PIGMENTATION
What is Pigmentation?
Pigmentation is a term to describe light or dark brown patches on the skin which are caused by an excess of melanin. People will sometimes use pigmentation to describe red patches left after blemishes, but these aren’t strictly pigmentation and are discussed under post inflammatory erythema in the acne scarring section.
Pigmentation can have many causes and to ensure treatment is effective, it is very important to work out why there is pigmentation.
Having trained in Dermatology at the world-renowned St John’s Institute of Dermatology, Dr Emma has managed many different pigmentary disorders and has significant experience of treating all skin tones.
Common causes of pigmentation include:
Sun spots (solar lentigines)
Sun spots (solar lentigines) are freckle-like lesions which develop after UV exposure over years. They can occur anywhere on the body, but are common on sun exposed areas like the face and the hands. Unlike freckles in childhood, they don’t fade in the winter. People of all skin tones can develop sun spots, but they are more common in light skinned individuals.
Melasma (hormonal pigmentation)
Melasma is a skin condition which results in brown blotches on the face, commonly occurring on the cheeks, nose, forehead and upper lip. Melasma mainly occurs in women and is common at times of hormonal changes eg taking oral contraceptive pills or pregnancy. Melasma results from an overproduction of melanin (brown pigment) in the skin caused by a combination of sun exposure and hormonal changes. Typically, the pigmentation will be most obvious in hot sunny weather and may fade significantly over the Winter months.
Post-inflammatory hyperpigmentation
Pigmentation of the skin can sometimes be caused after inflammation or damage to the skin. This can be from a number of causes including acne, eczema or even a cut or graze to the skin. Post-inflammatory hyperpigmentation (PIH) is much more common in dark skins which produce melanin easily. When there is an insult to or inflammation in the skin, excess melanin is produced which results in PIH.
What are the treatments for Pigmentation?
The treatment that Dr Emma recommends will depend on the exact cause of the pigmentation but may include the following:
Sun protection
UV exposure will exacerbate all causes of pigmentation and sun protection is key to managing all types of pigmentation. High factor (SPF50+) with excellent broad spectrum sunscreen and careful behaviour in the sun is essential to prevent worsening of the pigmentation.
Topical over-the-counter creams
Antioxidants such as Vitamin C and resorcinol can help to fade pigmentation and prevent further lesions from developing. Alpha-arbutin, niacinamide, thiamidol and 2-Mercaptonicotinoyl Glycine can be helpful to reduce pigmentation. However, significant pigmentation is likely to need prescription-grade treatments.
Medical creams
There are a number of different prescription-grade options to treat pigmentation including azelaic acid, retinoids and hydroquinone. Dr Emma will decide which option is best for you depending on your clinical presentation.
Tablets
In some types of pigmentation tablets may help to lighten affected areas. These can be very effective in some cases, but may not be suitable for all individuals, particularly if you have other health problems.
Procedures
For sun spots, freezing the area with liquid nitrogen (cryotherapy) can be used. Energy based devices (laser or IPL) can also be very helpful treatments for pigmentation caused by sun damage. Depending on your individual skin type, Intense pulsed light (IPL) or a different type of laser may be advised. In other types of pigmentation, energy based devices may be used as second-line treatments, but need to be used with caution due to the risk of either causing excessive lightening or darkening of the skin.
A Word from Dr Emma
“If pigmentation is affecting you and you want to take control of your condition, make an appointment now.”
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