Q&A About Hyper-pigmentation
What is hyperpigmentation/What causes hyperpigmentation?
‘Hyperpigmentation’ is a generic descriptive term referring to darkening of skin. This can have a number of underlying causes, some more common than others.
More specifically, hyperpigmentation occurs from an increase in melanin production and the most important risk factor for this is UV exposure (the dark spots that appear with age on the face are directly due to sun exposure and these are called ‘solar lentigos’) In acne, hyperpigmentation is commonly due to inflammation (Rendon M. Melasma and post inflammatory hyperpigmentation. Cosmet Dermatol 2003; 16: 9–15).
Post-Inflammatory Hyperpigmentation – dark spots on the skin – can occur either due to acne spots themselves when they get better or when skin becomes irritated from aggressive acne treatments. The marks are usually diffuse brown ‘macules’ – flat marks – that occur at the sites of previous acne lesions. These spots can continue for several months to years and often patients find them more disturbing than the acne itself.
Melasma is a type of pigmentation that is characterised by symmetrical brown pigmentation on the face which occurs mainly in women (90%) and more often in people of darker skin types. It is often due to changing hormones in young women, especially during pregnancy though the underlying reason for this is not completely understood. Unfortunately, melasma is very difficult to treat and requires a multi-modality approach. It is important to realise that no approach – whether topical, oral or laser or combined therapy - will completely eradicate the pigmentation and the aim of treatment is to improve the appearance of the pigmentation.
Who has hyperpigmentation?
A wide spectrum of patients – which would be consistent with skin problems in general – all age groups and genders as pigmentation problems have a variety of causes which can affect people at all points in their life.
How can hyperpigmentation be treated/What ingredients does Dermatica prescribe for hyperpigmentation
At Dermatica, pigmentation is treated with topical prescription medicine.
Hydroquinone is a skin bleaching cream and is considered the gold-standard for treating disorders of pigmentation like PIH and melasma (Draelos ZD. Skin lightening preparations and the hydroquinone controversy. Dermatol Ther 2007; 20: 308–313.)
In normal skin, melanocytes in the epidermis (top layer) of the skin convert tyrosine into melanin via the enzyme tyrosinase. This process occurs within specialised intracellular vesicles called melanosomes, which are then transferred to keratinocytes and sent to the epidermal surface. The quantity, melanin content and distribution of these melasnosomes determine the various hues of human skin colour – not the number of melanocytes themselves.
Hydroquinone works by reversible inhibition of the tyrosinase enzyme. Basically, it works by preventing new melanin production. As the skin cells mature, the heavily pigmented skin cells are shed and new skin cells are formed with less melanin.
When combined with a topical retinoid, the positive skin bleaching effects of hydroquinone are enhanced. This was first discovered in 1975 by Kligman and Willis who found that combining hydroquinone with tretinoin was more therapeutically effective than when each were used separately. There have been numerous well-controlled scientific studies performed since it was first introduced to provide further evidence for the use of combined therapy in the treatment of pigmentation.
How long does it take for treatment to start working?
That depends on a number of clinical factors: severity of pigmentation, sun exposure habits, compliance with treatment and Fitzpatrick skin type. Generally, patients should start seeing an improvement in their pigmentation after 12 weeks of consistent continuous treatment.
Why do these ingredients work better than other products on the market?
Because they are the only topical treatments that are evidence-based and have a strong scientific foundation to their use for these indications; these are prescription medicines.