Having a clear complexion is the gold standard of beauty across all age group and ethnicity. Even when a face is lined with wrinkles with the passage of time, one will look much better if spared of the dark spots and pigmented patches that come with aging. Unfortunately, as difficult as it is for “a leopard to change its spots”, pigmentation is equally notorious to treat. Consequently, there are two key actives required for managing hyperpigmentation — patience and diligence. A third requirement is perhaps to have realistic expectations.
Before we talk about treatment, you need to appreciate that hyperpigmentation is stubborn. It has taken years, probably most of your adult life to form; worsened by elements such as sun exposure and changes in your hormonal (estrogen and progesterone) level. The absolute number of pigment producing cells known as melanocytes might have decreased with age but what’s remaining show an increased in size; leading to more melanin production and deposition in the outer layers of the skin. Freckles, for example, are red or light brownish spots particularly common in fair skinned individuals due to hyperactive melanocytes that start in infancy. With age and UV exposure, it’s not uncommon for them to turn darker or increase in number. They might look adorable and earn you the nickname of Strawberry Shortcake but that’s when you were 14 and not 40. Melasma is a common pigmentation problem that affects Asian skin and is caused by genetics, hormonal disharmony and UV exposure. It usually appears as brownish or grayish patches over the cheeks, at times also affecting the forehead, temples and nasal bridge. Melasma tend to affect women more than men and can be aggravated during pregnancy and with the use of oral contraceptives.
Judging from the plethora of whitening products and services available in the market to aid us in our quest for a spot-free visage, it’s not difficult to realize there’s no single magic cream in the jar to help erase our spotty woes. One should take note that at best, a regimen, rather than a single product application, will produce better and more lasting results. To simplify matters, I’ve break this down to 4 main components.
Melasma can occur in many different layers of the skin. Most of the time this is located in the epidermis which is the layer above the bottom layer of skin cells where the stem cells reside. There are times when the pigmentation gets deposited into the dermal layers, or the layers beneath the stem cells. With a Wood’s lamp, an experienced doctor will be able to tell if you have predominantly epidermal or dermal melasma or a mixed variant. Chemical peels differ in the level that they penetrate and will work beautifully if the correct type is used, proving effective even on darker skinned individuals. For example, 10-20% tricholoroacetic acid peels (TCA) usually stay in the epidermis but if applied more times can go beneath the stem cell layer. 20-35% TCA peels and Luminizing peels tend to go a little deeper and can go below the stem cell layer and get some of the deeper pigmentation. One thing to remember is that the deeper you go the more time it takes to heal and the more risk.
Shun The Sun
One can never over-emphasize on the need for adequate protection from the harmful rays of UV radiation. It is pertinent to wear a good sunblock on a DAILY basis, let alone after a chemical peel to protect the new skin from sun damage. Besides avoidance and sunblock, additional sun protection with a wide brim hat and parasol are recommended. Sunscreen is incredibly vital for preventing rebound hyperpigmentation. It can also to some degree treat it, since the blockage of UV rays allows melanin to return to normal and damaged DNA to repair itself. Without using sunscreen, you cannot use peels, AHAs or retinoids since these lightening products are photosensitive and cause the skin to be more prone to damage and darkening from the sun.
Stop The Melanin
Melanogenesis or the production of melanocytes is a multi-step procedure that can be inhibited at different levels and this had led to a boom in cosmeceuticals over the years. Hydroquinone is one of the earliest available bleaching agent and is effective in strength from 2 to 8%. It achieves this by being cytoxic to melanocytes. As such, concerns about cancer were raised and had led to its restricted use in some European countries and Japan. In addition, rebound hyperpigmentation following monotherapy with Hydroquinone is also fairly common. Generally, these days, people tend to give it a miss if possible. The current trend is veered towards synthetic tyrosinase inhibitors and the natural varieties as both are considered safer alternatives to hydroquinone.
Melanin forms through a series of oxidative reactions involving the amino acid tyrosine in the presence of the enzyme tyrosinase. A tyrosinase inhibitor will help prevent the overproduction of this enzyme, and hopefully help prevent hyperpigmentation of the skin. For instant, one of the key components of the highly effective Lightening Complexion Corrector available from sloaneshop.com is kojic acid — a naturally occurring tyrosinase inhibitor. Other examples include arbutin, licorice, mulberry extract and burdock root extract.
Retinoids such as tretinoin and adapalene are derivatives of vitamin A. Besides accelerating epidermal cellular turnover, retinoids inhibit tyrosinase induction and interfere with pigment transfer. They also have the ability to disperse pigment granules within keratinocytes and may act as penetration enhancers when used with other lightening agents such as hydroquinone.
Laser & Light Therapy
Any lightening regime can be given a big boost with appropriate laser and light therapy. The more common form of melasma affects both the epidermis and dermis and for this variety, topical treatments are generally ineffective. Over the years, various light and laser treatment had been used to treat melasma with varying success. Currently, both the Fraxel laser and Q-switch YAG laser are FDA approved for treatment of hyperpigmentation with promising results. “At an appropriate setting, the Fraxel laser allows microscopic thermal spots to gently resurface portions of skin at a time.” Explains Dr. Chua Han Boon from The Sloane Clinc. “This allows the energy to penetrate deep enough into the skin to eliminate the skin cells that cause melasma while the outer layer of the skin is spared.”
The Q-switch YAG laser that can penetrate and target melanin in the deep dermis is another viable option for the treatment of melasma with minimal downtime. Laser treatments have been proven to bear a synergistic effect when used concurrently with topical medications.