Overview
If you pay meticulous attention to your skin, it’s likely you’ll have noticed small areas of discolouration and darkening. Yes, freckles are cute, but we’re not talking freckles, these are larger, uneven dark patches that seem to persist on your face, neck, shoulders and hands.
Pigmentation – or brown spots as they’re more commonly known – are caused by your skin’s arch nemesis, aka the sun. If you’ve read any of our informative postings regarding the damaging effects of sun exposure, you’re probably already pretty up to date with the ways that UVA rays can wreck your skin.
However, we wanted to really get to the bottom of the causes, the cures, and every other pigmentation related problem/question we’ve ever had. So, we turned to top Consultant Dermatologist, Dr Nazirin Ariffin.
What causes pigmentation?
“Also known as hyper-pigmentation, pigmentation occurs due to an increase in the number of pigment-producing cells in the skin, or the pigmented substance they produce (melanin),” says Dr Nazirin. Melasma is the most common form of facial pigmentation, and you’re likely to get it between the ages of 20 and 40. All you lucky people blessed with naturally tanned and darker skin are unfortunately more likely to be affected. Hyperpigmentation occurs when melanin is overproduced in certain spots on the skin. Hyperpigmentation results in flat, darkened patches of skin that are light brown to black in colour, and can vary in size and shape.
Interestingly, it’s not always brought on by sun exposure, as Dr Nazirin explains: “Ninety percent of sufferers are female and, in most cases, melasma is thought to be triggered by pregnancy, hormonal medication e.g. the contraceptive pill and medical conditions that cause altered hormone levels.””Post-inflammatory pigmentation follows injury or inflammation of the skin, for example following a flare-up of acne or eczema. Whilst often considered a temporary phenomenon, it can be more intense and longer lasting in skin of colour.”
What about freckles, are they any different? “Freckles are more common in fair-skinned individuals and are thought to be an inherited characteristic. They get darker in the sun and fade again during winter months, unlike brown spots or dark spots, which arise in middle age due to sun damage and persist in the absence of ongoing UV stimulation.”
How can you prevent pigmentation from forming?
We often feel like a broken record – yes, we think you know what’s coming: SPF. Dr Nazirin can vouch for our suncream obsession, too. The most effective way to prevent pigmentation from occurring in the first place, or to stop it from getting worse is to wear sunscreen daily”, she stresses.
In case you’re reading this and feeling jammy about your foundation +SPF10, know that sadly it’s not going to cut it. “Those seeking treatment for hyper-pigmentation will be advised to wear a broad spectrum SPF50 sunscreen 365 days per year before leaving the house, and to top up every couple of hours if they are going to be spending time outside or near a window in Spring and Summer. At times of peak UV radiation e.g. between noon and 2pm, wear a hat with a wide brim for extra protection if you are planning to be outdoors” Dr Nazirin advises.
What is the best way to treat pigmentation?
Dr Nazirin stresses that, “the most effective way to manage hyper-pigmentation is to combine avoidance of known triggers with active treatment.”
Here’s what Dr Nazirin says you can start to do:
“If pigmentation appears after starting a known culprit medication, withdrawal may be necessary if it is safe to do so. In the case of melasma, there is little one can do if it occurs for the first time or flares during pregnancy, however women taking hormonal contraception may wish to discuss alternative contraception methods with their doctor.”
“Think about the most careful you’ve ever been in the sun…and then think about being even more careful than that! Successful treatment of hyperpigmentation hinges on strict sun avoidance. It may only take a few minutes of sun exposure without adequate protection to undermine weeks of active treatment.”
“Look for ingredients like vitamin A (retinol), azelaic acid, niacinamide, kojic acid, vitamin C, arbutin, AHAs e.g. glycolic acid, licorice root extract and mulberry extract. Or your dermatologist may prescribed specific prescription skin lightening creams which may contain retinoid and/or hydroquinone.”
Professional dermatological treatments:
Other options:
In recent years, a number of skincare products that claim to reduce hyperpigmentation have emerged. Most rely on one of the following active ingredients to decrease melanin production and reduce the appearance of dark spots.
- Until recently, hydroquinone or hydrochinone was the most powerful active ingredient for treating hyperpigmentation. It’s still available in some over-the-counter remedies in the US, but only in low concentrations of 2% or less. Hydroquinone can also cause post-inflammatory hyperpigmentation, as it’s a skin irritant.
- Arbutin is a natural source of hydroquinone, and is one of the key ingredients used in skin whitening products in Asia. It’s not as strong or effective as industrially produced hydroquinone, but there are also safety concerns.
- Kojic acid is a by-product of the fermentation process involved in producing the Japanese rice wine, sake. It is a fairly weak inhibitor of melanin production. It has been banned in many countries.
- Vitamin C derivatives have been shown to be relatively effective against hyperpigmentation. They’re often used in conjunction with other active ingredients.
- Retinoid acid derivatives have also been shown to be relatively effective as a hyperpigmentation treatment. But they can both irritate skin and make it more sensitive to the sun, which can of course worsen hyperpigmentation. Concerns about the links between retinoids and birth defects also mean they’re not recommended for pregnant or breastfeeding women.
- Azelaic acid has also been shown to indirectly affect melanin production and reduce hyperpigmentation. It has little to no effect on freckles and age spots, and can irritate and inflame skin.