Pigmentation is small patches of light brown color on the skin which become more pronounced by exposure to the sun. These freckles, age spots, sunspots and other patches of pigmentation can be treated using a variety of methods. Lasers, prescription medicines and chemical peels all available depending on the specific patient’s needs.
What is skin pigmentation?
Excessive skin pigmentation is a result of abnormal production and deposition of melanin by the melanocytes. Melanocytes are pigment-producing cells. The number of melanocytes present in our skin will determine our skin colour. Production of melanin is dependent on UV or sun exposure, and is a natural protective mechanism of the skin.
Hyperpigmentation (areas that are darker than the rest of the skin) results from excess melanin production and deposition. Hypopigmentation is the loss of skin pigmentation.
What causes excessive skin pigmentation?
Excess skin pigmentation or hyperpigmentation is usually caused by an overwhelming increase in melanin. This leads to the excess production and clumping of melanin, and the appearance of brown or darker spots of pigmentation in the skin.
Reasons for skin pigmentation problems are;
- UV radiation – in most cases, especially in areas of high UV radiation levels like Australia, skin pigmentation problems can be caused by excessive UV or sun exposure (most common).
- Hormonal – as seen in melasma or chloasma that is a type of pigmentation usually caused by pregnancy or the pill (common).
- Trauma to the skin – this can be a result of physical trauma to the skin, chemical peels, laser treatments, or acne. This is known as post-inflammatory hyperpigmentation (common).
- Birthmarks and acquired pigmentation – skin pigmentation can be present at birth (birthmarks), appear in childhood, or adulthood. Examples of these include; congenital melanocytic nevus, cafe au lait spots, spilus nevus, hori’s macules, and nevus of ota.
How is pigmentation treated?
Essentially, hyperpigmentation can be treated with topical lightening agents (
creams) or
lasers.
The main difference between the two is that lasers can produce a faster and more effective result in most cases. Topical lightening agents usually only fade pigmentation rather than remove it completely.
However, there are more risks associated with the use of lasers as opposed to lightening agents. These risks include worsening of the pigmentation, loss of normal skin pigmentation (hypopigmentation) or scarring of the skin (rare).
Also, with laser treatment there is usually a period of recovery post-treatment. The mode of treatment used will depend on patient preference, patient risk tolerance, and the type of pigmentation treated. Pigmentation can be treated on any part of the face or body, including the neck, décolletage, back, and back of the hands.
How to Remove Pigmentation from face permanently
How to remove pigmentation with laser
Some lasers can be used for the treatment of skin pigmentation and have minimal or no impact on normal skin. This is possible due to the process of selective photothermolysis. This is a term that describes how a particular laser wavelength is attracted to pigmented lesions, and only minimally to the normal skin to allow selective removal of a lesion. This allows the laser to selectively disrupt the pigment with minimal or no damage to surrounding skin. Generally, the wavelengths that are attracted to the melanin in pigmented lesions range from 532 nanometers(nm) to 1064nm.
One type of laser for treating pigmentation are millisecond pulse width lasers. These lasers emit pulses of light that are attracted to the melanin in the pigment, and this selectively disrupts the pigment by thermally heating it. The length of each pulse in this case is in the millisecond range (1 millisecond = 1/1000th of a second), and although this sounds short, it is actually a long time in this instance. An example of this laser is the Gemini Laser.
Another type of laser for treating pigmentation is a q-switched laser. These lasers emit nanosecond pulses (1 nanosecond = 1 billionth of a second) of light that are attracted to the melanin in the pigmented skin. They also selectively heat the pigment to disrupt it, but as the pulses are much shorter, they also have a photomechanical effect ie. they shatter/shock the pigment causing it to break down. It is this effect that also allows these lasers to remove tattoo pigment as well.
Generally the advantage of these lasers is that they require fewer treatments to treat pigmentation than the millisecond lasers. It is a more aggressive and effective treatment, and therefore also has more side effects such as a longer recovery time as well as an increased chance of post-inflammatory hyperpigmentation (see below). An example of this laser is the Sinon Ruby laser.
How to remove pigmentation with skincare
The first method of treating skin pigmentation is to prevent it from appearing or worsening by applying sunscreen daily. UV exposure from sunlight or sun beds will invariably worsen any existing pigmentation and promote further pigmentation to arise. The risk of skin cancers also rises with increasing exposure to UV.
We recommend sunscreens with high levels of SPF.
Sunscreen should be applied everyday, even if it is cloudy, or overcast, as UV light is still present. It is also important to avoid direct sunlight, especially during the middle hours of the day, seek shade when possible, and wear a hat and protective clothing.
Topical lightening agents can be used in conjunction with sunscreen to help reduce skin pigmentation. Topical lightening agents like serums help to reduce pigmentation by inhibiting enzymes that produce melanin (skin pigment) and by increasing the turnover of the skin to minimise existing pigmentation. Common lightening agents include; hydroquinone, kojic acid, paper mulberry bark extract, retinoids, and glycolic acid
Which laser is best for hyperpigmentation?
Different types of lasers can be used to treat different kinds of pigmentation, depending on the level of pigment in the skin and the cause of the pigmentation.
We recommend Dermapen. Dermapen Treatments are highly effective for treating unwanted pigmentation. The treatment is for all skin shades, but is a particularly advantageous solution for dark skin tones, where laser treatments may not be the safest option due to further pigmentation risks.
Solar lentigos or sun spots (epidermal)
The most common forms of pigmentation are due to sun exposure. Solar lentigos, commonly known as ‘sun spots’ are an example of this. Solar lentigos are not cancerous, and appear as flat brown ‘muddy’ patches on the areas of skin that are more exposed to the sun. They commonly occur on the cheeks, temples, and forehead.
Seborrhoeic Keratosis:
Seborrhoeic keratosis are brown, wart-like growths on the skin. They can appear like stuck-on sultanas on the skin. They are benign growths, but need to be distinguished from malignant lesions such as melanoma prior to laser treatment.
Seborrhoeic keratosis can be removed with lasers such as the Gemini laser, or radiofrequency devices such as the Pelleve. These devices heat up the seborrhoeic keratosis and basically allow them to be separated from the skin and wiped off.
Post-inflammatory hyperpigmentation (mixed dermal/epidermal)
Post-inflammatory hyperpigmentation is due to trauma to the skin, resulting in inflammation and pigmentation. Causes include; acne, laser, laser hair removal, IPL, chemical peels, and physical trauma. In the case of post-inflammatory hyperpigmentation, it is important to note that treatment of this type of pigmentation can be worsened if the treatment further irritates the skin.
Some particular, laser treatments aggravate and irritate post-inflammatory hyperpigmentation and commonly make it worse. So we recommend the use of topical agents for post-inflammatory hyperpigmentation rather than lasers.
Melasma/Chloasma (mixed dermal/epidermal)
Melasma or chloasma is a form of pigmentation that is stimulated by oestrogen (either from pregnancy, the pill, or normal circulating oestrogens) and is a difficult form of pigmentation to treat. It appears as brown-gray patches on the face, usually on the cheeks, between the brows and on the upper lip.
Freckles (epidermal)
Freckles are small brown spots on the skin that tend to be more prominent in summer and fade slightly in the winter. Freckles are usually genetic and are brown because of the pigment melanin. Freckles are very small patches of brown skin, usually less than 3mm in diameter.
Freckles are responsive to the Sinon Ruby laser. The Gemini laser is an effective laser for Asian freckle treatment. Patients who tend to freckle may freckle with sun exposure. Most patients show an improvement > 50% after treatment in their freckling as long as daily sunscreen is used
Brown birthmarks (epidermal)
Brown birthmarks, otherwise known as cafe-au-lait spots, are not uncommon and can appear anywhere on the body. These spots can be different sizes and shapes and often range from light to dark brown.
Epidermal or superficial brown birthmarks such as cafe au lait spots and congenital melanocytic naevi can also be treated with the Sinon Ruby laser.
Pigmentation on Asian, olive, or dark skin
Pigmentation problems commonly occur on people with Asian, olive or dark skin. These can be more difficult to treat than pigmentation on fair skins, and require a different approach.
Laser treatments can sometimes cause post-inflammatory hyperpigmentation (see above), and this can make the original pigmentation problem seem worse initially post laser. It is important therefore to ensure proper:
- Preparation of the skin – often lightening serums/creams are used prior to help prepare the skin and reduce the chance of post-inflammatory hyperpigmentation
- Laser settings – choosing a laser that is appropriate to these skin types, the use of skin cooling during laser, lower settings, smaller laser spot sizes to minimise effects of the laser on the normal collateral skin
- Post-laser treatment – ensuring that the proper creams, including sunscreens and sometimes steroids, are used post-laser.
