Hyperpigmentation, Melasma and the Reality

Ever Wondered Why your pigmentation does not go away?

As an Aesthetician and skin clinic owner of Virago Skin & Body Studio for the past 21 years, I have gone through extensive education and schooling to understand the knowledge behind the spots that start to drown out our youth or self-esteem.

So here's a thought bomb: Have you noticed your pigmentation or melasma worsen after exercise, even though you are not outdoors in the sun? Many people don't know or understand this, but when your body produces pigment (melanin), it's the body's way of protecting the skin from DNA damage. When your body is exposed to a "heat" environment, not necessarily a sunny climate, for example, hot yoga, your body recognizes that you are in "hot" mode and if you are hot, then there must be sun - and so it produces more melanin to protect itself.

Now I am not saying don’t exercise or go out into the sun; both are good for you and necessary, but if you have persistent melasma or severe pigmentation, you may need to pay a little more attention to your skin.

And that is why there's no absolute guarantee that your dark spots will fade completely, even with treatment.

Many people struggle with hyperpigmentation, men and women; it’s one of those annoying skin conditions that seem to pop up out of nowhere; you wake up one morning, and there it is, a dark patch on your cheek - and there begins the nightmare of trying to get rid of it.  I know this condition may be "cosmetic," but the impact on one's quality of life and self-esteem is very real.

So, to understand how these issues occur and to help you manage this condition, you do need to understand the intricate cellular interactions of melanocytes and keratinocytes, which together make up the epidermal melanin unit.   So, let me attempt to break this down for you in a way we can all understand. Melanin (the natural pigment that gives our skin, hair and eyes their color) is produced by cells called melanocytes, which are found scattered throughout the base of the epidermis (take a look at the diagram below). The melanin is transferred into the keratinocytes via a cellular vesicle called a melanosome (responsible for the synthesis, storage and transport of Melanin). 

Did you know that Moles are larger masses of melanocytes?  

Now let’s take a look at how this process actually works. Let’s say you are exposed to the UV rays from the sun or a tanning salon.  This exposure causes DNA damage in the epidermis and results in melanin production in the melanocytes, which is then transferred to neighboring keratinocytes, leading to an accumulation of melanin in the keratinocytes and this results in the darkening of the skin or a tan.  The process of melanin production is the same, so I guess the mystery lies in the trigger!

What causes hyperpigmentation?

A common cause of Hyperpigmentation is an excess production of melanin. Melanin is the natural pigment that gives our skin, hair and eyes their color - okay, so we already know all that.  And we now know that Melanin is produced by skin cells called melanocytes. Several conditions or factors can alter the production of Melanin in your body; some probably well-known causes are – as I mentioned above -  heat and sun exposure, age is another (don’t we hate that one), and hormonal changes, for example, during pregnancy hormone levels change and can affect melanin production in some women. Certain medications can also cause hyperpigmentation. For example, some chemotherapy treatments can cause hyperpigmentation as a side effect. Birth control can be another trigger. Medications such as retinoids and some antibiotics can make your skin more sensitive to sunlight resulting in pigmentation.  

Types of hyperpigmentation

There are several types of hyperpigmentation; the ones you might be most familiar with are:

Sunspots & Freckles. Sunspots are common. They’re related to excess sun exposure over time. Generally, they appear as spots on areas exposed to the sun, like the face, hands, back.

Age Spots. Age spots are caused by overactive pigment cells. Age spots are more common in adults over 50 with skin that has had years of sun exposure. The age spots appear when melanin becomes clumped and produced in high concentrations. Because age spots can look similar to certain types of skin cancer, it’s important to see a dermatologist for a correct diagnosis. 

Melasma. More research is needed to understand the exact causes of Melasma. Melasma may develop when something triggers (there it is again) the skin cells (melanocytes), causing them to go into a melanin overdrive. Estrogen and progesterone sensitivity are associated with the condition, meaning birth control pills, pregnancy, and hormone therapy can all trigger melasma. Stress and thyroid disease are also thought to be causes of melasma. It could also be a combination of things that trigger the skin cells to produce excess melanin.  Fundamentally, melasma is a disorder of the melanocytes.  Pro Tip:  I advise all my clients with any skin condition to keep a daily diary.  This process will go a long way in helping you figure out what you are using, eating and/or doing that contributes to a flareup.

Post-inflammatory hyperpigmentation. This is a result of injury or inflammation of the Skin. A common cause of this type of pigmentation is acne.

So, how do we cure hyperpigmentation, then?

If you think hyperpigmentation will disappear as effortlessly as it appeared, you are in for a bit of a rude awakening, unfortunately.  It is going to take some effort and time to work through the problem. And as I mentioned above, there's no absolute guarantee that your dark spots will fade completely, BUT  -  it can be managed so that it does not significantly impact your life in a negative way. Be patient and address any problem areas as soon as they appear.

Hyperpigmentation can be treated in various ways, depending on the cause and severity of the condition. If your hyperpigmentation is severe, I recommend you see a Dermatologist or Aesthetician who can diagnose the cause of your pigmentation and prescribe the best treatment for you. Treatment may range from addressing an underlying medical condition or stopping a medication to reducing your sun/heat exposure and using topical treatments.

Topical prescription medication can treat some cases of hyperpigmentation. This medication usually contains hydroquinone, which lightens the skin and slows down the release of melanin. Topical hydroquinone can cause skin sensitivity after exposure to sunlight so it’s always a good idea to use a good sunscreen every day. Prolonged use of topical hydroquinone (without any breaks) can also cause darkening of the skin, a condition known as ochronosis. So, it’s not only a good idea to take a break in between treatments, but I highly recommend you use topical hydroquinone under the guidance of a skin specialist so that they can properly guide you on how to use the medication without any adverse effects.

Some topical retinoids can help treat hyperpigmentation and dark spots. Retinoids are derived from vitamin A and have a small molecular structure that allows them to penetrate deep into the skin and work from within to suppress melanin production. If you have sensitive skin or fall under any risk category, you should consult your doctor first. Retinoids can cause dryness and peeling of the skin and skin irritation can occur from prolonged, high-dose use. Both medications can take a few months to lighten darkened areas.

There’s also laser and chemical peels - chemical peels, for example, have a stronger concentration of acid that helps them target and treat hyperpigmentation. However, if not used correctly or by a specialist, chemical peels can have some side effects, such as itching, burns and even scarring. To avoid making your problem worse, it is always better to consult a doctor or a skin specialist rather than picking an OTC chemical peel and doing it yourself.

What about home care? This can include over-the-counter medications that may lighten dark spots. These medications don’t contain as much hydroquinone as prescription medications, so they might be a good option if your pigmentation is not severe.

Sunscreen doesn't clear pigmentation, but it is the most critical factor in helping to improve most causes of hyperpigmentation.  It's more of a protection / preventative method.  If you struggle with hyperpigmentation, you should be using sunscreen. Look for:

• A physical blocking sunscreen, preferably with zinc oxide as the main active ingredient. At Vskincare, our Reflect sunscreen is mineral based, a non-nano zinc oxide that acts as a protective layer on top of the skin to deflect and disperse harmful sun rays. It protects without penetrating the skin, so the body doesn’t absorb it.

• Your sunscreen should be at least an SPF 30

• Broad-spectrum coverage UVA and UVB.

Another way to Protect your face, learn to love hats, wear broad-brimmed hats and use an umbrella when stepping into the sun.

If you have melasma, try to keep your face and body as Cool as much as you can, especially in the summer – heat can lead to inflammation and stimulate melanocyte pigment production (remember what I said earlier about heat and exercise). Also, avoid using the sauna, steam room and hot yoga if you struggle with melasma.  If you exercise regularly, try to cool your skin down as soon as you are done. A cold shower might do the trick!  You will find in cooler times of the year, your melasma may be less prominent.

Your Skincare Routine and the products you use become important if you struggle with hyperpigmentation. If you are one that does not want to use medicated topical creams or you are just taking a break from them, use products that will help you to continue managing the condition.  Pro Tip: exfoliate once a week to remove dead skin cells. This will help shed the hyperpigmented cells and speed up healing.  Try Vskincare Foaming Enzyme Cleanser this will help with resurfacing, declogging, and brightening of the skin and to speed up cell turnover and repair Vskincare DNA repair serums (Derm Repair and Recovery) help facilitate this process. Derm Repair embodies Level 3 DNA which activates DNA repair of our cells. It is a powerful repair botanical that helps reverse aging and reduce pigmentation.  Zinc Fingers are critical components of proteins and provide the tools the skin needs to repair DNA and cellular damage. Included in this serum is AC-11, a specialized extract of Cat’s Claw that is clinically proven to increase DNA repair.  Recovery epidermal repair serum uses ozonized ethyl oleate with a remarkable ability to neutralize toxins, calm inflammation, activate epidermal wound repair, minimize the appearance of pores and age spots, and dramatically improve skin texture.