Freckles & Dark Patches
Skin pigmentation disorders are conditions that cause the skin to appear lighter or darker than normal, or blotchy and discoloured. Skin pigmentation problems can also result in freckles and sun spots. Abnormal pigmentation of the skin especially the skin of the face is a common problem that can be associated with a lot of anxiety and psychological distress. There are a large variety of causes of abnormal pigmentation of the skin that require different treatment approaches.
Melasma is defined as areas of poorly defined brown patches, usually symmetrically arranged over the face, especially over exposed regions. Common affected areas of the face include the forehead, nose, cheeks and upper lip. Superficial epidermal (upper layer of the skin) deposits appear brown. Deeper dermal (deep layers of the skin) appear blue grey. Mixed deposits take on a brown grey discolouration. Women tend to be more affected than men. The cause of melasma is not fully understood.
What are the possible causes of Melasma?
Ultraviolet light exposure, chronic inflammation and inflammatory disorders are common causes of melasma. Excessive use of cosmetic products can also trigger melasma. Medication including anti-epileptic medicine, blood pressure medicines, anti-malarial medication and tetracycline can also cause excessive pigmentation. Hyperpigmentation that develops in pregnancy is known as chloasma.
How can chemical peels help with hyperpigmentation?
Dr Zein Obagi devised the skin stretch test to help establish how deep hyperpigmentation affects the skin. On stretching the skin if the pigment appears to lighten then pigment is likely to be restricted to the epidermis (upper layer of the skin). When the skin does not lighten and the hyperpigmented regions are of a blue grey colour as opposed to brown, the pigment is likely to be affecting the dermis (deeper layers of the skin).
After initial stabilisation of skin and with adequate preconditioning with bleaching and blending agents, chemical peels can be used to help tackle more stubborn pigmentation problems. Peels are chosen dependent upon the depth of the hyperpigmentation and include the ZO 3 step peel for superficial pigmentation. The ZO controlled depth blue peel is more appropriate for deeper pigmentation.
TREATMENT OPTIONS FOR DARK CIRCLES
Obagi Blue Peel (Superficial)
ZO Three Step Peel
Platelet Rich Plasma
ZO Medical Retinol Skin Brightener (0.25%)
ZO Medical Retinol Skin Brightener (0.5%)
ZO Medical Retinol Skin Brightener (1.0%)
What about Dermalux?
At Rejuvence Clinic we have the Dermalux LED system in place. LED light therapy has been shown to be very effective in the treatment of a number of conditions including acne, rosacea, inflammation and hyperpigmentation. Dermalux has been used successfully in the treatment of pigmentation changes and specifically melasma and chloasma. Please contact us for a consultation and the most competitive package prices in London.
At Rejuvence we use a consistent and evidence based approach in the devising of treatment plans for hyperpigmentation problems. The treatment of hyperpigmentation and especially post-inflammatory hyperpigmentation does require patience and a careful approach to ensure skin appearance does not worsen. At Rejuvence we understand the psychological distress that accompanies such conditions and are here to support you every step of the way but will ensure that treatment is not rushed and the right treatment choices are made at the right time.
Generalised pigmentation resulting from any type of skin injury, disease or inflammation is known as post-inflammatory hyperpigmentation. Ultraviolet exposure (sunlight) usually worsens post-inflammatory hyperpigmentation. It occurs commonly in all skin types but racially mixed skin is more sensitive to the effects of inflammation and dermatological procedures. Patients with oily skin also tend to develop more severe, resistant post-inflammatory hyperpigmentation. Oily skin is the result of excess sebum production and this in turn is a pro-inflammatory substance.
Dark regions of hyperpigmentation can be bleached using hydroquinone based topical creams. Hydroquinone blocks the enzyme tyrosinase and thereby stops the process of melanin production. It is important to note that hydroquinone can induce sudden increase in melanin production if used for longer than 3 to 4 months continuously. Therefore hydroquinone must NOT be used for more than 3 months continuously. In tandem with hydroquinone, alpha hydroxy acid based products can be used as an exfoliant to improve barrier function and epidermal turnover.
In regions of uneven skin tone blending involves the use of topical products that combine hydroquinone with tretinoin. This helps to lighten hyperpigmented regions and even out colour tone.
In view of the potential for rebound hyperpigmentation with continuous hydroquinone treatment, skin needs to be stabilised using anti-inflammatory agents such as antioxidants alongside retinol for improved skin health and skin function. Hydroquinone is usually used in a cyclical manner lasting no longer than 3 to 4 months. A hydroquinone free skin care regimen should be started for maintaining skin improvements and preventing future recurrences of post-inflammatory hyperpigmentation and melasma. If melasma returns, patients are able to return to bleaching and blending. If hydroquinone is combined with tretinoin it can normally be used for slightly longer than if used for bleaching.
Sebum is oily secretion produced by sebaceous glands that are paired to hair roots of the skin. Sebum induces inflammation and represents a major cause of treatment failure. Appropriate use of cleansers, scrubs and exfoliators as well as sebum control pads helps to reduce sebum and hence ensure good control of symptoms.