I am Dr. Avanti Trivedi so today I will be speaking on pigmentation. So, pigmentation is nothing but increase in melanin in the skin which results in dark spots, generalized tanning, darkness, patchy skin. The causes of pigmentation can be various. It even normal sun exposure is something which can stimulate melanocytes to form melanin and causes pigmentation or tanning which is the most common type of pigmentation which we come across. So other than that melasma is another pigmentation which we commonly see in on butterfly area of the face is commonly seen in females especially post pregnancy or people who take contraceptive pills or hormonal treatments. Other than that, there is a pigmentation which is called post inflammatory hyperpigmentation which we see whenever there is any irritation or inflammation on the skin, even as simple like acne or mosquito bites sometimes scratches, burns these things can also give rise to marks or pigmentation that takes like ages to go.
Lichen planus is a type of pigmentation which we see on the face, neck in both the sexes but more common in females characterized by slatey-greyish pigmentation. Other than that, even multiple vitamin deficiencies or some drugs can cause pigmentation on the face or generalized pigmentation. The types of pigmentation it can be either epidermal which is little superficial, it can be dermal which is a deep pigmentation or mixed type of pigmentation especially in melasma we see a mixed the type of pigmentation. Acne marks or photo-tan freckles these are more of superficial pigmentation and the lichen planus type of pigmentation becomes a little deeper type of pigmentation.
More superficial it's little easy to treat the pigment and the results are better or superior. Deeper the pigment it takes more time to go as well as its little tough to treat. The management wise the main thing prevention of pigment is more important compared to the treatment because the result for the treatment also varies from person to person. It takes a long time and its little tedious procedure. So, prevention is little better than cure as in prevention the photoprotection or sun protection is one of the most important things because any dark spot when exposed to sun becomes darker. So, when you are taking good sun protection it helps in prevention of the pigment and it prevents the pigment to get darker as well. So, using a good sunscreen with good SPF more than 30 and reapplication every 3-4 hour is something which helps a lot in preventing a pigment.
Other than that, having a well-balanced diet, vitamins that also helps a lot in preventing pigmentation, getting you a brighter complexion. In management, it can be divided into a medical line of management or some active treatment. In medical management, topical creams like skin lightening creams which are little safe can be used though it gives a little slower result. With proper medical advice you should use it because there are multiple over-the-counter creams or sometimes your friends tell you ki this cream is working very well for the pigment but most of them have steroids or hydroquinone and that causes for the side effects. It may give you immediate glow or immediate lightning but in the long run, it gives a lot of side effects like skin thinning and hair growth and acne. So, it has to be used with proper medical advice. Other than that, orally taken vitamin supplements like antioxidants, vitamins or glutathione even that helps a lot in skin lightening, reducing pigmentation.
Inactive management there are various treatments which are done for the skin lightening starting from basic like skin polishing or microdermabrasion which helps in removing the superficial dead skin layer from the skin, helps in removing the tan or superficial marks. Other than that, there is a treatment called mesotherapy where we insert with the help of either micro needles or injections or electroporation; skin lightening agents are deposited in the mesoderm of the skin so it helps in more brightening or lightening and reducing the pigment of the skin. Chemical peel is one of the very commonly done procedures depending upon the type of the pigmentation and the age of the patient; we have to select the peel either superficial for the tan or mid depth or deep peels.
Again, the precautions like sun protection and selection of patient and peel are really important while we do the peel otherwise rather than giving a good result or reducing the pigment, it can itself cause a post-inflammatory hyperpigmentation. Then there is a laser treatment which works really wonders for all type of pigmentation especially deeper pigmentation which are little difficult to target with other line of management. They respond really well to use Q- switched ND: YAG laser especially the lichen planus like pigmentation or the deep even the birth mark; they respond really well to the laser treatment.