Hyperpigmentation
Hyperpigmentation
simply described is a focal area or patch of darker pigmentation on any
area of the skin. Special cells in the skin called melanocytes
naturally produce melanin - the pigment which your body uses to create
skin and hair color. The production of melanin is under very
sophisticated and tight control but is influenced by a wide variety of
biological and physiological factors. When there are too many
melanocytes attracted to a given area, or if they are overactive,
overproduction of melanin occurs and hyperpigmentation results.
Understanding
what hyperpigmentation is may be simple but it is far from a simple
problem. A full medical history and physical examination must be the
foundation for any treatment plan for hyperpigmentation problems. A
working diagnosis is also extremely important for developing the best
strategies. Not all hyperpigmentation is the same. Hyperpigmentation
can be associated with certain medical problems and conditions.
Different forms of hyperpigmentation will respond better to different
types of treatment. Always consult with your physician expert in
cosmetic skin care.
Without question, every treatment plan will
include minimizing sun exposure. Sun (UV radiation) avoidance, sun
protection and sunblock will always represent the simplest and most
critically important part of any plan for the treatment of
hyperpigmentation.That's because nothing stimulates melanocytes and
melanin production more than UV radiation exposure. And pigment
stimulation is the last thing we want when we are treating
hyperpigmentation!
Resurfacing techniques - topical home use
"peeling" agents (e.g. alpha-hydroxy acids, lactic acid, retinoids),
office microdermabrasion, office chemical peels (e.g. glycolics,
trichloracetic acid or TCA) - are commonly employed in most treatment
plans dealing with hyperpigmentation. Resurfacing eliminates dead or
dying pigmented surface skin cells (keratinocytes) allowing the less
pigmented, fresher, new skin cells to be revealed at the surface.
Resurfacing also stimulates cellular growth and turnover from the deeper
levels of the skin, further assisting the skin in its shedding of
pigmentation and the pigmented keratinocytes contributing to the
hyperpigmentation. Certain types of lasers can also be used along these
lines. But be careful - laser therapies can also cause
hyperpigmentation! A series of 5 to 6 in-office chemical peels
performed weekly, combined with a customized at-home regimen of topical
agents can be quite helpful. Our skin care center's aestheticians have
found that a series of once a week Obagi Blue Peel Radiance® (glycolic,
lactic, and salicylic acid) peels in combination with the use of the
Obagi-C® Rx (vitamin C, hydroquinone) system at home can be very
successful. A series of in-office microdermabrasion treatments are an
alternative option to the office peels.
Below is a list of some
currently available topical agents (brighteners, lighteners, whiteners)
which are often used in the war against hyperpigmentation. You will
find that many of these compounds are combined within a single product.
Combinations of methods and the use of multiple ingredient topical
agents seem to work better than any single mode therapy or single
topical agent. However, no single agent seems to work as well on
hyperpigmentation as hydroquinone does alone.
Alpha lipoic acid- Weakly inhibits melanin production.
Aleosin- Derived from the Aloe Vera plant. Weakly inhibits melanin production.
Emblica fruit- Weakly inhibits melanin deposition.
Licorice extract- Active ingredient is glabridin (also known as glycyrrhiza) which decreases melanin production.
Daisy flower (Bellis perennis) extract- Decreases melanin production.
Willow
bark extract- A beta-hydroxy acid; a resurfacing (peeling) agent which
helps to shed dead skin cells, remove surface pigment/pigmented
keratinocytes, and reveal brighter, fresher layers underneath.
Acetyl Hexapeptide- Decreases melanin production.
Pelvetia canaliculata extract- Derived from seaweed. Decreases melanin production. Blocks UV radiation damage to DNA.
Watermelon fruit extract- Blocks UV radiation damage to DNA.
Kojic
acid- Derived from mushrooms/fungi. Also a byproduct created during
the manufacturing of Japanese rice wine (sake). Decreases melanin
production. Also decreases number of dendrites (the connecting bridges
melanocytes use to inject melanin pigment into the skin cells around
them).
Azeleic acid- Found in barley and other grains. Primarily
used as an anti-acne agent but has the "side effect" of decreasing
melanin production.
Hydroquinone- Works by decreasing/blocking
melanin production and by decreasing the number of viable melanocytes in
a given area. Well known as a major component in photographic
developer for film and paper! The only actual "bleaching" agent
recognized by the FDA. Available as less than 2% concentration as OTC,
up to 4% concentration or more as prescription. In 2006, the FDA
revoked its previous approval of hydroquinone as an OTC pending further
study because of concerns regarding its absorption and potential
carcinogenicity. Ochronosis - the appearance of bluish/black skin
discoloration spots - is another concern and a recognized potential
unwelcome side effect that may be seen with long-term use. Final FDA
decision on all this is still pending. Irritation reactions are very
common and occur in ~25% of patients starting use of hydroquinone - a
small spot test area should be tried first. True allergy to
hydroquinone is rare. Hydroquinone treatment makes the skin more
sensitive to sunlight and all other potentially irritating skin
agents/treatments. Precaution should be taken accordingly.
Arbutin (Bearberry)- A "natural" form derivative of hydroquinone. Decreases melanin production.
Beta carotene- Decreases melanin production.
Gluconic acid- Binds copper (micronutrient needed for melanin synthesis) leading to decreased melanin production.
Paper mulberry (Mulberry extract)- Derived from an Asian tree root. Decreases melanin production.
Ascorbic acid (vitamin C)- Decreases melanin production. Can be irritating to the skin.
Norwegian kelp- Decreases dendritic transport of melanin.
N-acetyl glucosamine (NAG)- Decreases melanin production.
Niacinamide- Decreases dendritic transport of melanin.
UPA (undecylenoyl phenylalanine)- Decreases melanin production.
Steroids-
Decrease irritation/inflammation of the skin, limit irritation from
other products used in combination therapy (e.g. hydroquinone), also
decreases melanin production.
Retinoids- A family of resurfacing
(peeling) agents which are vitamin a derivatives. Retinoids help to
shed dead skin cells, remove surface pigment and pigmented
keratinocytes, and reveal brighter, fresher layers underneath.
Streamlines "easier" absorption of other agents into the skin when used
in combination therapy. Decreases melanin production. Increases skin
cell turnover and promotes growth of plump, new skin cells up from the
deeper layers further forcing the elimination of the older, pigmented
cells which are contributing to the hyperpigmentation.