Pigmentation Treatments Sydney
Pigmentation disorders are common. Dark skin pigmentation, or hyperpigmentation, is particularly prevalent and is often associated with aging. While the triggers may vary, excess skin pigmentation occurs when pigment-producing cells (melanocytes) become more active than normal, which leads to the production and deposition of more pigment (melanin). Conversely, lack of skin pigment, or hypopigmentation, occurs when melanocytes are destroyed or silenced. Though most forms of pigmentation can be treated with lasers or lightening creams, prevention is always the best cure.
Treatment of Commonly Occurring Skin Pigmentations
Age spots/sun spots (solar lentigines) are pigmented skin blemishes associated with aging, sun damage and, to a lesser degree, other forms of skin damage. They are sometimes erroneously called liver spots, which is misleading because they are unrelated to the liver and in no way reflect liver function. Age spots range in color from light brown to black and are predominantly located in areas exposed to the sun, such as hands, face, and arms. It is not entirely clear how sun damage triggers age spots: most likely, UV radiation produces mutations, local inflammation and other changes that increase local proliferation of melanocytes and/or activate melanin-producing genes. In most cases, age spots are harmless though they may be cosmetically frustrating. Age spots respond well to laser and light based therapies.
Before After
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Freckles are small, pigmented spots containing more melanin than the surrounding skin. Freckles are not caused by aging and/or sun damage. In contrast to age spots, freckles tend to fade with age. Sun exposure, while not a cause of freckles, typically makes freckles much more prominent. Freckles are found mainly in fair skinned people and tend to run in families. The cause of freckles appears to be largely genetic. In fact, researchers have found that people who possess a particular variant of the melanocortin-1 receptor (MC1R) gene tend to develop freckles. Freckles are not considered a skin disorder and are harmless. They respond extremely well to 1-2 laser or IPL treatments.
Freckles can return following successful treatment if the treated skin is exposed to the sun. Lifelong sun avoidance and daily use of SPF 30+ sunscreen are highly recommended.
Before After
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Melasma is a challenging condition characterized by increased tan-like skin pigmentation typically having uneven, patchy distribution that may involve the forehead, cheeks, upper lip, nose, and chin. Chloasma is a variant of melasma occurring mainly in women and associated with increased levels of certain hormones. Chloasma may be triggered by pregnancy, oral contraceptives and occasionally other hormonal imbalances.
Before After
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While hormonal changes seem to be the most common cause of melasma / chloasma, other factors may have a role. In particular, a combination of sun damage and certain ingredients found in deodorants, toiletries, perfumes and other personal care products may result in melasma - apparently due to local sensitization of melanocytes.
In some cases, melasma resolves on its own if the underlying hormonal imbalance is removed (e.g. when hormonal contraceptives are replaced by a non-hormonal contraceptive or after childbirth). If the cause is non-hormonal, avoiding sun exposure and reducing/eliminating suspect skin care products may improve melasma. In persistent cases, prescription and non-prescription skin lightening creams are usually effective, as illustrated below. Read more about melasma
This type of pigmentation occurs when the skin is traumatised, creating inflammation that subsequently progresses to dark pigmentation. It is important to note that treatment of post inflammatory pigmentation can be made worse by treatments that further irritate the skin. In particular, laser treatments can aggravate post-inflammatory hyperpigmentation and commonly make it worse. Our doctors strongly recommend the use of skin lightening creams rather than lasers for post-inflammatory hyperpigmentation. The patient illustrated below developed post inflammatory hyperpigmentation following premature exposure of her skin to the sun after a laser treatment. This pigmentation settled quickly with prescription skin lightening creams.
Brown birthmarks such as café au lait spots (illustrated below), naevus of Ota, Naevus of Ito, Naevus Spilus usually respond to laser treatments, whilst others including Becker's naevus are unresponsive.
Read More about laser treatment of pigmentation >>
Common Causes of Skin Lightening or Hypopigmentation
Trauma to the skin, including sun damage, can result in permanent damage to melanocytes, to permanent loss of pigment and to the formation of white patches, for which surgical correction, camouflage makeup or cosmetic tattooing represent the only treatment alternatives.
Albinism, an inherited disorder in which an abnormal gene restricts melanin production. Because of the absence of melanin, albinos have light skin, white or pale yellow hair and gray eyes. There is no cure for albinism, and individuals should use a sunscreen at all times because they are prone to sun damage and skin cancer. This disorder can occur in any race, but is most common in Caucasians.
Vitiligo is a form of hypo pigmentation caused by patchy loss of melanocytes. These white patches are very sensitive to the sun. This skin pigmentation disorder affects nearly 2% of the population and is more evident in those with darker skin. It is believed that vitiligo may be caused by an autoimmune disorder that causes the body’s immune system to attack its own pigment cells. Other associated immune system diseases include diabetes, pernicious anemia, thyroid disease, or Addison’s disease.
Vitiligo causes smooth, white skin patches, usually around the mouth and eyes, or on the back of the hands. In some people, these patches can appear all over the body. There is no cure for vitiligo, though there are several treatments, including dyes or psoralens (light-sensitive drugs) used in combination with ultraviolet A light treatment, and more recently the excimer laser, which delivers ultraviolet B light.
Most hyperpigmentation problems are either caused or exacerbated by sun exposure. The risk of skin cancers also rises with increasing exposure to the sun. Daily application of an SPF 30+ sunscreen and avoidance of sun beds is an important first step in prevention of skin pigmentation and skin cancer. For more information on sunscreens, click here.
Other steps to avoid skin damage should also help. Women with a history of chloasma, for example, may be able to prevent recurrence by using non-hormonal birth control methods. However, such steps should be discussed with a physician and balanced against the disadvantages of the non-hormonal alternatives.
About Pigmentation Treatments:
Hyper pigmentation treatments include topical lightening agents, laser / intense pulsed light, cryotherapy and chemical peels. However, it is important to understand that none of these methods is optimal for every individual or for every hyper pigmentation problem. The best treatment for your particular skin pigmentation can only be determined after proper diagnosis by one of our doctors.
Skin lightening creams
- Tyrosinase inhibitors:
These compounds represent the gold standard for treating certain forms of dark pigmentation. Their effectiveness, both alone and in combination with other treatments, has been documented in a large number of clinical studies. These compounds work by inhibiting the enzyme tyrosinase, thus blocking a critical step in the synthesis of melanin (dark skin pigment). They do not bleach skin in the sense that they do not destroy previously synthesized melanin. Treatment usually takes several weeks to produce results because even though the synthesis of new melanin is blocked quickly, the existing melanin takes a relatively long time to migrate out of the skin in the process of natural exfoliation. To speed up this migration, skin lighteners are sometimes combined with exfoliating agents such as alpha-hydroxy acids.
Skin lightening creams are available over the counter in low concentration and on prescription at high concentration. ( Australian law prohibits the naming of prescription medications in a public forum. These names can be communicated to you via a private email, so Contact Us if you are interested to learn more. Side effects of short-term use tend to be mild and superficial, especially for low-to-medium strength formulations.
- Vitamin A creams
Various vitamin A creams are used in the treatment of melasma and other hyperpigmentation problems. Vitamin A creams seem to reduce hyper pigmentation by accelerating epidermal exfoliation (sloughing off of epidermal cells), which leads to a greater loss of epidermal melanin. In patients who do not respond sufficiently to tyrosinase inhibitors, adding vitamin A appears to improve effectiveness, possibly because the mechanism of action of these different compounds are complementary.
- Alpha hydroxy acids (AHAs)
The exfoliating effect of AHAs increases the turnover of skin cells and so causes more melanin to wash out of the skin. As a result, AHAs may enhance the effectiveness of other treatments, such as tyrosinase inhibitors. High strength AHA peels applied by a physician are additionally effective in reducing skin discolorations.
Chemical peels and laser resurfacing
Skin resurfacing, whether with a laser or a chemical agent, may significantly reduce certain types of pigmentation problems
Laser and intense pulsed light
Because pigmentation contains excess melanin it absorbs light differently to normal skin. Lasers and IPLs produce light that is selectively absorbed into unwanted pigmentation. This light breaks up melanin molecules and so fades hyperpigmented lesions without damaging surrounding skin. Freckles and age spots are particularly responsive to laser and IPL treatments.
Cryotherapy
Cryotherapy is useful only for small, well-localized hyperpigmented lesions, such as some age spots.
Hypopigmentation or loss of skin pigmentation is a condition where the body does not produce sufficient melanin. Hypopigmentation can occur following injury to the skin and can follow an ulcer, blister, burn, or infection. It can also occur genetically,or as part of an autoimmune disease where the immune system erroneously attacks its own melanocytes (e.g. vitiligo).
Treating hypopigmentation is often challenging. Hypopigmentation after a burn or similar skin injury may resolve itself over time as melanocytes migrate to the damaged area. Current treatments for vitiligo are of limited effectiveness. For many people, simply camouflaging hypopigmented areas with sunless tanning products, makeup or cosmetic tattooing represents the best option.
