Ready to Tackle Your Post-Summer Hyperpigmentation?

The summer months can wreak havoc on your skin, particularly when it comes to pigmentation. All that increased sun exposure leads to an increase in melanin production, causing freckles and dark spots.

A recent dermatological study found that in patients with pigmentary concerns, almost half felt self-conscious about their skin to some degree and a third felt unattractive because of their skin.

Interestingly, 41% had never attempted treatment, and of those who had, more than one-third expressed dissatisfaction with the results. Many expected to see an improvement in their skin within just one to four weeks, and only 16% were ‘very’ or ‘extremely’ satisfied with existing options.

In our latest blog, we go in-depth into some common pigmentation problems, your treatment options and what you can expect in terms of results.

What is pigmentation?

Pigmentation is the biological process that determines our skin colour, and it’s primarily driven by a pigment known as melanin. There are two types of melanin:

• Eumelanin produces darker skin tones

• Pheomelanin produces lighter ones

Which type of melanin your body produces, and how much of it, will depend mostly on genetics, which is why children generally tend to have similar skin and hair colours to their parents.

So, pigmentation itself is not a problem. The issue is hyperpigmentation, when an overproduction of melanin produces visible dark areas on the skin’s surface. While there are many possible causes of this, sun exposure is one of the main culprits and will exacerbate all other causes of hyperpigmentation.

How does sun exposure cause hyperpigmentation?

Melanin is produced from cells in the basal layer of the epidermis called melanocytes and then distributed to the other epidermal cells known as keratinocytes. This melanin helps to protect those cells from the sun by absorbing UV radiation, which is why people with fairer skin are more prone to sunburn and skin cancer than those with darker skin tones – although it’s important to note that people with darker skin tones still benefit from sun protection- more of which later.

When we expose our skin to the sun, it responds by producing more melanin, in an effort to protect itself. This is what produces a sun- tan, but repeated exposure to the sun over time can lead to an overproduction of melanin in certain places, causing areas of hyperpigmentation.

What other factors can cause hyperpigmentation?

As mentioned above, genetics play a huge role in melanin production, and if one or both of your parents experience hyperpigmentation, you are at higher risk too. There are a few inherited syndromes (where patients have other underlying defects) which include freckling, but these are uncommon. A few freckles in childhood is often an inherited trait and though exacerbated by the sun, is most often not linked with sun damage and is of no clinical significance. The tendency to freckle on sun-exposed sites though, is a sign that a patient is at higher long-term risk of skin cancer and should take care to sun-avoid.

The type of hyperpigmentation most commonly associated with hormonal change is melasma, which is characterised by symmetrical, darker patches of skin, most often found on the forehead, cheeks and upper lip. This also has a genetic basis but is more commonly seen in women as it is exacerbated by use of the contraceptive pill, pregnancy and the use of HRT. Sun exposure- to both visible and UV light- also plays a huge role in the progression of melasma.

Post-inflammatory hyperpigmentation (PIH) presents as flat, dark patches on the skin that develop following any inflammation, however caused. After any trauma to the skin, part of the body’s natural defence response is to trigger the melanocytes to release more pigment. This can lead to unwanted, persistent dark spots or patches that remain long after the initial injury has healed.

This can be seen after psoriasis, eczema, insect bites and is a notable consequence of acne. In particular, damage to the dermal/epidermal junction where the melanocytes live, can lead to lasting pigmentation as typified by the severe pigmentation seen after lichen planus. Post-inflammatory hyperpigmentation is particularly prominent and severe in darker skin types.

How can hyperpigmentation be treated?

As with any medical treatment, there is no one-size-fits-all approach to treating hyperpigmentation, and I always carry out a full and thorough consultation with every client before recommending a course of treatment. The right treatment for you will depend on many factors, including the type of pigmentation you have and what has caused it.

Please note that sometimes we may need to prepare the skin before we can actively treat you or you may need to wait until a tan has faded and avoid the sun for 4 weeks before and after your procedure. This is to reduce the risk of rebound post-inflammatory hyperpigmentation. We aim to make things better, not worse!

Treatments include but are not limited to the following:

Medical (topical) depigmenting creams

These work by blocking the enzymes that are involved in melanin production, fading existing dark spots and preventing new ones from forming. This includes chemicals such as hydroquinone, kojic acid, arbutin, tretinoin, alpha and beta-hydroxy acids, cysteamine and many others. Some treatments are done in clinic and others at home or a combination of both and this can offer long-lasting results, visible within a few weeks of treatment.

Oral tranexamic acid tablets

These can be very helpful in treating melasma in select patients. There may be reasons why this may not suit you and a full consultation is essential first.

Skin peels

There are several different chemical peels available. The type of hyperpigmentation you have will dictate which peel you are offered, and the depth of hyperpigmentation will dictate the depth of the peel. You may need a course of peels to effectively treat the issue, but this can offer impressive results. Some peels are not suitable for all skin types.

Intense pulsed light

IPL uses a band of light of the wavelengths which are taken up by melanin so that those cells with excess melanin get destroyed and the melanin gets gobbled up by the body’s macrophages (‘bin-men cells’) and taken away. It can appear to get darker initially but over time, the pigmentation reduces.

Excel V+ laser treatment

Excel can also target pigment but uses a single wavelength of light rather than a band. The effect is the same as with IPL.

Microneedling with or without topical tranexamic acid

This treatment combination can be quite effective for melasma, with a recent study showing 72% of patients receiving microneedling and tranexamic acid at monthly intervals reported ‘excellent satisfaction’.

Microneedling with Exosomes

Exosomes are a means by which the cells signal to each other. I use ExoCoBio plant-based exosomes which help to reduce pigmentation.

CO2 laser

I use the Cutera Secret PRO device, which combines fractional CO2 laser with microneedling, to treat skin texture and tone. CO2 laser can be used on its own as well and literally resurfaces the skin, partially removing the epidermal layer which has the excess pigment. New skin is formed in its place, and this new skin has normal pigmentation. In this way, CO2 laser is highly effective at treating diffuse solar lentigines (sunspots). This treatment would not be suitable for deeper dermal pigment.

Whatever your pigmentation concerns, the first step is to book a consultation where we can work together to tailor the best treatment plan for you.

For more information or to book an appointment, please contact us.