Introduction:
Pigmentation can come in many shapes and forms.
We all have different forms of pigmentation found on our skin, within our hair and in our eyes that makes us totally unique.
Pigmentation, when referring to the skin, can often be the umbrella terms for many different types of skin conditions and lesions we see in our day to day life; as well as in the treatment room.
When discussing skin pigmentation conditions, we could be referring to melasma, sun damage, vitiligo and many, many more.
However, we also have pigmentation lesions that are treatable, such as solar lentigos, ephelides (freckles) and more.
So, let’s dive into what pigmentation is, and what treatment options you have to reduce specific pigmentary skin conditions.
How is pigmentation formed?
The skin cells that produce pigmentation (aka. Melanin) are called your melanocytes. Each melanocyte interacts with around 36 keratinocytes [1].
Your melanocytes are found within the basal layer of the skin which is found between your first layer; the epidermis, and the second layer; your dermis. Each melanocyte is connected to fibroblasts found within your dermis and keratinocytes within your epidermis [2].
We also have melanosomes which is a specific organelle which melanocytes produce. Melanosomes are transferred from melanocytes to keratinocytes in order to form perinuclear melanin caps [3].
Each melanocyte goes through a transfer process which causes your skin to change in pigment. Your melanocytes are connected to arms called your dendrites and these dendrites feed the changed melanin to your keratinocytes, all thanks to an enzyme called tyrosinase. Your altered keratinocytes are constantly moving upwards towards the surface of your skin. These changes are eventually visually seen on the surface [4].
When we are exposed to the sun or have pre-existing genetics, sometimes we have an excessive amount of melanosome activity. Other skin conditions such as vitiligo stop the production of melanin. This is essentially the main way pigmentary conditions can arise and begin to present themselves on the skin.
3 top pigmentation skin conditions and lesions:
Melasma – Melasma is a pigmentary skin condition which is often caused by hormonal changes such as pregnancy, and sun exposure. You will often see splotches of hyperpigmentation typically around the cheek and forehead area. Studies have shown that those that suffer from melasma often have an increase in melanocytosis and melanogenesis. Melanocytosis is an increased number of melanocytes and melanogenesis in an increased production of melanin [5].
Sun damage – Sun damage can come in many forms. This can be a mixture of different pigmentary lesions such as solar lentigo. This is due to excessive UVA exposure which degrades our skin. Sun damage is found within your epidermis as well as your deeper layer; the dermis [6] and typically occurs over time, as we age.
Freckles – Also known as ephelides. This can be found in individuals of all ages and formed due to genetics a lot of the time. If you have freckles, a lot of the time someone else in your family probably does too. Of course, ephelides can also arise from sun exposure as well. It has been found that the melanocytes in ephelides are larger and have more numerous dendrites [7].
Treatment options:
Melasma – Melasma doesn’t like heat too much, so we do need to be careful when treating with laser-based devices. In the treatment room, Cosmelan is a modality that we usalites a lot of the time when it comes to treating melasma. Cosmelan is a treatment devised by Mesoestetic and involves the use of a depigmenting solution that is kept on the skin for around 8-10 hours after application. The solution is corrective and regulates the production of melanin within the skin [8].
Sun damage – Fraxel is your go-to. Fraxel is a non-ablative fractionated laser and works at resurfacing skin texture while leaving the stratum corneum intact. Most of the time, clients will only need 1 treatment for an incredible result [9]. Fraxel works by creating Micro-thermal zones (MTZ) and collects dermal debris like melanin, collagen and elastin. This dermal debris is called Micro-epidermal necrosis debris (MEND) and this is bundled up and removed via the epidermis. Essentially, the debris gets shot up through the epidermal layer of the skin, almost like an elevator, and is removed via natural healing processes, leaving the skin fresh and even. Not only this, Fraxel causes the skin to induce the inflammatory cascade where new collagen formation occurs [10], so this can be perfect for treating fine lines and wrinkles.
Freckles – IPL stands for Intense Pulsed Light and is a modality used widely for the treatment of freckles [11]. IPL works by targeting melanin within the skin and stimulating basal cell mitosis, which basically causes a rapid acceleration of keratinocytes that hold the melanin due to the heating effect. This causes an upwards transfer of melanosomes and dead keratinocytes and thus, is removed via the skin surface in the form of micro-crusts [12].
Must-have products –
– Medik8 Oxy R Peptides – A great go-to pigment inhibitor. This product contains 1% Oxyresveratrol and is perfect for suppressing pigmentation from stimulating.
– Skinceuticals Phortin – A new one on the Flawless Rejuvenation shop. Containing Phloretin, 10% L-ascorbic acid (vitamin C), Ferulic acid so it is perfect for any form of pigmentary condition, especially melasma.
– The Skincare Company B3 – Niacinamide. One of the best ingredients to stop that tyrosinase/pigmentation transfer.
References:
Ref 1, 4 –
Ebanks, J. P., Wickett, R. R., & Boissy, R. E. (2009). Mechanisms regulating skin pigmentation: the rise and fall of complexion coloration. International Journal of Molecular Sciences, 10(9), 4066-4087. https://doi.org/10.3390/ijms10094066
Ref 2 –
Yamaguchi, Y., Brenner, M., & Hearing, V. J. (2007). The regulation of skin pigmentation. Journal of biological chemistry, 282(38), 27557-27561. https://doi.org/10.1074/jbc.R700026200
Ref 3 –
Ando, H., Niki, Y., Ito, M., Akiyama, K., Matsui, M. S., Yarosh, D. B., & Ichihashi, M. (2012). Melanosomes are transferred from melanocytes to keratinocytes through the processes of packaging, release, uptake, and dispersion. Journal of Investigative Dermatology, 132(4), 1222-1229. https://doi.org/10.1038/jid.2011.413
Ref 5 –
Sarkar, R., Arora, P., Garg, V. K., Sonthalia, S., & Gokhale, N. (2014). Melasma update. Indian dermatology online journal, 5(4), 426. https://doi.org/10.4103/2229-5178.142484
Ref 6 –
Longo, C., Casari, A., Beretti, F., Cesinaro, A. M., & Pellacani, G. (2013). Skin aging: in vivo microscopic assessment of epidermal and dermal changes by means of confocal microscopy. Journal of the American Academy of Dermatology, 68(3), e73-e82. https://doi.org/10.1016/j.jaad.2011.08.021
Ref 7 –
Praetorius, C., Sturm, R. A., & Steingrimsson, E. (2014). Sun‐induced freckling: ephelides and solar lentigines. Pigment cell & melanoma research, 27(3), 339-350. https://doi.org/10.1111/pcmr.12232
Ref 8 –
Mesoestetic (n.d.) Cosmelan. https://www.mesoestetic.com/professional/lines/cosmelan
Ref 9 –
Preissig, J., Hamilton, K., & Markus, R. (2012, August). Current laser resurfacing technologies: a review that delves beneath the surface. In Seminars in plastic surgery (Vol. 26, No. 03, pp. 109-116). Thieme Medical Publishers. https://doi.org/10.1055/s-0032-1329413
Ref 10 –
Rahman, Z., Alam, M., Dover, J. S., & Lett, S. T. (2006). Fractional laser treatment for pigmentation and texture improvement. Skin therapy letter, 11(9). https://www.skintherapyletter.com/hyperpigmentation/fractional-laser-treatment/?amp
Ref 11 –
Fischer, D. L., Han, H., Gade, A., & Nestor, M. S. (2021). Intense pulsed light for the treatment of pigmented and vascular disorders and lesions: A review. Dermatological Reviews, 2(2), 69-81. https://doi.org/10.1002/der2.47
Ref 12 –
Goldberg D. J. (2012). Current trends in intense pulsed light. The Journal of clinical and aesthetic dermatology, 5(6), 45–53. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390232/