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Pigmentation Conditions

Pigmentation Conditions

What are Those Brown Marks on My Face?


 By: Christine Dale, BSN, RN, CLHRP

 If you think fine lines and wrinkles are the only signs of aging you may be addressing as you get older, think again!

Much like a ripening banana, brown spots (and other colors) in the skin can start making their appearance as we age- as early as your twenties, for some!

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What are they? And what can we do about them?

Helpful Definitions

Term Definition
Hyperpigmentation

Areas of the skin that have become more pigmented than the surrounding skin

This symptom may be long lasting, such as in Melasma, or it may last a short time, like the skin redness that occurs after a chemical peel.
Photosensitivty

Being prone to be sensitive to light/sun

Reactions can occur, when the individual is exposed to light/sun.
Addison's Disease Condition in which the adrenal glands don’t produce enough hormones

Melasma

(or, Chloasma)

Groups of brown spots on areas of the face. Some pregnant women get this, in the form of a “mask” of pigmentation over the middle of the face.

There is more than one cause, and many non-pregnant people get this too.

Photofacial

(or Intense Pulsed Light Therapy "IPL")

Non-invasive therapy, whereby pulses of light are flashed onto the skin. The wavelength of light and the settings of the machine target specific pigmentation, to “break it up” and eliminate it, from the skin.
Melanocytes Melanocytes are cells that contain our melanin, or skin pigment.
Pigment Color
Tyrosinase An enzyme in our bodies, that is responsible for breaking down our melanocytes.

 

 

*Close-up of the Melasma on my left cheekmelasma

 

A Personal Experience with Melasma

Often, hyperpigmentation (or, rather,the cause) may be with the individual for the majority of their life.

I struggle with Melasma, and have since my early twenties. The hyperpigmentation primarily affects my cheeks, but can become more visible on my forehead and upper lip during certain times of my life (such as with each of my pregnancies). I have learned (for the most part) what makes my Melasma worse, and what makes it better.

For me, hormone fluctuations, the sun, stress, and certain foods (dairy, sugar, and wheat) increase my hyperpigmentation. To combat my Melasma, I find that a good skin care regimen, diet and lifestyle control, and a PHYSICAL sun protection agent (such as “Everybody Loves the Sunshine”, by Living Libations or “Colorescience SPF”) are my primary tools to prevent visible worsening of my symptoms. Lactic acid chemical peels and having a Photofacial (or Intense Pulsed Light “IPL” therapy) at least a couple times a year successfully targets and reduces the appearance of my Melasma.

(For more information on Lactic Acid Peels, Click HERE.)

(For more information on Photofacial (IPL) Therapy, click HERE.)

 

 

Causes of Hyperpigmentation…

First, understand that hyperpigmentation is a SYMPTOM. It’s your body’s way of throwing you a sign that something may need to be addressed.

While hyperpigmentation (in itself) isn’t harmful, the underlying cause may warrant further research, to make sure the body is healthy.

There are many ways to classify the underlying causes of hyperpigmentation. Without going into “Skin Science 101”, let’s cover a broad range of some of the most common causes:

  • Some types of medications (either by way of directly causing hyperpigmentation, or through photosensitivity) To see a list of medications that can cause increased sensitivity in the sun, check out this page, at: http://www.skincancer.org/publications/photosensitivity-report/medications
  • Melasma
  • Hormones (such as the decrease in estrogen in women approaching menopause, which allows testosterone to become more dominant, leading to melanin production)
  • Some conditions, such as Addison’s Disease
  • Oral Contraceptives
  • Injury or inflammation
  • Acne
  • Pregnancy
  • Photo damage, such as sun burns
  • Higher levels of heavy metals in the body

Process of Elimination…

Even the most experienced diagnosticians can struggle with determining the causes of hyperpigmentation! There are just SO MANY factors to consider! Pregnancy, certain medications, or a sunburn may be easy enough to rule out! However, trying to determine if your pigmentation issues are stemming from a medication or just good ole hormones is a trying process!

So, let’s take a look at what you can do to the skin, for the sake of keeping the symptom of hyperpigmentation at a level that is acceptable to you!

 

Treating Hyperpigmentation…

When treating hyperpigmentation, there is a very FINE LINE to “walk”!

The first step in addressing hyperpigmentation, is to narrow down a list of suspected causes! Once the cause is eliminated from your life, so is the hyperpigmentation (theoretically). This is easier said than done!

Certain medications (that are known to cause skin hyperpigmentation) may be necessary for your well-being (such as in certain cases of medical conditions). Obviously, in the case of pregnancy or oral contraceptives, hyperpigmentation may be a situational issue.

Many cases of hyperpigmentation may be successfully managed by using many noninvasive treatments!

  Let’s take a moment to look at a few of my favorite pigmentation treatments!

 

*LACTIC ACID CHEMICAL PEELS

Lactic acid has a unique ability to penetrate the skin more deeply (as compared to other acid-based peels). Many things are still not understood about lactic acid's ability to counteract hyperpigmentation. However, we do know that lactic acid peels can assist the skin in getting rid of pigment in more superficial layers, as it is a great exfoliator! Lactic acid peels work on pigment by working to “lift” it into the more superficial layers of the skin. Lactic acid also helps to hydrate and nourish the skin cells, contributing to a healthier glow. I use lactic acid peels as a “preparatory” treatment before getting a photofacial (about one month before). This works by “bringing the more pigmented spots into the more superficial layers of the skin”, making them more easily treated by my subsequent photofacial treatment. 

 

*PHOTOFACIALS

*A Photofacial before and after, of the hands

Before and After IPLLight energy is absorbed through the skin into areas where there is pigment. The wavelength of light can be adjusted in order to target the pigment more specifically. The pigmented areas readily absorb the light energy, causing the “breaking up” of areas of hyperpigmentation. The dark spots then slough off with the layers of dead skin as they progress to the surface naturally. Multiple sessions may be needed, depending on the depth and severity of the issue. (*The more superficial the pigmentation, the better the result, when using treatments that target the pigmentation by “lifting” it.)

 

Preventing sun damage goes a long way!

“One thing we know for sure, STRICT avoidance of the sun is a MUST for individuals with pigmentation conditions such as Melasma.”

Much to the dismay of sun-lovers, UV rays can cause a swift and furious return of hyperpigmentation! One thing we know for sure, strict avoidance of the sun is a must for individuals with pigmentation conditions such as Melasma. Being mindful of where, when, and how much sun exposure you receive can go a long way in minimizing your pigmentation struggles!protect your skin

To reduce your UV exposure, try these simple tips:

-Stock up on big-brim hats! (Don’t forget to use them!)

-Physical sunscreens (those that do not require heat/sun to activate them) with at least SPF 30! (And, reapply!)
-The hours between 10:00 a.m. and 2:00 p.m. generally, have been known to give us the highest dose of UV rays! (Plan your gardening time wisely!)
-Be mindful of medications and substances that can cause you to be more sun-sensitive!
-Watch out for those sneaky rays of sunlight, coming in through the side windows of your car! (A wide pair of sunglasses may help!)

 

 

Why No Easy Fix?

For whatever reason, in some individuals, there is a paper-thin line between STIMULATION and IRRITATION of the skin.

melasmaThe melanocyte cells in our skin house pigment (see picture on right). Melanin cells are the reason for variances amongst people in skin color (and for the skin’s ability to “tan” or become darker). The skin can generally withstand some stimulation without spilling out some of this pigment. However, when an action or treatment “crosses” the line into irritation, the melanocytes can begin “spilling” some of that pigment into surrounding tissues. This is where hyperpigmentation becomes visible. What is “stimulation” for some, may be “irritation” for others!

For this reason, it is of EXTREME IMPORTANCE to work closely with a clinician who is very experienced and knowledgeable in order to find what works (and doesn’t) for your skin type!

Other Options

There are a variety of topical substances currently used to treat hyperpigmentation. Each comes with its own risks and benefits.

Hydroquinone:

  • Blocks Tyrosinase
  • Results visible after at least 5 weeks
  • Can cause loss of pigment (de-pigmentation)
  • Can be irritating, and not safe, for some individuals

*A more natural alternative here, is to use quality skin care products that contain: stone crop, licorice root, or bearberry. Eminence organics carries a wide range of products containing ingredients known to maintain healthy skin and decrease the appearance of hyperpigmentation!

Topical Steroids:

  • Poorly understood
  • Can be irritating; can also cause telangiectasia (tiny blood vessels become more visible, like “threads”, under the skin) and hypertrichosis (excess hair growth)

Azelaic Acid:

  • Dicarboxylic acid gel or foam that is used to manage Rosacea
  • Decreases production of keratin (a protective protein in the skin)
  • Can be irritating

Retinoids:

  • Significant results are usually seen after a longer duration of use (sometimes taking up to 24 weeks)
  • Effects the production of melanin in several ways
  • Can be irritating, and users must take extra precautions, due to increased photosensitivity

Kojic Acid:

  • A substance derived from several types of fungi
  • Decreases production of melanin
  • Can be irritating (usually in concentrations over 1%)

Arbutin:

  • A naturally-occurring plant product, that is a derivative of hydroquinone
  • Inhibits Tyrosinase, to decrease melanin

Glycolic Acid:

  • An alpha-hydroxy acid that directly affects tyrosine, and promotes exfoliation
  • Can be irritating

Mequinol:

  • A hydroquinone derivative, that may compete with cells that create melanin
  • Takes several weeks to obtain visible improvement
  • May cause irritation

*Medications still under review: These substances are currently under review, for showing promise, in regard to targeting hyperpigmentation: N-acetyl-4-S-cysteaminylphenol , Alpha-tocopheryl Ferulate, Ascorbic Acid, Niacinamide, Liquorice derivatives, and Flavonoids

 ATTENTION!!

 If you're interested in trying some of the treatments described in this article, check out our one day SALES EVENT this Thursday, June 15, 2017-9:00 a.m.-5:00 p.m.!

Click HERE for details!


 

Christine Dale Simply Beautiful Medical SpaChristine Dale is a Bachelor’s level Registered Nurse, and a Master Injector for Simply Beautiful Medical Spa of Arkansas. She and her husband adventure through life with their five children! Christine enjoys blogging about aesthetic procedures and health, and spends most of her free time reading about medical-aesthetic procedures and advancements, as well as attending educational and training opportunities to build her skills. She and her husband also enjoy parenting, fishing, hunting, and exploring Arkansas’ beautiful wilderness!