasma is a form of pigmentation that is stimulated by oestrogen (either from pregnancy, the pill, or normal circulating oestrogens) and is a difficult form of pigmentation to treat. It appears as brown-gray patches on the face, usually on the cheeks, between the brows and on the upper lip. The following pictures show some examples of treatment results at The Victorian Cosmetic Institute. To see our full page of information dedicated to melasma, including case studies, click here.

skin pigmentation case study skin pigmentation case study

Freckles (epidermal)

Freckles are responsive to the q-switched Medlite laser or the Sinon Ruby laser.  Patients who tend to freckle may refreckle with sun exposure. Most patients show an improvement > 50% after treatment in their freckling as long as daily sunscreen is used. For more information on freckles and some case studies, click here.

Brown birthmarks (epidermal)

Epidermal or superficial brown birthmarks such as cafe au lait spots and congenital melanocytic naevi can also be treated with the q-switched Medlite laser or the Sinon Ruby laser.

 

Pigmentation on asian, olive, or dark skin

Pigmentation problems commonly occur on people with asian, olive or dark skin. These can be more difficult to treat than pigmentation on fair skins, and require a different approach.  

Laser treatments can sometimes cause post-inflammatory hyperpigmentation (see above), and this can make the original pigmentation problem seem worse initially post laser. It is important therefore to ensure proper;

  • preparation of the skin - often lightening serums/creams are used prior to help prepare the skin and reduce the chance of post-inflammatory hyperpigmentation
  • laser settings - choosing a laser that is appropriate to these skin types, the use of skin cooling during laser, lower settings, smaller laser spot sizes to minimise effects of the laser on the normal collateral skin
  • post-laser treatment - ensuring that the proper creams, including sunscreens and sometimes steroids, are used post-laser.

Case study: This patient presented with a number of pigmentation issues, including solar lentigos, seborrhoeic keratosis, and hori's macules (deep dermal pigmentation). Her skin was prepared with Kligman's formula (a lightening serum) prior to treatment with laser, and a combination of lasers were used to treat the various pigmentation problems she had. There was a short period of time when the patient experienced hyperpigmentation post-laser, but the final result shows a significant clearance of pigmentation after 6 months.

Dermal (deeper) pigmented lesions

Dermal pigmented lesions are deep skin pigmentation that is best treated with the 1064nm wavelength of the Medlite laser  or the 694 nanometer wavelength of the Ruby laser. The 694 and 1064 nanometer wavelengths are deeper penetrating, and are able to shatter deeper pigments. Types of dermal pigmentation include; melasma, Naevus of Ota, Naevus of Ito, Becker's naevus, and acquired bilateral naevus of Ota-like macules (Hori's macules/naevus).

Naevus of Ota 

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.  

You are welcome to 'ask us a question' using the button on the top left hand corner of the screen if you have further questions, or to make an appointment phone us directly on 1300 863 824 or use the 'make an appointment' button above.



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