Pigmentation

Uneven pigmentation can not only be ageing but can make otherwise healthy skin appear flawed. Pigmentation is the presence of a black or brown pigment called melanin, which lives in your skin cells (specifically, in the keratinocytes). Everyone has melanin and it exists to protect your skin cells from damage by sunlight, but it begins to make your face look less fresh if it’s distributed unevenly. When a section of your skin is darker than the rest, this is known as hyperpigmentation; when it’s lighter than the surrounding area, then it’s called hypopigmentation. If either one is something that’s bothering you at the moment, then read on as there’s plenty you can do about it.

Treatments:

Chemical Peel

Microneedling

FAQ - PIGMENTATION

What is pigmentation?

Pigmentation is caused by the distribution of melanin, a black or brown pigment molecule, under your skin. This pigment exists to protect your skin cells from the sun and everybody has it. But normally, we don’t notice a nice, even distribution of melanin. We just like how it looks and I don’t mean that we like a tan, I mean that humans are drawn to even skin tone, however light or dark. In fact, evolutionary biologists have shown that the evenness of skin colouration has a huge effect on how young and attractive we consider a face to be - a bigger effect, even than the presence of wrinkles or lines.

Why is my complexion getting darker?

There are plenty of reasons why you might be starting to experience hyperpigmentation. The first of these is sun damage, which includes age spots. To understand why we get age spots, we have to understand how melanin protects the skin against sun damage.

Melanin protects your skin against ultraviolet (UV) light from the sun by absorbing and dissipating its energy safely. This ultraviolet light is present in daylight, not just sunlight – it’s present regardless of cloud cover and needs to be protected against even on cloudy days. There are two types of UV light: UVA and UVB. These are both forms of ultraviolet radiation.

UVA reaches us all day, every day as it passes through clouds. It also passes through glass, so being behind a window doesn’t protect you. You need to wear sunscreen to guard against it effectively. While UVA on its own doesn’t result in sunburn, it does break down the collagen and elastin that keep the skin firm and springy, so up to 80% of what we consider to be the ‘signs of ageing’ (wrinkles, age spots, rough texture etc.) are due to exposure to UVA. This is called ‘photoageing’. The skin protects itself against UVA light by a response that darkens the existing melanin in the skin, but this isn’t enough protection to stop the ageing of the skin.

In countries like the UK, UVB only really reaches us in significant doses in the summertime. This is the kind of UV light which will burn your skin if you don’t protect against it with sunscreen. The skin will try to protect itself against UVB by making more melanin, which is why we get a tan or freckles. As much as tanning is fashionable, it’s actually a sign of skin damage, so it’s much safer to protect your skin with sunscreen and use fake tan if you want this look. Skin cancer has more than doubled since the 1990s, so this is a problem which we really have to take seriously.

Age spots are the result of skin damage, caused by everyday exposure to UVA light, accumulated over a lifetime. They’re patches of melanin clustered together under the skin, showing up as uneven pigmentation pattern in the skin. This accumulated UVA exposure results not just in age spots, but also in wrinkles, rough texture, and possibly skin cancer. This is why, for the best (and healthiest) skin, you need to wear high-factor sunscreen all the time.

Another reason that your complexion might be getting darker is melasma. This is a condition where pigmentation forms a ‘mask’, often butterfly-shaped, of colour across the face. Melasma is caused by hormonal fluctuations, which in turn can be caused by hormonal contraception, pregnancy, or hormone replacement therapy (HRT). Unfortunately, melasma never goes away, so it’s a question of managing this condition rather than finding a one and done treatment. We can work out what’s best for you and your skin, so this condition can be managed well.

The last reason that your complexion may be getting darker, is post-inflammatory hyperpigmentation. This is where brown spots show up on your skin as a result of acne scarring, eczema, or perhaps overenthusiastic pigmentation treatment with lasers. This happens because the inflammation caused by the condition, or the treatment, encourages the melanocytes (the pigment-producing cells in the skin) to create more pigment.

What causes pigmentation?

Pigmentation is the presence of a black or brown pigment molecule called melanin, which lives in your skin cells specifically, in the keratinocytes. Everyone has melanin and it exists to protect your skin cells from damage by sunlight, but it begins to make your face look less fresh if it’s distributed unevenly. This uneven distribution is when pigmentation becomes problematic and it has different causes. Sometimes it’s hormonal (melasma), sometimes it’s the result of acne or eczema scarring (post-inflammatory hyperpigmentation), but most often it is the result of sun damage. When a section of your skin is darker than the rest, this is known as hyperpigmentation; when it’s lighter than the surrounding area, then it’s called hypopigmentation.

The skincare industry primarily focuses on hyperpigmentation so there are fewer studies out there about hypopigmentation. There are some studies into vitiligo which is an autoimmune condition where the skin loses its colour in patches. Vitiligo is the most prevalent example of depigmentation, which is the form of hypopigmentation we’re talking about here. There have also been studies into albinism, a congenital disorder which is also characterised by pigment irregularities, however, albinism is technically a complete absence of melanin (amelanosis), whereas the sort of hypopigmentation that occurs over time is depigmentation.

What we know is that lighter colour is due to a lack of melanin in the affected area, melanin inactivity in that area, or a combination of both factors. There are a number of things that could cause this, such as trauma or a chemical reaction. With vitiligo, there is a genetic factor, too. Over-treatment with laser or skin peels or any other form of skin resurfacing, such as dermabrasion, can also cause hypopigmentation.

Which treatments are best for pigmentation?

First off, if you want to treat hyperpigmentation and hypopigmentation, make sure you're also on point with your skincare regime. However, for those who need something stronger, certain treatments such as skin peels can work wonders, as can microneedling. And, sunscreen is key, particularly so if you’re having treatments which can leave your skin more sensitive to light than normal for a while.

Chemical Peels work by used acids on the skin to encourage the shedding of the outer layers which removes the pigment from the surface layers. The whole idea of peeling the skin can sound alarming but today’s peels are far less scary than they were 20 years ago. Most skin peels nowadays are pretty gentle and some don’t even cause noticeable peeling, as they work beneath the surface to cause regeneration. There are some more aggressive ones which you’ll need to factor in 7-10 days of downtime afterwards because of redness, skin tightening and flaking.

Microneedling uses a mechanised needling device to make thousands of tiny punctures in the skin, in order to generate a wound-healing response and is usually used as a skin-tightening, collagen boosting treatment. Which it is, but microneedling is also a great treatment for improving pigmentation in the skin, because the process of healing the tiny wounds made by the treatment creates new, fresher-looking skin and clears away the old, over-pigmented skin on the surface. You will need a course of treatment, perhaps four or six of them, each a month apart, in order to see the most benefit.

Can I use skincare to help treat hyperpigmentation?

The great news is that hyperpigmentation can be treated effectively with skincare, and there are various routes that you can take here. What’s important, is consistency. You have to use the right skincare every single day, and with care, for it to have the desired effect. You also have to commit to using sunscreen every day, because if you don’t, the sun damage will undo all the hard work that the skincare is doing.

Various products and ingredients can help to treat hyperpigmentation:

• Skincare ingredients such as vitamin C, liquorice, azelaic acid and kojic acid, which all inhibit the action of an enzyme called tyrosinase. These help to stop the skin from making so much pigment in the first place, as this enzyme is vital to the process.

• Ingredients which prevent the transfer of pigment from the cells that make it (melanocytes) to the skin cells where it is stored (keratinocytes). Niacinamide is one ingredient to look out for – it’s a version of vitamin B3, and it can reduce pigmentation in this way.

• Exfoliating acids. These encourage the shedding of outer, pigmented layers of skin, allowing the fresher, clearer skin underneath to grow through and show up. These chemicals are alpha-hydroxy acids (AHA's) such as glycolic acid (a bit stronger) and lactic acid (a little gentler), or salicylic acid which is a beta-hydroxy acid (BHA).

• Retinol creams. Retinol is a brilliant ingredient which speeds up the turnover of skin cells, with the end result being improved pigmentation (and the added bonuses of improving skin texture and reducing fine lines). It can cause irritation, especially if used in a concentrated form, so be cautious with it.

• Some over-the-counter products have a reasonable amount of evidence showing that they work to reduce hyperpigmentation and fade age spots. These products are not as powerful as prescription lightening agents – but they’re not significantly worse, and they have a much lower risk of irritating the skin.

• A prescription-only cream containing 4% hydroquinone is the absolute gold standard for busting hyperpigmentation. There is plenty of evidence backing up this ingredient’s effects. If prescribed to you, it should be applied as directed morning and night. It will take at least eight weeks to work.

While using the products I’ve mentioned above to reduce pigmentation, you must also use a high-factor sunscreen every day. This helps to stop the pigmentation from getting worse and also stops your skin from sustaining new damage. ‘High-factor’ means SPF30 in winter, SPF50 in summer. Reapply it at lunchtime, whatever your skin colour. Sunscreen is always important, but especially so when actively treating skin concerns which is when your skin can be more sensitive to ultraviolet light than it normally is. Once you start treatment, you can’t give up on looking after and protecting your skin, if you do the pigmentation will reappear.

Find a routine that works for you. We recommend a multiple ingredient protocol. Start with 4% hydroquinone, then apply a high-quality vitamin C serum, and round it all off with a generous slathering of sunscreen.

What’s the best skincare for melasma?

Melasma is a type of pigmentation that is thought to be driven by hormones – it usually shows up for women when they are pregnant, or using the contraceptive pill, or during the hormonal ups and downs that accompany the menopause, but it can also occur in men.

Often, melasma appears as a butterfly-shaped patch across the middle of the face. You can treat melasma in the same way as you would any other type of pigmentation, by using a prescription-strength retinoid (such as tretinoin) and combining this with the prescription pigment-buster hydroquinone. And, absolutely 100% using sunscreen on top!

One additional treatment that can really help to get melasma under control is to take tranexamic acid. This usually comes in pill form and blocks oestrogen receptors in the body, which can help stop extra pigmentation occurring. This is extremely effective when combined with using prescription hydroquinone and a retinoid. Tranexamic acid is available from UK pharmacies without a prescription and it is most commonly used to reduce heavy menstrual bleeding. One thing to note about tranexamic acid is that there have been a small number of reported cases involving deep-vein thrombosis associated with the drug.

Can I use skincare to help treat Vitiligo / Hypopigmentation?

The short answer is no. There are some prescription steroid creams which have shown to be effective in vitiligo patients, but they carry a risk of skin atrophy which is when the skin becomes thin and translucent, and you can see the veins more clearly. In terms of over-the-counter products, I’m afraid there’s nothing you can do.

How can I prevent hyperpigmentation?

Hyperpigmentation can be guarded against by protecting your skin from UVA damage in general, and this means using a broad-spectrum sunscreen. Using a good sunscreen is a great idea for your skin’s health as well as its cosmetic appearance because, by using sunscreen daily, you’re protecting yourself well against skin cancer.

A product’s SPF rating tells you how much UVB it can block or absorb, but if you want to prevent UV-related damage, you also need to block UVA rays. Most sunscreens do offer ‘broad spectrum’ protection, meaning that the sunscreen contains a certain proportion of UVA blockers. By and large, the higher the SPF, the higher the UVA protection is too.

Sunscreens work in one of two ways. This division is typically between ‘physical’ and ‘chemical’ sunscreens, although the word ‘chemical’ can sometimes put people off. The word just sounds bad to some people, even though it really needn’t as everything is chemical in one way or another. That’s not to say there aren’t some bad chemicals out there, but by the same token just because something says ‘chemical’, that doesn’t mean it’s bad.

Physical sunscreens (also known as sunblock or mineral sunscreens) work by literally shielding the skin with a physical barrier of product which bounces the sun’s ultraviolet rays away from the skin. They contain finely milled titanium dioxide or zinc oxide, and they used to come up quite chalky on the skin. However, they’re worth another look now, as year on year the formulations get better and the product’s finish improves.

Chemical sunscreens are those which protect the skin by absorbing UV light and preventing it from affecting the skin. Some ingredients that do this are oxybenzone, avobenzone and octisalate. Most skins tolerate these sunscreens really well so they’re often a good option but they should be avoided if you’re swimming in the ocean. The UV-absorbing ingredients in these sunscreens, while generally fine for us humans, have been shown to kill developing coral and to bleach existing coral, as well as effects on fish. This isn’t such a concern walking around in the UK, but is something you might want to consider if you’re going on holiday.

Clients with melasma

Sunscreen, as mentioned above, is key for protection against a worsening of melasma in those who already have the condition. While there is thought to be some genetic predisposition to the condition, it’s generally very hard to predict who will and won’t get melasma in their lifetime, as it is primarily hormone-driven.

Since melasma is mainly hormonal, those suffering from melasma and using hormonal contraception (an IUD or oral contraception) might consider talking to their doctor about the benefits of continuing these forms of contraception. It just makes it much more difficult to treat the melasma and it can even make things worse.

How can I prevent hypopigmentation?

Because we don’t know too much about where it comes from, it’s equally difficult to give good advice on how to prevent it. Hypopigmentation, ironically, tends to occur on areas exposed to the sun. So, maintaining healthy skin in those areas is the best thing you can do if you want to minimise your chances of hypopigmentation. The face and hands are the areas to protect, so make sure to complete a healthy facial skin routine, morning and night, and keep your hands moisturised. Drink lots of water, too, as this will keep everything hydrated and ensure the nutrients your skin needs to function are efficiently delivered to the appropriate areas.

Does skin pigmentation change with time?

Your skin accumulates damage by UVA light over the course of your lifetime and this will start to show up as hyperpigmentation such as age spots as you get older. This is why evenness of skin pigmentation is such a good visual indicator of a face’s age. There is also a possibility of melasma beginning later in life or it can begin during pregnancy or HRT. Sadly, it is not a case of knowing whether or not you will ever suffer from melasma by the time you’re twenty.

How can I treat hypopigmentation?

With hypopigmentation, you’re looking to increase the amount of melanin and/or activate it within the affected area. In 1997, treatment was attempted using a tattoo gun (without ink!) on patients with hypopigmented scar tissue. A similar approach was undertaken in a patient with vitiligo, where the condition had been unresponsive to other treatment. This creates puncture wounds down to the dermal-epidermal junction and resulted in improved pigmentation and, in both cases, was successful. Puncture wounds? Yes. For those of you familiar with treatments, this may sound familiar. That’s right, it’s microneedling, one of the treatments that stimulates your body’s wound-healing response. During this process, there’s an increase in cytokines in the area, which leads to the production of the various enzymes and proteins which activate melanin. The result? Improved pigmentation.

How to get rid of hyperpigmentation from acne?

Acne can leave behind post-inflammatory hyperpigmentation (PiH): flat spots of pink, red, brown or black discolouration. The skincare mentioned already on this page can help with PiH, as can light treatments like laser, and skin peels. Laser can be particularly helpful in softening the pitted scars left behind by acne, which often goes hand-in-hand with this hyperpigmentation. The laser can work to stimulate the growth of new collagen and elastin in the skin below the scar, as well as breaking up the pigment under the skin so the body can clear it.

Another treatment which is brilliant for post-inflammatory hyperpigmentation is microneedling. Not only used to tighten the skin and anti-ageing but also used to treat hypopigmentation as well, it's a very versatile treatment. The treatment involves making thousands of very small holes in the skin using a needling device. This pricking of the skin stimulates a wound-healing response, which floods the skin with growth factors and prompts the skin to create new, firming collagen.

Can I get rid of Pigmentation naturally?

No. You may have read that there are remedies involving bleaching agents like lemon juice, but these are a really bad idea as using a bleaching agent in an uncontrolled and patchy way like this is more likely to damage your skin than help it. What you can do is strengthen your skin through healthy living and a good diet, but unfortunately once you have hyperpigmentation in your skin, it’s not going away without direct action to shift it.