SKIN PIGMENTATION: The Challenges of Treatment

February 2, 2018


What is Pigmentation?

Increase in melanin (hyperpigmentation or hypermelanosis) can be due to an increased number of pigment cells (melanocytes) or from increased production of melanin.

Pigmentation of the skin normally varies according to race and the amount of sun exposure. The melanocytes of dark skin produce more melanin than those of people with light skin. More melanin is produced when the skin is injured, e.g. following exposure to ultraviolet radiation. Hormonal effects of oestrogen during pregnancy or due to medication can cause pigmentation of areolar, vulva and abdomen (linea nigra).

Generalised hyperpigmentation may rarely arise from excessive circulating melanocyte stimulating hormones (MSH), when it often has a bronze hue. It occurs in Addisons, Haemochromatosis, Metastatic melanoma, Afamelanotide treatment.

Localised pigmentation may be due to melanin, haemosiderin or externally-derived pigment.

The main diagnoses to consider are:
• Benign pigmented skin lesions – moles, seb. keratoses and lentigos
• Skin cancers -melanoma and pigmented basal cell carcinoma
• Post-inflammatory pigmentation 
• Current or previous skin infection – P.Versicolor or Erythrasma
• Chronic pigmentary disorders 
• Photocontact dermatitis to certain plants
• Thickened skin, e.g acanthosis nigricans or ichthyosis
• Pigmented purpura due to capillaritis, senile purpura, or after varicose vein surgery or sclerotherapy

What is the treatment of hyperpigmentation?

Broad-spectrum SPF 50+ sunscreen is important to minimise darkening by UVR. Cosmetic camouflage can be used.
Historically these agents have be used to lighten epidermal melanosis, alone or, more effectively, in combination:
• Hydroquinone
• Topical retinoid
• Topical corticosteroid
• Glycolic acid and other fruit acids
• Azelaic acid
• L-Ascorbic acid (vitamin C)

Resurfacing using chemical peels, laser, intense pulsed light (IPL) or dermabrasion may risk further damage to the epidermis and formation of more pigment. Newer treatment modalities include Picosecond, Lasers or Tixel, a new thermal mechanical ablative device.

In our clinic at Skinderm, we use a variety of treatments tailor made to treat each skin type, and race. Underlying skin conditions need to be addressed first in order to successfully treat hyperpigmentation. DermaPlex Anti-Dark spot serum is one of the successful treatments used for treatment of post inflammatory pigmentation though it is effective for other causes as well. It is a non-classical lightener with unique combinatios of the lightning actives such as diacetyl boldin, octadecedionic acid, hexylresorcinol, etc. Advantages are that it can be used on sensitive skin and areas which makes it more convenient for patients.

We have a Skinderm Genesis treatment which includes a combination of topical lighteners together with Tixel and Picosecond laser in order to achieve optimum results. The addition of glutathione is often effective, with Cyclokapron as pulse therapy for Melasma.

Dr. Lushen Pillay
MBChB (UP) MMed Derm (Wits)  FC Derm (SA)
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