Skin Hyperpigmentation: Cosmetic Therapy

Areas of darker pigmentation on the skin can be caused by a number of factors: age, sun damage, hormonal changes such as pregnancy or contraceptives and acne scarring. Hormonally caused hyperpigmentation is commonly referred to as mask of pregnancy or melasma and it appears on specific areas of the face, the forehead, cheeks, nose and upper lip, often with a symmetrical pattern on both sides of the face.

In this post I wanted to cover some of the cosmetic treatments available for more stubborn hyperpigmentation that doesn't respond to treatment with targeted skin care. I feel my pigmentation patches are small and don't currently warrant this level of treatment. However, I am aware hyperpigmentation can be more severe and I wanted to provide an overview for anyone considering taking the next step in treating pigmentation.
  

Dermaroller or Micro-needling
Dermaroller therapy involves the use of micro-needles to penetrate the skin and create tiny holes, the idea being that ir promotes natural skin regeneration and repair where the skin has been 'wounded'. It is recommended for the treatment of acne scarring, fine facial lines and stretch marks as well as uneven pigmentation. Having seen pictures of the device (see below) I feel very uncomfortable by the idea of home use and would suggest this should be left to medical trained professionals. You can read more information about the treatment on the website www.genuinedermaroller.co.uk.

A dermaroller

I'm not sure how I feel about this kind of therapy personally. I've studied wound healing and I can understand the theory behind it: the skin repairs itself and collagen production is stimulated in the dermis. In the wrong hands I suspect it could more do damage than good. As I felt so unsure, I asked anti-ageing and beauty expert Dr. Daniel Sister his thoughts on the technique.

"Micro needling is a very old technique and very effective/ineffective depending on the needles length. Home usage with 0.5mm (needles) is useless and not safe as there is no way to be certain the patient will disinfect correctly before the second usage.

Longer should be only for medical practitioners, and they are effective by creating microtrauma in the deep dermis which will react then as if a wound and re-create more collagen"

Intense Pulsed Light (IPL) Treatment
I asked skincare and beauty expert Lesley Reynolds Khan, co-founder of Harley Street Skin, what treatments she would recommend for hyperpigmentation. One of the treatments she suggested was IPL.

"Intense Pulsed Light (IPL) uses wavelengths of heated light which are directly aimed at the pigmented spots. The advantages of this technology include the fact that the pigment is able to be targeted precisely without damaging the surrounding tissue. Skin pigmentation in the face, neck, chest and hands can be treated safely and effectively. The added benefit of the Palomar IPL Technology is that is also works to activate cells in the skin called fibroblasts which stimulate collagen remodelling and new collagen production. Effectively, this helps to rejuvenate the skin, improving its texture, visibly minimising pores and reducing superficial fine lines and wrinkles to reveal a more youthfully hydrated appearance."

Image from www.facialplasticsurgery.net

 
IPL seems popular for the treatment of a variety of imperfections, particularly as it can be so targeted. Different wavelengths are used to target different areas/depths of the skin. Although I may not be considering IPL for my skin pigmentation, I am seriously considering it for the strange vascular blemish I have on my face but that is the subject of an entirely different post! For a really interesting review of IPL treatment for pigmentation, including results, I would really recommend you take a look at Gouldylox's excellent post. I was particularly fascinated by how the excess melanin travelled to the surface of the skin and looked like coffee ground before eventually dropping off.

Fractional Laser Skin Resurfacing is an alternative to IPL. It promotes rejuvenation as well as tackling patches of pigmentation. Apparently there is a shorter recovery time using this type of laser though I believe there is still some down time with this treatment.


Multi-Mask Peel
Another treatment Lesley recommended was the Multi-Mask Peel offered at Harley Street Skin. The peel contains a form of Kojic Acid found in Sake and Shitake mushrooms. Kojic Acid is often used in treatments as an alternative to hydroquinone (see below). The peel works by re-newing the upper layers of the skin and apparently this treatment is particularly effective on melasma caused by pregnancy and other hormonal factors. Because the peel re-news the skin, it will also improve the general appearance of the skin, softening lines and refining pores.

Pictures before and after the Multi-Mask Peel

The peel is left on the skin for varying amounts of time; 8 hours for fair skin, 10 hours for medium, olive and Asian skin and 12 hours for dark skin. This is followed by 28 days of specialised skin creams to suppress melanin. As you might expect from a peel treatment, the skin will peel and be a bit pink for a week or so but apparently it's not horrendous.


Products containing Hydroquinone
I had not come across hydroquinone until I started looking into hyperpigmentation treatments at the beginning of this year. I quickly gathered that it came with a bit of a reputation. Hydroquinone is banned from over the counter treatments (OTC) in Europe. Despite the FDA almost banning it in 2006, hydroquinone is still included in a number of readily available treatments in the States. It is essentially a skin bleaching agent and there are concerns because it cannot be ruled out as a potential carcinogen. In the UK it is only available in prescribed treatment regimes such as Obagi Nu-Derm. I asked Dr. Sister whether he thought there were situations where the benefits could out-weigh the risks?

"Hydroquinone is and should stay a medical treatment and absolutely not be sold OTC. It is effective when correctly used and for the correct indication and not to become another 'Michael Jackson'".

Image from Bossip.com

I think the use of topical hydroquinone should not be undertaken lightly. If you're considering it, I would caution you to make sure you know the possible risks and only do it with medical supervision. I certainly feel there are other alternatives to explore first.


My great thanks to Lesley Reynolds Khan from Harley Street Skin and Dr. Daniel Sister, consultant at BeautyWorksWest, for their input in this post.