Pigmentation: Patience is Key

One day I woke up in 2018 and I was like "WTF, I LOOK LIKE A GIRAFFE". No seriously, I was only 26, but I had more sun damage and hyperpigmentation than my grandmother. I immediately googled what to do, and it led me to an esthetician, which led me to a series of deep chemical peels and ultimately my career as an esthetician. Oh and I also had a face, neck, chest, and arm full of acne. I was looking rough tbh, but my lifestyle was also rough, and it showed. I LOVED to tan, I probably laid in a tanning bed every other day from the time I was 16, so 10 years of tanning beds, multiple beach and lake vacations had done a number on my skin. I HAD NO IDEA HYPERPIGMENTATION WAS A THING. So here is your warning, prevention is key and cheaper than correction. Too much sun damage can also cause irreversible hypopigmentation, which I also have. Some people are more prone to pigment, and there are other things that can lead to pigment such as hormones, stress, heat, etc. I figured I needed to write a blog so it is a one stop shop to understand why pigment happens, and what to do about it.

Brown spots, sun spots, melasma, post inflammatory erythema, post inflammatory hyperpigmentation, and more are all kinds of pigmentation in the skin.

Pigmentation is one of the most stubborn and difficult skin conditions to correct. It typically takes very very consistent product usage, in clinic treatments, lifestyle changes to prevent more pigment, and time.

Why does it happen?

Melanocytes are skin cells that live in the deepest part of our epidermis, and through a process of melanogenesis each melanocyte produces and delivers melanin to the skins upper layers where is becomes visible.

Tyrosinaise is one of the most important enzymes in this process. It determines how fast melanin is produced. Too much enzyme activity causes dark spots in the skin.

External Triggers.

• Excessive UV Exposure: It is the leading cause of unwanted pigmentation.

• Inflammation: Irritation and inflammation can cause uneven skin tone.

• Hormones: Our hormones can influence melanogensis, which is why you see melasma during or after pregnancy.

• Picking your skin: Physical trauma to the skin can cause an overproduction of melanin to the skin because of a cascading response to protect the skin.

Pigmentation issues are so frustrating because there is no quick fix, but you can do things to prevent and correct the damage!

What can be done?

1. Prevention is key. Avoid external triggers. Use antioxidants and soothing ingredients to keep the skin barrier healthy and hydrated.

2. Use serums to target tyrosinase enzymes. These are called "Tyrosinase inhibitors"

3. Use a variety of brightening ingredients to target different parts of the melanogenesis process. Just one probably isn't enough. Find products that have multiple brightening ingredients.

4. Make sure your cell turnover is healthy. Chemical exfoliants shed skin quicker, helping to fade dark spots. Retinol, glycolic acid, lactic acid, PHA's are all my favorites.

   
   

What would a skin care regimen look like to focus on targeting pigmentation?

Morning:

• Cleanser

• Vitamin C serum + optional Azelaic Acid

• Moisturizer

• SPF

Evening:

• Cleanser

• Exfoliant (Glycolic acid, retinol, lactic acid, PHA)

• Tyrosinase Inhibiting serum

• Moisturizer

Of course this is a basic routine, and other things would need to be taken into account, but overall this is a good standard to go by.

Ingredients to look for:

Tyrosinase Inhibitors-

• Azelaic Acid (love for post-inflammatory hyperpigmentation)

• Hydroquinone (most aggressive and you need a prescription)

• Kojic Acid

• Hexylresorcinol

• Tranexamic Acid (my go to for melasma and most stubborn pigment)

• Alpha-Arbutin (derived from hydroquinone)

• Beta-Arbutin

• 4-Butylresorcinol

• Phenylethyl Resorcinol

• Thiamidol

Botanical Inhibitors-

• Licorice Root Extract

• Mulberry extract

• Bearberry extract

• Ellagic Acid (this is rare to see in formulations, you may see it as pomegranate extract)

• Mulberry

• Grape Seed extract

Other ingredients that can decrease melanin production & transfer-

• Ascorbic Acid ( some people find this Vitamin C irritating, there are lots of Vitamin C's out there though)

• Niacinamide (slow down transfer)

• Retinoids (Retinol, Retinal, Tretnoin, Retin A, Adapalene, Tazarotene)

• AHA's such as Glycolic or Lactic Acid

• PHA's such as lactobionic acid, or gluconolactone (these are more gentle chemical exfoliants)

Treatments:

Chemical Peels are a gold standard to help "lift" pigment from the skin. Even if you don't have visible pigment yet, this can help move pigment through the skin before it even shows up. Basically what the peels do is it breaks the "glue" between skin cells. When those bonds are broken, it forces them to shed away. It is basically removing cells that contain the melanin. However, if those melanocytes are in "over production" mode, it is possible the those pigmented cells show back up. That is why it is VERY important to be using pigment inhibiting ingredients and antioxidants, before, during, and after chemical peels. (or any other kind of treatment such as microneedling or lasers)

Also, you can overdo peels, and why deeper chemical peels are not recommended in the summer months. Excessive inflammation can create pigment, or worsen pigment. the heat and sun do not mix well with freshly peeled skin.

My other favorite treatment, especially for melasma and post inflammatory erythema, is microneedling with a peel. This way I can target multiple things at once. I can deliver the peel right where I want to target melasma, and also help break up the scarring of PIE more effectively. PLUS you get all the regular benefits of microneedling.

What I see often in my treatment room is that most people that want more even skin tone, but are not using any tyrosinase inhibitors. So I recommend starting there before any kind of treatments. If you don't have any visible pigmentation, thats great! but one day it will show up. I rarely see skin that does not have any form of pigment. If I do, its typically more because of genetics or lifelong diligent care of their skin, especially daily SPF. Even then, I will see sun damage on areas that were more neglected such as the chest, neck, and shoulders.

This is your sign to start working on pigment, before it becomes stubborn and more difficult to treat, the longer the pigment is in the skin, the more difficult it will be to correct.