Dr. Anoop T

It is a condition that causes discoloration and discolored patches to appear on the skin. The color of one’s skin is determined by the production of melanin in the body, and hyperpigmentation is caused by a disproportionate production of melanin. People of any race or skin color can be affected by this condition. 

The most common pigmentation problems are brown sun spots, melasma, age spots, and pigmented birthmarks.  Pigmentation issues very depending on the natural colour of the skin. Treatments include fade creams, IPL, Elos Aurora, lasertreatments like Fraxel Dual and in some cases biopsy or skin excision is required to exclude skin cancer such as melanoma.

Three skin irregularities caused by this condition are; Post Inflammatory hyperpigmentation, Lentigines (or sun spots) and Melasma.

1. Treatment of brown sun spots: Many people have mottled brown spots, freckles and patches on their skin due to excess pigmentation. These are easily treated with medical grade Elos IPL or Fraxel Dual laser. There is a range of different causes of pigmentation. Treatments differ depending on what type of pigmentation is affecting your skin. The brown pigmentation is called melanin and is made by special cells in the skin called melanocytes. The main categories of pigmentation problem are freckles, age spots, (also called liver spots or sun spots) melasma and postinflammatory hyperpigmentation. 
2. Melasma: Women with a genetic predisposition to this condition or those with darker skin complexions and those who have a higher exposure to ultraviolet rays are most commonly affected by melasma. It is a condition that affects the areas of the skin that are most exposed to the sun. It involves female hormones and so women who are pregnant are generally affected by melasma. Melasma is blotchy areas of brown skin pigmentation on the face. Melasma, (also known as chloasma), appears as blotchy pale brownish pigmentation on the face, especially forehead, cheek and upper lip. It is more common on darker skin types. It is especially common in women aged 20-40 and is associated with pregnancy or taking the contraceptive pill or injection. It also happens in healthy, non-pregnant woman taking no medications and men using aftershave. Sun exposure following some cosmetics can cause a phototoxic reaction where the chemical substance absorbs UV light. The resulting pigmentation extends where sun and cosmetic use have coincided, for example down the neck, often more on the right side in countries that drive on the left. Melasma is more stubborn and unpredictable to treat than freckles or age spots because the melanocytes have become sensitized and continue to produce extra pigment with even the slightest hint of sun. Sun protection is an essential part of treatment. Melasma can be treated with Active FX Laser Resurfacing. It destroys up to 80% of melanin, efficiently, which is ideal for cases of melasma that cause excessive pigmentation of skin.
3. Lentigines: Minute brown spots that appear on your face and body, which is the collective result of continuous exposure to the sun, photodamage or chronic sun damage, are called lentigines. The spots usually have a visibly distinct border and appear on areas most exposed to the sun such as the face and hands.

How is one affected by post inflammatory pigmentation?
If there is an excessive production of melanin in the body, it could then overflow to the surface of the skin; this is caused by an inflammation. Post inflammatory pigmentation is the formation of brown patches on the skin that are the result of infection, injury or other conditions. Patients who already have a skin problem are more likely to be affected by this condition.

Post inflammatory hyperpigmentation (PIH) occurs after injury to the skin from whatever cause and is far more prevalent in darker skin. PIH appears as a dark brown area over the area of the previous injury and is due to excess melanin being produced by melanocytes as a result of the inflammation. Typically PIH resolves over several months but can persist for 1-2 years and in some cases can be everlasting. Treatment is generally patience as it will resolve and treatments risk further inflammation and therefore further PIH.  However hydroquinone can be useful in some patients and others benefit from mild treatments of Elos Aurora, IPL or Fraxel Dual laser.

Treatment of freckles

Freckles are small flat brown marks on sun exposed areas. The medical term is ‘ephilide’ and they are an accumulation of melanin in the surface skin cells (keratinocytes). The tendency to form freckles is inherited and is often seen in red heads and younger people. Freckles usually fade in winter and reappear in summer.

They need no treatment except sun protection. They can also be faded by Elos IPL, but will reappear with sun exposure. No treatment can transform a skin which freckles, into one which tans evenly.  Of course, further sun exposure can bring the freckles out again so it is very important to apply a good sunscreen following treatment to maximise results.

How does laser treatment help to remedy hyperpigmentation?

• Clear and Brilliant, Fraxel and Photofacial are three types of laser treatment that have been known to resolve hyperpigmentation.
• Short bursts of energy and heat are produced by the laser and aimed at the cells that have a concentration of melanin. The excess melanin from these cells is then broken down and destroyed with the help of the laser.
• Each case of hyperpigmentation varies, and their treatment varies on the extent of the condition as well. The treatment will be administered over a course of sessions.

Though these treatments are effective, one must always stay protected from damage due to overexposure to the sun, by wearing the sunscreen with the correct SPF and other sun gear.