Before I begin, allow me to state up front that I am not a dermatologist or any kind of uniquely trained skin specialist. My training gets conducted each day with each new client. With each new observance of a skin condition, I hit the books, conducting as much research as possible to give the best possible treatment and/or advice. And I will state affirmatively that I am very careful to never attempt to treat any condition that I am not confident I can help with.
Skin hyper pigmentation is a bit like Humpty Dumpty on the wall. A fragile thing teetering that can result in a big fall. Whether or not Humpty Dumpty can be put together again, depends on the complex approach to treatment. No one thing will successfully treat skin pigmentation. This is mainly because there can be different types of pigmentation on one face, with one type possibly reacting well to a treatment and another potentially worsening.
Things that are considered “pigmentation”
Liver spots (mainly hands)
Melasma (more common in females)
Rosacea (which can resemble other conditions and must be approached carefully)
Post inflammatory pigmentation (acne, aggressive skin treatments, bad sunburn…etc.)
Vitiligo (hypopigmentation…. absence of colour)
Things that may look like pigmentation
Seborrheic keratosis (darker spots with scaling)
Actinic keratosis (this may become cancerous if not monitored)
Many of us look in the mirror and self diagnose. Many of us will go to a med spa or esthetician and believe they can diagnose. In fact, a simple observance can be easily made in many cases by nonmedical practitioners owing to the number of times they have seen the same condition in others, but this still isn’t terribly safe when planning a treatment.
Hyperpigmentation occurs when the melanocytes in the skin over produce. This is generally caused by damage of some kind. As many of the treatments we use for anti aging and to address hyperpigmentation also involve some level of controlled damage, it is critical to be very very careful. However, even hair removal treatments and products, acidic products too strong for the skin, and some medications can lead to hyperpigmentation.
Melasma is a condition that often develops due to a hormone disruption, such as pregnancy, birth control. It often appears like a mask all over the face or on areas like the forehead and around the mouth. Sufferers are often so frightened to make the condition worse they tend to avoid treatments and resort to heavy makeup day after day. Heavy makeup every day is never a good idea for skin in the long term. I have, however, had clients who have been informally diagnosed with melasma and their conditions does look very much like it, but that do not really meet the common criteria for developing it, such.
Reinforcing the fact that just because it looks like it, doesn’t mean it is!!! And even doctors can be wrong.
Indeed, melasma is tricky and treating it does carry risk. There are lasers that have been shown to work very effectively on melasma. One off label use of lasers used to remove tattoos is to treat melasma. So, there is hope for melasma sufferers. However, in saying that, one treatment type alone is unlikely to be enough. Treating melasma may require a protocol of both skin treatments and products, including medications.
However, while that is very promising for melasma sufferers it is critical that the condition be affirmatively determined to be exactly that. A simple observation is not enough and anyone other than a qualified medical practitioner is not equipped to diagnose.
But melasma is often not the only pigmentation condition. There could be other types of pigmentation and if the melasma is treated with an aggressive treatment such as a laser, there is a very high risk of exacerbating the other types of pigmentation. This is particularly so for clients with darker skin tones, and those who tend to tan in the sun. When it comes to the use of laser applied for these treatments, they should only be trusted to experienced doctor’s offices. Without seeing immediate and long-term results and reading repeated positive reviews, you are taking a risk.
The caveat meant in this blog is PLEASE PROCEED CAREFULLY.
Proceeding carefully means to begin gentle and see what happens. Naturally I am not a fan of suggesting medications such as topical steroids and hydroquinone to treat hyperpigmentation. There are risks that are assumed with these medications. I do believe that Tretinoin, prescription strength Retin A is a useful tool, but it makes clients very sun sensitive and so sun avoidance absolutely must be practiced. That said, I reiterate, I am not a doctor. Only a doctor can advise on the risks and cautions of certain medications. Doctors, however, are also not generally in the business of skin care formulation to know well what natural plant-based products might be tried before going the medication route.
Did you know that micro needling is the safest and most gentle skin resurfacing treatment available for hyperpigmentation? While practitioner skill dependent, Micro needling is unlikely to exacerbate melasma since the condition is generally deeper than the microneedles can reach. It does not harm the epidermis either, thereby also not likely causing any worsening of hyperpigmentation that is occurring closer to the surface of the skin. Micro needling is NOT AGGRESSIVE OR ABLATIVE, yet it is astonishingly effective.
In my practice I have had many successful treatments of hyperpigmentation and I am amazed at how it can be corrected in as little as a single session. Best of all, clients receive a red-light therapy treatment before leaving, thus reducing erythema considerably, meaning little to no down time.
In terms of melasma treatment, micro needling CAN achieve positive results, but we cannot say that it will. It is far wiser to try micro needling first, perhaps to address other forms of hyperpigmentation, before jumping into something more aggressive. However, what is so remarkable about micro needling is that it leads to a complex restructuring of the skin. In doing this, damaged skin is restored to health, and it is actually thickened! Thicker skin means that underlying conditions, such as melasma and rosacea (also a tricky condition) are less visible. So, while the condition may still exist, if you can’t see it, or it isn’t as noticeable as it was before micro needling, then it isn’t going to bug you as much, will it?
Of course, all pigmentation issues remain close by. They can return at any time, so maintenance and management are key. The sun will always be your nemesis.
This is where home care becomes so important. Regular dermal rolling at home. An excellent skin care program. A VERY GOOD SUNSCREEN regularly applied through the day when UVA/UVB rays are near and continued micro needling….2 to 3 times a year for optimal results. A plant-based skin lightening compound.
The best is that micro needling doesn’t just help with hyperpigmentation…it isn’t that selective! By restructuring the skin, it staves off aging, corrects damage, softens lines and wrinkles, evens skin tone, and yup, even tightens. These are not advantages that can be offered by the melasma responsive lasers…. they ARE selective.
And yet, gentle treatment options do not just end there. Low level light therapy is extraordinarily effective as well. It helps correct hyperpigmentation, induces the development of new and healthy collagen and elastin proteins to address the signs of aging, and improves skin overall. Light therapy is very affordable and can be tried alone (though results will be slower) or in combination with micro needling.
We truly are living in exciting times when it comes to keeping our skin healthy and young looking far longer in life than our mothers and grandmothers were able. The best part of these times is that we can entirely avoid the scalpel in achieving this. Discoveries are being made every day.
But just as you see in the skin care aisle at the pharmacy or department store, a lot of companies are competing for your business, making dubious promises, and keeping us always trying and spending, trying, and spending.
The only way for consumers to make informed choices is to do homework, and lots of it.
But when it comes to the hyperpigmentation that bugs you so much, please heed this caution…. PROCEED CAREFULLY and arm yourself with knowledge. Never be afraid to ask questions, to demand to see photos, to talk to clients. It isn’t just your money; it is your fac