Pigmentation: Book Review: The Skincare Bible by Dr Anjali Mahto
Hello, it’s Tina here again, with the next part of our Skincare Bible book review. This time we will talk about pigmentation problems – one of the most common issues which brings people to the dermatologist. Dr. Mahto covers three broad groups of pigmentation issues: melasma, “spots” (with sub-categories, such as age spots, freckles or “liver spots”), and dark circles around the eyes. These all are examples of unwanted pigmentation and, to some extent, there is a similar approach to their treatment. The rule of thumb here is: if you see no improvement after six to eight weeks of over-the-counter treatment, see a doctor; a GP, or better yet, an experienced dermatologist. There is no need to suffer and hide, there is a whole variety of treatments available!
Melasma and how to treat it
Let us start with melasma. You might remember that we have talked about it before, in our blog about hormones, since the condition often occurs during pregnancy. However, it can surprise you even if you are not pregnant. Sun exposure and hormonal treatments are among the most common triggers for the condition, but an underactive thyroid gland can also be a culprit. Melasma usually affects women, most often between the age of 20-40. It manifests as a symmetrical brown pigmentation, most often on the face. Yes, it is the infamous brown moustache...The bad news is that melasma is a chronic condition and might reappear. However, as we said, not everything is lost; there is a range of options for its treatment.
Melasma can affect both layers of the skin – the top layer (epidermis) and the deeper one (dermis) and a good dermatologist can diagnose the area with a special UV lamp. As you would probably guess, melasma in the epidermis responds better to the topical treatments with creams, the one affecting deeper skin layers can require different types of treatment.
Standard topical treatment includes creams with hydroquinone (2-5%), often used in combination with tretinoin (a retinoid agent), which improves the penetration of hydroquinone in the skin. The creams are applied at night, but sometimes irritation appears and it is necessary to build up the tolerance. Hydroquinone should not be used over extended periods of time and in large skin areas, this is also why it is a prescription-based agent in some countries. Even though you can buy it online, resist the temptation and do consult a specialist! If used improperly, it can cause further damage to your skin.
There is also a number of natural active ingredients, which act as skin lightening agents. Dr. Mahto recommends kojic acid (an extract from fungi), glabridin (liquorice extract), arbutin (bearberry extract), or niacinamide (vitamin B3). Fresh soy milk and vitamin C in all forms can also be helpful. With vitamin C, be careful, as not all forms are equally efficient! Look for products which contain magnesium ascorbyl phosphate (MAP), ascorbyl-6-palmitate, disodium isostearyl 2-0-L-ascorbyl phosphate or ascorbit acid sulphate with concentration up to 20%. Higher concentrations can cause irritation.
Other ingredients you can try are glycolic acid, which works well in combination with hydroquinone, azelaic acid (sounds familiar? Yes, a true all-rounder, it can also treat acne and rosacea or retinoids. Most of them are available only on prescription, but products with lower concentrations can be bought over the counter. Dr. Mahto also recommends specific products in her book, so if you are interested, check ut ochapter 5.
As I said earlier, if you do not see a significant improvement after roughly three months, consult a professional who can offer you another range of treatment options, such as chemical peels and laser treatment.
Chemical peel is a label that actually covers a broad range of ingredients of different concentration. After a cleansing, a chemical solution is applied on the face and left to do its magic. During the process, you can feel stinging or tightness, after the treatment redness is common, as well as peeling and shedding. This can last up to a week before the new, healthy skin resurfaces. And of course, because the skin is brand new and extremely sensitive, you should be very careful about sun exposure and use an appropriate sunscreen, with at least 50 SPF. Otherwise you risk worsening the problem. On the same note, sunscreen is also a great prevention measure for melasma!
Laser can also be used for treating melasma, however, with a somewhat controversial score, as there is a risk of worsening of pigmentation. Here more than ever: make sure you are in hands of a qualified professional, ideally of someone who has training and experience with using a number of tools and methods, so that the best one for your specific issue could be picked.
Age spots (aka liver spots)
Call it the way you want/as you wish, the brown spots, called solar lentigines in the expert talk, are a very common phenomenon, especially if you have fair skin, and they usually become more prominent as you get older. They occur on the sun-exposed parts of the body – face, chest, forearms, or the back of your hands. The good news is that they usually respond well to a treatment. The active ingredients are very similar to those used for treating melasma: creams containing hydroquinone and retinoid agents (especially tretinoin), chemical peels, light therapy and laser - this time with a less controversial reputation, compared to melasma! Cryotherapy (freezing with liquid nitrogen) is also an option.
And, again, sunscreen is a must after those treatments, to protect the new and sensitive skin. Not to forget that it is also the best preventive measure you can take!
Dark eye circles
Do you think they are a sign of a lack of sleep? They can be, but they can also result from a loss of fatty tissue around the eye, thinning and excessive pigmentation of the skin, or puffy eyelids. Apart from genetics, dehydration, alcohol and smoking can play a role. When starting a treatment, it is a good idea to rule out other medical conditions that might cause the dark circles.
There is a number of factors linked to lifestyle one should consider before treatment: limiting alcohol and salty food to reduce eye puffiness and getting enough sleep are the number one. Sunscreen designed specially for the eye area and wearing good quality sunglasses is also important, so that you reduce unnecessary sun exposure.
For some people, a bit of concealer under the eyes will do the trick. However, if you want to go further, you can try brightening ingredients we listed above in the part about melasma. Chemical peels are another option, often used in combination with micro needling – a procedure where mini-needles make small punctures in the skin. This results in swelling and redness, but also improves the effects of the chemical peel, as the active ingredients can go deeper in the skin.
Platelet-rich plasma is another treatment that got significant attention thanks to Kim Kardashian – yet the results are varied. Plasma is extracted from a blood sample and applied after a microneedling treatment. Lasers can also be helpful, but here again, make sure you are in hands of a qualified professional, as the eyes are particularly sensitive to laser light.
Dermal fillers, usually containing hyaluronic acid, are another option. If a loss of fat around the eyes is an issue, fat transfer could be a useful option. Although it does not tackle the pigmentation as such, it can improve the appearance of the eyes quite significantly. This, however, should only be performed by an experienced plastic surgeon.
It might sound repetitive, but a consultation with a qualified cosmetic dermatologist is the way to start – and to go. Dark circles can have a number of causes and, as such, the treatment often requires a combination of different methods. It also takes time to see the results. An expert with a good overview of all the options can help you much more than someone who offers just a limited portfolio.
Have you been affected by pigmentation issues? What treatments did you go for? I will be glad to hear about your experience.