Skin is the largest organ of the body. It is made up of two layers, the upper ‘epidermis’ and the lower ‘dermis’. The epidermis contains certain cells called melanocytes, which produce a pigment called ‘melanin’. The color of skin depends on melanin. The thickness of the epidermis and vascularity of the epidermis are other factors affecting the color of the skin.
Hyperpigmentation is a medical term used to describe darker patches of skin. These patches result from excess melanin production, which can be caused by everything from acne scars and sun damage to hormone fluctuations.
Freckles: These are small, flat round lesions, which occur in the lighter skin types. They tend to turn darker in summer and lighter in winter. Causative factors are genetics and sun exposure.
Treatment: Various peels like glycolic and TCA help in lightening freckles. For more stubborn variety light systems like the IPL and lasers like the Q switched NdYag and KTP can be used. Minimal sun exposure, sunscreen and skin brightening and lightening cosmeceuticals will help to keep the pigment at bay.
Solar Lentigines: These are flat pigmented 1to 3cm lesions present mainly on sun exposed areas. They start to appear in the third decade of life.
Treatment: Everyday use of sunscreen is an absolute must. TCA peels, Intense Pulsed Light systems and lasers such as KTP and Q Switched NdYag can remove them completely.
Melasma: Is a stubborn pigmentation seen mainly in women. Occasionally, men too get affected by this condition. It is characterized by a patchy tan or brown discoloration that occurs over the upper lip, cheeks, forehead, chin and bridge of the nose. The areas affected are bilateral and frequently symmetrical.
The majority of cases are due to sun exposure, hormonal changes such as pregnancy, menopause, oral contraceptive pills and familial predisposition.
Treatment: Melasma is a stubborn condition and requires multiple sessions of treatments. Often 2 or more treatments are combined to give better results. Epidermal melasma (superficial) responds better and faster to treatment. Sunscreens form the most essential part of treatment of melasma. A variety of depigmenting agents such as Hydroquinone, Kojic acid, Glycolic acid, Retinoic acid etc can aid in the treatment of melasma.
In addition to this, superficial peels such as Glycolic acid peels and Salicylic acid peels; moderately deep peels such as 50% glycolic acid and TCA, as well as deeper peels such as Cosmelan can be used to treat melasma. Lasers such as Q switched NdYag show limited results. Light systems like the IPL, as well as Microdermabrasion, Meso therapy has also been successful in treating melasma depending upon the depth and intensity of pigment.
PIGMENTED CONTACT DERMATITIS
This condition can occur both in men and women. The pigmentation occurs due to frequent and repeated contact with small amounts of sensitizing allergens primarily present in cosmetic and textile materials. It is characterized by a diffuse to reticulated (lace like) pattern of hyper pigmentation and its colour may vary from slate gray, gray brown to blue brown. The sites of Pigmented Contact Dermatitis depends on the allergen responsible and in case of cosmetics, it frequently involves the face and neck. Another common area is the underarms.
PIGMENTED PHOTO CONTACT DERMATITIS
This condition occurs with musk containing fragrances, medications like anti diabetic medications, and certain antibiotics; Photodynamic substances in cosmetics on exposure to sunlight leave behind a reticulated pigmentation. Avoidance of the incriminating agents and lightening agents and procedures are part of the treatment plan.
LICHEN PLANUS PIGMENTSOSUS
This is a pigmentary disorder commonly seen in India. It involves mainly the face, neck, and upper limbs but can be more widespread. The pigmentation varies from slate gray to brownish black. It can be diffused or reticulate in pattern. This is a rather difficult condition to treat and it may take years for the pigment to fade.
MACULAR AMYLOIDOSES This kind of pigmentation is very common in Indians. It usually involves both the arms, and the back. The common causes of this pigmentation are friction, hot showers, and use of loofah and bathing brushes. The pigmentation is usually brownish black with reticulate pattern.
All these conditions require a medical evaluation. Strict use of sunscreen and avoidance of triggering factors is the mainstay of treatment followed by applications of various skin lightening products and treatments to lighten he pigmentation.
Melasma is a skin condition presenting as brown patches on the face of adults. Both sides of the face are usually affected. The most common sites of involvement are the cheeks, bridge of nose, forehead, and upper lip.
1. Lightening creams: Lightening creams are over-the-counter (OTC) treatments that work with select ingredients to help decrease pigmentation. Many of these creams are available in stronger prescription forms. They’re usually applied once or twice a day to help lighten the skin over time. Topical treatments for lightning also come in gel form.
2. Face acids: Face acid or skin acids, work by exfoliating, or shedding, the top layer of your skin. Whenever you exfoliate your skin, new skin cells emerge to take the place of the old ones. The process helps even out your skin tone and makes it smoother overall.
3. Retinoids: Derived from vitamin A, retinoids are among some of the oldest OTC skincare ingredients used. Their small molecular structure allows them to penetrate deep into the skin and treat the layers below your epidermis.
4. Chemical peel: A chemical peel uses acids at stronger concentrations to treat the desired area of skin. They reduce the appearance of hyperpigmentation by removing the epidermis. Deeper versions may also penetrate the middle layer of your skin (dermis) to produce more dramatic results.
5. Laser peel (skin resurfacing): A laser peel (resurfacing) treatment uses targeted beams of light to reduce hyperpigmentation. There are two types of lasers: ablative and non-ablative. Ablative lasers are the most intense, and they involve removing layers of your skin. Non-ablative procedures, on the other hand, target the dermis to promote collagen growth and tightening effects.
6. Dermabrasion: Dermabrasion also involves the removal of your epidermis, but its effects continue down to the part of your dermis. While dermabrasion is sometimes used to smooth out wrinkles, the procedure has been historically used to address texture concerns.