Why "pigment happens"
The skin has an extraordinary self protection mechanism. When there's an overload of ultra violet light, your melanin-making cells go into overdrive to create protective pigment.
Early on, this protective pigment (melanin) production is even ( the idea of a tan ). In time, even the smoothest "tan" transforms to dark patches, spots and muddy complexions. All habitually exposed areas react in the same way with melanin cells that clump together.
FACT # 2 - Sun protection is first level prevention
Sun Smart
Prevention is the most important choice you can make. Understand the methods of protection.
- Sunscreen and sunblock
- Avoiding risky exposure hours (10 A.M. - 2 P.M.)
- Hats
- Sun umbrella
- Cover clothing
Top Priority - Sunscreen & Sun Block
This can't be emphasized enough! If it's a daily habit to apply a sun protection product, you're way ahead of the game.
By the way, natural light, even through a window, can trigger pigment - especially if you happen to be plagued with melasma!
Sunscreen vs Sun Block - What's the Difference?
Sunscreen "absorbs" UV rays. Sun Block reflects them.
Sunscreens need to be applied after the most basic skin care products and before makeup. Chemical sunscreens need 15-30 minutes to start working. Pay attention to directions. Unfortunately, they don't last all day and can wash off or sweat off before the day is over. Go for at least SPF 30.
Sun Block works by reflecting UV light and it works immediately. Look for zinc oxide with levels of 15-20% to provide the highest level of protection. Sun blocks are the most sensible option for those with sensitive skin or more intense pigmentation issues. Hybrid sunscreens incorporate both chemical and physical (mineral) ingredients, in which case look for 8% or higher zinc as part of the included active components.
But...cream or lotion sunscreens and sunblocks only go so far
No sunscreen or sun block can provide 100% protection. It's up to you to make adjustments to your lifestyle if you have persistent pigmentation problems. That means hats, reapplication of products (sometimes double layering), and avoiding unnecessary time in the sun.
It's an Inside Outside Job
Superficial pigment is your first sign of what's going on beneath the surface. If you were to see your skin with a black light filter, you'd likely be shocked. Much of the pigment that's waiting to show it's unwanted effects is lurking deeper in the dermal layer of the skin. The more often and longer you've been in the sun over your lifetime, the more hidden pigment there is!
This is one reason you begin to see skin get duller as you get older. This deeper level pigment absorbs light, causing your skin to lose it's ability to reflect light. Not only does this make your skin look dull, it makes you look older. A scientific study showed that perception of age can be dramatically influenced by pigment alone!
"... facial skin color distribution, or tone, can add, or subtract, as much as 20 years to a woman's age." 1
It's not just discoloration on your face that "ages" you, but pigment on your chest can too! And of course, spots on your hands are a total giveaway. Wearing driving gloves to prevent spots is a very sensible thing to do.
Dr. Fitzgerald explains, "By lifting brown patches and discoloration from your chest, light reflects up onto your face. This has the remarkable effect of making your face look younger."
Although sun exposure is the biggest bugaboo in causing discoloration, there are other reasons for hyper pigmentation that have nothing to do with sun. Read on...
"Mystery" Hyper Pigmentation
Not in the sun but still getting bothersome pigment? Some possible reasons...
- Working out
- Work that makes you hot or sweaty
- Sauna or hot tub
- Fragrances
- Aggressive exfoliation
- Products that are too strong for your skin
- Medications
- Pregnancy
- Allergic skin responses
- Insect bites
- Genes
What to Do?
Keeping your cool when you can't avoid heat and hot environments
- Fans - the wind chill effect will cool your body
- Open windows - same idea as a fan. Stuffy rooms hold heat
- Handheld misters - throw in some ice cubes
- Wet cloths around your neck or forehead
- Cool drinks - water is best as it requires no elevation in digestion "heat"
- Mineral water sprays
Be your own detective
- If you get brown patches where you usually apply perfume or cologne, that's the likely culprit
- Revisit your skin care products - layering too many active products like acids and retinols can cause inflammation which in turn calls up pigment
- Scrubbing with abrasive exfoliants can also irritate and inflame the skin (You may not see it!)
- Check the side effects of any medications you're on
- Do your elders have lots of spots and splotches? Having those genes calls for you to be extra careful about sun exposure and sun protection
- Have you experienced pimples or acne? Again, that inflammation response is red marks that can end up as dark marks
Reversing Existing Problems
There are increasingly effective products that help lift pigment. Not all work on every level of pigment, and they aren't "fast", but most have the power to lighten and blend existing discoloration to varying degrees IF you use them consistently along with sun protection.
Remember....even one day at the pool or beach without sufficient sun protection can undo weeks of diligent product use.
Reducing pigmentation with home use products
There are many ingredients that help lighten dark spots and general discoloration. Many are familiar with hydroquinone. Although hydroquinone has particular effectiveness, all over the counter products containing it are banned by the FDA due to its potential for skin rashes and permanent discoloration from long term use. The only products with hydroquinone available are RX through a physician.
No product can eliminate all pigmentation, but you can achieve more evenly toned skin with the right product ingredients. More often than not, you'll see a combination of ingredients...Examples include a blend of ingredients in SkinCeutical's Discoloration Defense serum and Alastin's A-Luminate Brightening Serum.
For the most part, ingredients function as pigment suppressors instead of actually lightening or "bleaching" dark spots. This means they must become an ongoing part of your skin care routine along with mandatory sun protection.
Helpful lightening agents
- Vitamin C Serums
- Tranexamic Acid
- Niacinamide 5%
- Arbutin
- Kojic acid
- Azaleic acid
- Bakuchiol
- Glycolic and Lactic Acid
- Retinols (start lowest strength and work your way up)
In the Dermatology Office
Pigment can be superficial and/or deep. The deeper pigment can't be effectively lightened via non-RX topical products alone. Why?
Deeper Pigment treatment options
Deeper pigment granules are oddly shaped and have "legs". This makes getting them to rise to the surface for the natural process of shedding more challenging. Technological devices can "shatter" pigment into microscopic particles. This is effected with heat absorption or with acoustics. (If the idea of acoustic action seems odd, think of glass shattering at high frequency sound.)
Pico second lasers work on this acoustic premise and are more suitable for skin that is darker or darkens easily.
Pico Genesis is a widely used laser in dermatology practices that care for patients with a variety of skin colors and ethnicities.
Superficial Pigment
Superficial pigment can be blended and lightened with filtered IPL (referred to as BBL or Broad Band Light), Fraxel DUAL, Clear + Brilliant, pigment-reducing chemical peels and a combination of product and in-office treatments.
Dark spots and discoloration affect nearly everyone at some point. Understanding the various steps you can take to prevent and treat will make it easier to have skin that looks even and appealing. View additional information on Hyper Pigmentation.
Device Treatment Options
Level 1 - Mild discoloration with no defined borders
- Fractional laser with specific wavelength - Fraxel Dual / Clear + Brilliant
- Intense pulsed light - BBL
- Ultra fast-pulsed laser with "acoustic" action - Pico Genesis
- Infusion microdermabrasion - Diamond Glow or HydraFacial
Level 2 - Moderate discoloration with deeper "roots"
- Fractional laser - multiple sessions
- Laser combination Pico Genesis with Enlighten
- Adjustable Light Therapy BBL PhotoFacial
- Medical chemical peels - Cosmelan
- RX multi-product topical systems - Obagi
Level 3 - Defined dark spots that can't be concealed with camouflage
- Laser with increased power levels - Enlighten laser
- Laser combined with pigment suppressors which may include RX levels of hydroquinone or oral tranexamic acid
Lasers and lights totally changed the way dermatologists treat widespread, deeper and difficult discolorations.
Heat or Acoustics?
HEAT ABSORPTION: One method relies on heat which is absorbed by melanin (or hemoglobin when you wish to treat redness and spider veins). The heat will cause the pigment granules to shatter. When these particles are more the size of dust, it's easier and quicker for your body to slough them away.
SHOCKWAVES: Another method which is newer and friendlier to ethnic skin are the picosecond lasers which send out light pulses so fast, the acoustic shock does the work. This speed of treatment helps prevent heat buildup that's so tricky when treating skin that has more pigment cells to begin with.
Treatment Safety
Your genetic background really really matters!
No single treatment option is ideal for everyone - which is why your dermatologist will always have a variety of devices. Because everyone has different gene pools, sensitivities and lifestyles, we choose different technologies to treat effectively with the least risk of side effect.
Many of the sensitivities are based on ancestry. Skin with darker pigment inherent in the genetic fingerprint tends to be more sensitive and more reactive to inflammation.
Think back to grandparents and great grandparents. Do you have Asian, Hispanic, Southern European or Middle Eastern skin genes? Think twice about standard laser treatment without cautious preparation. Opt instead for devices that don't create a build up of heat. As tempting as it might be to self-choose, rely on the experience of a skilled dermatologist.
Melasma
Hormonal pigmentation known as melasma, is most often seen in women who are or have been pregnant or take certain birth control medication or use hormone replacements. Melasma is considered a chronic condition and it's always quickly aggravated by sun exposure. Expect management but not a "cure".
Treating skin with persistent melasma the same as you'd treat skin that's only discolored from the sun is a MISTAKE - and can make things worse. Go pro and get a proper evaluation from a board certified dermatologist.
**Melasma is never a "fix and forget" condition. You'll need a consistent comprehensive plan to keep Melasma under control.
The Pigment PLAN
Be willing to commit to a plan. This might include initially undergoing a series of laser or light treatments along with support products. Then once you've reached an acceptable level of clearance, opting for the maintenance of occasional treatment to keep the pigment at bay. Achieving 100% evenly toned skin may not be possible, but the improvements over time can be quite amazing.
Picking your Provider
Lasers are only as good as the person holding the handpiece. Such powerful devices demand serious education and expertise. Our team is made up of highly qualified and highly experienced medical professionals who are neither complacent nor think they "know it all". It is this attitude and dedication to attaining and sustaining the highest levels of expertise possible that translates to the best and safest treatments for you.
The RFMD Team
Dr. Rebecca Fitzgerald, FAAD opened her private practice in 2005 after many years of experience in both medical and advanced aesthetic dermatology. She spearheaded a major California clinic study in the use of Sculptra, an absolutely life-changing injectable for patients experiencing facial lipoatrophy, years before its FDA approval for cosmetic use. Her intensive research, educational publications and training videos have made her one of the most sought-after "filler doctors" in California, across the U.S., and around the globe.
Two additional board certified dermatologists, Dr. Ray Jalian and Dr. Helen Fincher bring particular skills to the laser and device section of the practice. Harvard and Stanford trained respectively, both are intensely focused on safely providing as perfect as possible end results for our patients who are dealing with pigmentation, scars, redness, Rosacea, photo damage and aging concerns.
Board certified Nurse Practitioner Angela Sarff rounds out our laser and tech team with a wide range of skills in the use of all devices developed to improve pigmentation issues. The Fincher, Jalian and Sarff trio collaborate on the use of our advanced technologies including pico-second laser, radio frequency micro-needling, hybrid resurfacing laser and focused ultrasound.