Pigmented Lesions

Pigmentation

Pigmentation conditions are vast and wide, and completely unbiased, affecting people of all ages, genders and nationalities.

To really simplify – Hyper (or “excess”) Pigmentation is described as patches of skin that become darker shades of brown than the normal surrounding skin.

The cell responsible for producing the colour in our skin is called a melanocyte, which is found on the base layer of our epidermis. The process of producing pigment, called melanogenesis, is a complicated one requiring a number of enzymatic and chemical reactions.

This pigment, also called melanin, is a natural form of protection for the skin, and also determines hair and eye colour. In the skin, the enzyme tyrosinase converts the amino acid tyrosine into melanin. The melanocyte has dendritic (octopus like) arms that deliver small packets of melanin (melanosomes) to the surrounding cells of the epidermis.

Genetic predisposition creates variations of skin colour in each individual due to the amount of melanin content, the ratio of pheomelanin (yellow/red pigment) to eumelanin (brown/black pigment) as well as the size of the pigment parcels.

The cause of darker patches is essentially an over production of melanin, increased number of melanocytes, and/or a build-up of pigment granules. Pigmentation changes may be inherited (genetic) or acquired (developed over the lifetime) due to internal or external factors. These may include hormones, UV exposure, heat, friction or trauma to the skin, prescription medications and inflammatory skin conditions.

These pigment changes may be temporary, such as a sun tan, or more permanent, such as nevi (mole) café au lait spots (birth marks) or solar lentigo (age spot).

While melanin production is a natural process, and one that is important for normal cell protection, there is a myriad of conditions that cause excess darkening of the skin. Each cause may have specific elements to consider, making certain products or treatment more or less effective, in some cases may make the pigment worse. Treatment remains challenging, particularly for melasma.

Treatment options and how we can help

Treatment of hyperpigmentation can be difficult, so it is crucial that the multiple pathways associated with the development of discolouration are targeted. This is particularly important for stubborn or hard-to-treat conditions such as melasma.

The first step is assessing the type of pigment

  • Location/depth in the skin – e.g. Epidermal, dermal or mixed.
  • If it is responsive – e.g. reactive or nonreactive
  • Physiology – e.g. increased melanin vs. increased number of cells (either melanocyte or keratinocyte)

The multiple pathways that need to be addressed include:

  • Slowing the formation and transfer of pigment (tyrosinase inhibition and melanin transfer inhibition)
    • Tyrosinase inhibitors: Kojic acid, azelaic acid, hydroquinone and its derivatives such as arbutin, licorice root extract, phytic acid, ferulic acid
    • Melanin transfer inhibition: Niacinamide
  • Reducing inflammation
    • Tranexamic Acid
  • Regulating cell turnover/exfoliating the skin.
    • Vitamin A, AHA (glycolic acid, lactic acid), BHA (salicylic acid)

Strict sun protection is also essential including SPF 30 or higher.

A treatments options may include:

  • Homecare products containing the above ingredients
  • Chemical peels
  • Skin Needling
  • Laser/light based treatments may be suitable for some forms of hyperpigmentation

Epidermal hyperpigmentation generally responds well to topical skin-lightening products, laser and chemical peels. However, mixed and/or dermal pigmentation is more challenging to target with topical treatments. Results for hyperpigmentation conditions may be slow and requires strict patient compliance.

Please note: Before any pigmentation removal is performed at Skintellect, we strongly recommend a skin cancer check be performed prior to treatment. This is to ensure we do not reduce or remove visible signs of suspicious lesions, possibly prolonging the diagnosis of skin cancer.

Prevention is better than a cure. Vigilant SPF and sun protection goes a long way to slow down discolouration from UV damage.

If you’d like to discuss your concerns with us, please book a skin consultation so that we can determine a suitable and tailored treatment plan just for you.

For more information on specific pigmentation conditions, please see:

  • Melasma
  • Freckles
  • Post Inflammatory Hyperpigmentation (PIH)
  • Nevi (moles)
  • Solar lentigo (age spot)

References

Xing X., Dan, Y., Xu, Z., Xiang, L. (2022) “Implications of Oxidative Stress in the Pathogenesis and Treatment of Hyperpigmentation Disorders”, Oxidative Medicine and Cellular Longevity, https://doi.org/10.1155/2022/7881717

olghadri, S., Bahrami, A., Hassan Khan, M. T., Munoz-Munoz, J., Garcia-Molina, F., Garcia-Canovas, F., & Saboury, A. (2019). A comprehensive review on tyrosinase inhibitors. Journal of enzyme inhibition and medicinal chemistry, 34(1), 279–309. https://doi.org/10.1080/14756366.2018.1545767

Lee, E. J., Kim, J., Jeong, M. K., Lee, Y. M., Chung, Y. J., & Kim, E. M. (2021). Whitening effect of novel peptide mixture by regulating melanosome biogenesis, transfer and degradation. The Korean journal of physiology & pharmacology : official journal of the Korean Physiological Society and the Korean Society of Pharmacology, 25(1), 15–26. https://doi.org/10.4196/kjpp.2021.25.1.15

Nautiyal, A, Wairkar, S. (2021) Management of hyperpigmentation: Current treatments and emerging therapies. Pigment Cell Melanoma Res. 2021; 34: 1000– 1014. https://doi.org/10.1111/pcmr.12986

Bhattar, P. A., Zawar, V. P., Godse, K. V., Patil, S. P., Nadkarni, N. J., & Gautam, M. M. (2015). Exogenous Ochronosis. Indian journal of dermatology, 60(6), 537–543. https://doi.org/10.4103/0019-5154.169122