Pigmentation Problems

Do you have brown spots that you don't want?

Pigment problems are usually related to one of three things: damage from aging / sun exposure, reaction to injury (post-inflammatory), or from hormones (melasma). Below, we go into depth on the biology underlying pigmentation problems, prevention using sunblocks, and some useful lasers for treatment. For the ultimate in taming pigmentation problems, we use the powerful trifecta of microneedling, peels, and pigment-control products. We give tips on peels, and what ingredients to look for in products. 

Part of our secrets to success at Pulsar Health in West Palm Beach, FL, is using top quality products and the guidance we give on what to do when, to optimally manage your skin's pigment, so why not call today and start getting it taken care of?

Having unwelcome dark spots, called hyperpigmentation, comes in three main flavors:

1. Sun damage / age-related
2. Post-inflammatory (after injury such as a burn or scars)
3. Melasma or hormonal

The biology underlying pigmentation problems

The pigment producing cells in the deepest layers of the skin, called melanocytes, make packets of pigment, called melanosomes, that are taken up by the surrounding skin cells, called keratinocyte.. What regulates skin color is "epigenetics" - which of your genes get expressed and by how much - which is affected by the environment, both the external exposures as in ultraviolet radiation from the sun, and the internal body environment such as hormones and inflammation. In skin cells, genes expression leads to protein production. An important protein in pigmentation problems is an enzyme called tyrosinase.

Tyrosinase makes fruit and vegetables "brown" as they are handled. Ultraviolet light, or UV radiation, is the natural trigger for tyrosinase activity, so more melanin is produced to protect you from it. In other words, you tan. Unfortunately, it's not always a lovely golden smooth tan. UV "damage" can cause patchy brown spots. The damage typically accumulates over time, as your skin repair processes slow down with aging, so older people tend to have more "brown spots" and skin irregularities. 

Tyrosinase also makes your skin brown if you have an injury, especially if you already have darker skin. This is called post-inflammatory hyperpigmentation. The body does naturally work on reversing this over time, but sometimes it can be "permanent" or till death do us part. Many of the products we use to treat hyperpigmentation target tyrosinase by inhibiting it. 

Melasma, known previously as "the mask of pregnancy," is hormone-related hyperpigmentation and typically affects young ladies. It can be challenging to treat effectively, and management rather than complete permanent cure is more realistic as a goal. It is triggered by several factors including:

• hormones (the contraceptive pill, thyroid problems,...)
• oxidative stress (pollution, sleep deprivation, and yes UV radiation)
• medications (such as phenytoin). 

Not only does melasma involve inappropriate melanocyte activation and accumulation of melanin, but there are other changes in the skin such as increased blood vessels, more mast cells, abnormal elastin accumulation (called actinic elastosis), and alterations in the basement membrane between the skin's epidermis and dermis layers. 

Enough science! Well, until we get to the ingredients list below lol. What do you do to address hyperpigmentation?

Prevention

The very first step in the management of health or beauty issues is always prevention. You guessed it. Sunblock. Even when you treat it, you still need to prevent hyperpigmentation happening again, and sunblock not only helps prevent hyperpigmentation, but also other damage such as dry "weathered" skin, wrinkles, broken blood vessels, and, of course, the biggie, skin cancer. 

At Pulsar Health, we like to have physical elements in the sunblock and the products we sell are actually good for your skin, not chalky or junking up your pores or hard to put on, so no excuses! We recommend putting the sunblock near your toothbrush so that it's a no-brainer in the morning. Currently our favorites are Isdin sunblocks and those from Elta MD. The physical elements don't "need" reapplication unless sweated or rubbed off during the day, and the other constituents help treat your skin. The main physical ingredients are zinc oxide and titanium oxide, with iron oxide forming a tint that can protect from the blue light indoors / on device screens. Isdin sunblocks have an ingredient that even won a Nobel prize for reversing DNA damage!

Devices for Treatment

Sun damage causing hyperpigmentation and redness can be treated using a pulsed dye device called an IPL. It is not a laser as it is a mixture of different wavelengths, and it can only be used on lighter colored skin tones. It is a quick and effective treatment that makes your dark spots darker for a week or two before they lighten up. For simple sun damage, it is very effective and even adds a little collagen to reduce long term wrinkling. We love using it for arms and the chest area as well as the face and hands.

For a real laser, the Alexandrite (755 nm wavelength) targets dark pigmentation in light skin, and is more effective than the IPL for stubborn pigmentation. Like the IPL though, it cannot be used safely in darker skin tones. These require a pico wavelength or Q-switched laser, similar to the lasers that are used for tattoo removal.

Powerful Trifecta of Microneedling, Peels, and Pigment Control Products

For post-inflammatory hyperpigmentation, melasma, and darker skin tones, we recommend the powerful trifecta of microneedling, peels, and pigment control products:

1. Microneedling can "break up" the pigment and help skin heal
2. Peels can "lift off" pigment improving skin turnover
3. Products work on taming tyrosinase and melanin production one way or another

None of these is an instant solution. It takes time and repetition as well as controlling the underlying conditions that exacerbate the hyperpigmentation. Sometimes going back on the oral contraceptive pill can help melasma, and scar thickening in post-inflammatory hyperpigmentation may benefit from steroid use into the scar. At Pulsar Health, we can guide you on what your skin would benefit from next.

Microneedling is very comfortable when performed at Pulsar Health, yet also very effective. We use high strength numbing cream with the MDPen for microneedling the face and neck areas. The MDPen allows us to control not only the depth of the needles, but also the speed so that we can perform a very even treatment as we gently go over your skin. We use lower depths to treat the eye area, and deeper over scars, wrinkles and where we are breaking up pigment. Sometimes we combine microneedling with other devices and certain peels to produce a powerful lifting and rebuilding effect. We can combine microneedling with brightening products and stem cells that help brighten and rebuild the skin.

Treating hyperpigmentation can be tricky and your skin's responses as well as our experience determine what we do, such as which peels to use and when. We have over 26 different types of peels at Pulsar Health, from lines such as Vi-Peel, PCA, Glytone, and Image MD, and we make a determination on which one to use to start you off gently, and see how you respond. There are specific peels designed for hyperpigmentation such as Vi-Peel's precision plus peel (all skin types) and Glytone's Triple-Bright (only lighter skin types and work up to it). Peeling will also vary in intensity depending on how often you have peels (more "frequent fliers" - those who do peels regularly - peel less as their skin is already healthier), what strength peel is used and how long it is left on your skin, as well as other modifications such as neutralizing or using hydrocortisone creams. In general, we recommend that you stop using retinols and retinoids at least a week before a peel. Ingredients in some of the peels we use are:

• Mandelic Acid is a mild alpha hydroxy acid (AHA). It has a large molecular size, slowing its penetration, and is made from bitter almonds. It has a gentle effect on lightening discoloration and softening fine lines as it exfoliates, brightening the skin. It helps with reducing inflammation, such as in acne, and improves elasticity. It is not as effective at treating hyperpigmentation as other products.
• Lactic Acid is also classified as an alpha hydroxy acid (AHA). Usually derived from milk, lactic acid is stronger than mandelic acid, but milder than glycolic acid. Like mandelic acid, its' effects on hyperpigmentation are mostly a side-effect of exfoliation removing pigmented keratinocytes. At lower concentrations, it helps with hydration (a humectant), and at higher concentrations, it exfoliates more to help with fine lines and unclogging pores in acne. 
• Tricarboxylic Acid (TCA) is a monocarboxylic acid, not an AHA. It comes in various strengths and is often combined with other ingredients in peels. It can function as a light peel at low concentrations to a very intense peel at higher concentrations and durations of treatment, that are used in the spa to treat wrinkles and pigment problems. Like the AHA peels, it treats hyperpigmentation by chemical exfoliation, removing that layer of keratinocytes.

Pigment control products at home are very important in hyperpigmentation treatment. Your skin regimen, diet and medications can be looked at to make sure there isn't anything making your hyperpigmentation worse. Treatment products for hyperpigmentation can include the following ingredients for those who want to know:

• Hydroquinione, the granddaddy of "skin bleaching" is a prescription in the United States in strengths over 2%. It blocks tyrosinase, the enzyme that makes melanin, and takes a few weeks to work. We recommend using it for no more than 3 to 6 months. Longer durations and high strengths (greater than 4%) are more likely to have side effects such as redness and irritation. Excessive use can even trigger the skin condition called ochronosis, where the skin can turn blue-grey and thicken. Hydroquinone also makes your skin more sensitive to the sun, so it has to be used with a sunblock / only at night. It is derived from benzene, and is a type of. phenol.
• Arbutin, a natural compound derived from the leaves of plants such as cranberry, blueberry and pears, is hydroquinone attached to a sugar molecule (alpha arbutin) which slows down its' effects and makes it a bit safer. It has less of a bleaching effect. Arbutin, like hydroquinone, should not be used in pregnancy.
• Azelaic acid is a dicarboxylic acid. It is an antioxidant that also works on inhibiting tyrosinase. Azelaic acid use needs to be built up carefully, but it can be used even in pregnancy and is very effective (eventually) in calming inflammation associated with sensitive skin, acne and rosacea, as well as hyperpigmentation. It also doesn't play well at first with Vitamin C, retinoids and beta hydroxy acids, so we monitor your skin care regimen when starting on this, such as layering it over the moisturizer to "dull" it some until your skin gets used to it. 
• Tranexamic acid (TXA) is one of our favorite ingredients for the treatment of hyperpigmentation. Relatively new to the market, it is derived from the amino acid lysine and was originally administered to reduce bleeding in trauma or heavy periods. 5% TXA has been shown to be as effective as 3% hydroquinone but much better tolerated in reducing hyperpigmentation, as it works by suppressing melanocyte activation, reducing production of tyrosinase and other proteins that are active in producing melanin. It also helps with decreasing redness in rosacea and acne, and protects skin from UV radiation. At Pulsar Health, we have found that it is effective in evening out pigmentation in our clients with Fitzpatrick 6 skin tone (darkest of the skin colors). You will find TXA in VI-Peel's Dark Spot Treatment and Glytone's TranEXamide discoloration serum at Pulsar Health.
• Niacinamide (Vitamin B3) is the other ingredient we like for hyperpigmentation. 5% Niacinamide lightens dark spots by reducing transfer of melanin from melanocytes to the skin cells (keratinocytes), so it's the main ingredient in PCA's eye cream for dark undereye circles, as well as in their Vitamin B3 brightening cream. It helps to calm inflammation, improving rosacea, acne and eczema. Additionally, it boosts ceramide which hydrates skin, balances oil production from sebaceous glands, and enhances keratin production, building up the skin's barrier function. It even helps skin texture and fine lines!
• Kojic Acid, made from fungi / fermented food, is an ingredient found in treatment of hyperpigmentation because it can prevent the formation of tyrosine. It also has antimicrobial effects so can be helpful in acne and yeast infections. It protects from UV radiation and reduces fine lines.
• Vitamin C reduces tyrosinase activity by inhibiting the binding of copper to tyrosinase, so it has a mild skin lightening effect. One of its major functions is as an antioxidant and protector of its compatriot Vitamin E, both of which reduce free radicals and UV damage. Vitamin C is important for collagen cross-linking / strengthening, so has an anti-aging effect, but its delivery, stability and permeability vary widely in different formulations. 
• Vitamin A derivatives Retinol (milder) and Retinoids (stronger, such as prescription strength tretinoin) have many functions, including reducing melanin production by inhibiting tyrosinase. They also disperse the keratinocyte granules containing melanin and increase skin turnover. This removes the pigment containing cells faster, similar to how peels work. Retinols and retinoids can be irritative to the skin and their formulation makes a big difference on that effect, as other ingredients modify the skin's reactions. Bakuchiol is a naturally derived ingredient which is replacing retinol in some products and is much better tolerated. 

As you can tell if you made it this far, the treatment of hyperpigmentation can be complex and ongoing, so do your best to prevent it using sunblock, and come visit us for a consultation to personalize your regimen. You can bring photos of your current products or even the products themselves, so we can advise you better.