If you are struggling with unevenly pigmented skin, take 5 minutes to read about how cosmetic treatments can be beneficial in achieving healthy, radiant skin.
What determines your natural skin colour?
Let’s first look at how your skin gets its pigment.
Your skin colour is determined by the activity of a special type of skin cell called a melanocyte. Melanocytes are present in the epidermis or topmost layer of your skin. They produce a substance called melanin and transfer it to neighbouring skin cells giving them colour. When all these cells reach the surface of your skin, your skin has colour. This is genetically determined with lighter skin tones having a different type of melanin to darker skin individuals. The amount of the 2 different types of melanin determines your overall complexion.
What causes an unevenly pigmented skin?
This happens when the melanocytes malfunction producing excess melanin or do not distribute the melanin evenly. There are quite a few triggers of increased pigmentation on your skin. External factors like excessive sun exposure, pollution and skin trauma as well as genetic ageing and hormonal influences within the body are culprits. These factors do not operate in isolation instead they have a combined effect on your skin causing pigmented spots or patches. Consequently, your skin ends up with an overall uneven pigmentation.
In the skin of colour, pigmentation is the first sign of ageing and appears as an uneven skin tone.
Types of unevenly pigmented (hyperpigmented) skin
Hyperpigmentation is a symptom and not a diagnosis. It is worth trying to establish a diagnosis so that treatment can be planned accordingly. Although there are three different types, you may actually have more than one type of hyperpigmentation contributing to your unevenly pigmented skin.
Photodamage causes unevenly pigmented skin
When exposed to UV radiation in sunlight, the melanocytes produce more melanin. The melanin absorbs the radiation acting as your natural sunscreen. This is how the skin defends and protects your DNA in the deeper skin layers.
An increase in the level of melanin makes the skin darker. Over time, as damaged cells are shed at the surface, you revert back to your natural complexion. If you have a lighter skin tone you don’t produce sufficient melanin to protect from UV radiation hence tan easily. Unfortunately, you are also more susceptible to sun damage earlier in your life.
If the UV exposure is constant or there are other triggers, the skin continues to produce excess melanin without switching off. But instead of creating a uniform pigment, irregular melanin secretion occurs contributing to an unevenly pigmented skin.
There are a number of reasons why aging combined with UV radiation causes age spots. As you age, there are background changes genetically programmed causing cellular DNA damage and death. DNA is also damaged by free radicals created by UV radiation as well as pollution in the environment. The defense and repair mechanism in the skin becomes inefficient with advanced aging. The number of melanocytes and their function also reduces with age.
Skin pigmentation due to aging or sun exposure tends to be uneven and may appear as freckles. Freckles later join up over time to make spots that eventually form patches. Sunspots are more pronounced in paler skin types due to the lack of melanin.
The success of treatment depends on when treatment is initiated, earlier the better.
Post-inflammatory hyperpigmentation (PIH) creates unevenly pigmented skin
Another cause of unevenly pigmented skin is post-inflammatory hyperpigmentation. When the skin is injured, the melanocytes get stimulated to produce more melanin. Unlike other types of pigmentation, this pigmentation is confined to the site of trauma to the skin. Due to this the skin can appear unevenly pigmented.
This type of pigmentation is much more common in darker skin tones where melanocytes are easily triggered. This can happen if the skin is not adequately prepared and primed before invasive treatments like micro-needling, laser treatment, or skin peels. It can also occur following skin injuries like previous acne, chickenpox, laser hair removal, or surgical scars.
In theory, this type of pigmentation is more straightforward to treat as stopping further trauma to the skin will prevent further pigmentation.
Melasma can cause unevenly pigmented skin
Melasma is a complex, chronic skin disorder where sun exposure causes patches of pigmentation in the presence of other factors such as hormones, medical conditions, pregnancy, or medication. During pregnancy, melasma is referred to as the mask of pregnancy or chloasma and it may remain after birth. Melasma may start with hormonal contraceptives but not reversed once discontinued. The exact mechanism of what causes melasma is yet unknown.
The pattern of pigment is often larger patches in a symmetrical distribution. Common sites are the forehead, cheeks, upper lip, chin, and the bridge of the nose.
Melasma is very resistant to treatment due to multiple factors contributing to it. Many patients have an ongoing battle with unevenly pigmented skin often worsening in the summer months.
Treatments available for unevenly pigmented skin
The aims of treatment:
- Avoid further insult
- Reverse damage
- Prevent further damage.
Protect the skin
A broad-spectrum sunscreen with at least an SPF of 30 should be worn all year round for two reasons if you have unevenly pigmented skin. One is to prevent further damage to the skin from UVA radiation causing overactivity of the melanocytes. The second reason is due to the treatment itself. The treatment serums can sensitise the skin to UV radiation therefore the skin needs to be protected. As harmful UV radiation is present in daylight, sunscreens should be worn daily all year round regardless of the weather.
Vitamin C is a powerful antioxidant at 10-15% and can protect the skin from free radical damage. It will potentiate the benefit of sunscreen while preventing further damage if applied prior to the sunscreen.
Inhibit melanocyte activity
Reversing damage to the skin can improve unevenly pigmented skin.
- Ingredients such as hydroquinone is a powerful agent capable of stopping the production of melanin and is often called a ‘bleaching’ agent. It does have its limitations, risks and serious side effects so it is not suitable for everyone. It is a prescription-only medicine in the UK and must only be used under the guidance of a doctor.
- Cysteamine, an antioxidant known to reduce pigmentation, is now available as a topical treatment. Cyspera® has comparable results to hydroquinone-based therapy.
- Vitamin C (L-ascorbic acid) decreases melanin production while reducing cellular inflammation and stimulating collagen synthesis.
- Vitamin A derivatives (retinoids and retinol) reduces melanin production while increasing cell shedding.
- Other pigment suppressants include arbutin, kojic acid, azelaic acid, and resorcinol which are available without a prescription.
- Ingredients such as niacinamide (vitamin B3) are often incorporated into serums as they block the transfer of melanin to the skin cells.
Increase cellular turnover.
By increasing the cellular turnover, melanin present on the skin surface can be exfoliated away so that new healthier cells can take their place. This is one of the modalities of treating unevenly pigmented skin.
The skin has a unique ability to speed up its rate of cell division when the surface layers are removed by exfoliation. The most commonly used ingredients are alpha hydroxy acids and vitamin A derivatives (retinoids and retinol). Lower percentages are available over the counter whereas higher percentages have to be prescribed. Common examples of alpha hydroxy acids are glycolic acid, lactic acid, mandelic acid and citric acid. They break the connections holding superficial skin cells to the skin and cause ‘chemical’ exfoliation. With continued use, they also stimulate collagen stimulation. Vitamin A derivatives increase cell turnover by speeding up new healthy skin cell production.
Some treatments should never be the first treatment if you already have or are at risk of unevenly pigmented skin. Your skin must be adequately prepared with medical skincare to ‘suppress’ the melanocytes. This will avoid post-inflammatory hyperpigmentation in susceptible individuals.
Targeted Chemical peels
These work by chemically exfoliating the skin and speeding up skin cell production while removing superficial uneven pigmentation. You can achieve faster results by combining clinic skin peels with home skincare treatment to reveal radiant new skin.
Medical micro-needling, Lasers and other devices
This treatment helps to dislodge existing uneven pigmentation and encourage the skin’s natural healing so that new skin is formed.
By directly injecting areas of discolouration with skin brightening agents, unevenly pigmented skin can be improved.
Unevenly pigmented skin can affect a person’s self-esteem so much that they’d rather not be seen even by their family in their natural skin. It can lower self-confidence, preoccupy their thoughts, and be a barrier for them in their personal and professional life. At Skin Enhance Clinic, combination treatments are available after an in-depth consultation and skin analysis. Just as the unevenly pigmented skin took years to appear, the treatment also takes time and requires patience and commitment on your part.