Beauty advice on hyperpigmentation

All of the treatments and solutions to hyperpigmentation

By Helen Brown

If research by cosmetics monolith P&G is to be believed, conquering uneven, discolored skin could be the anti-ageing war's biggest battle. They say that facial skin discolouration can make a woman look 20 years older. And the problem is worryingly widespread. Clinique claim that one in four women are concerned with hyperpigmentation, while a random street survey of post-holiday complexions shows that, rather than a sun-kissed glow, the thing that belies those hazy days basking in the sun most is a facial feast of age spots, mottled brown patches and giant freckles.

 

 

What is hyperpigmentation?

Hyperpigmentation is an unusual darkening of the skin characterized by flat brown lesions known individually as lentigo.

What are the prime causes?

"The main cause is exposure to sunlight," states Dr Nick Lowe, Consultant Dermatologist at Cranley Clinic, London (www.drnicklowe.com). "We think it is the longer waves of UVA that cause most hyperpigmentation. It takes 20-30 years for this damage to show up which means that most people with this problem probably weren't using sunscreen with adequate UVA protection in the past."

Raging hormones can also play a part. A butterfly-shaped darkening of the skin known as chloasma can often appear across the cheeks, upper lip and forehead during pregnancy or in women taking the contraceptive pill.

How can we reverse the signs?

Some hormone-induced pigmentation can fade away on its own as the hormones balance out again. After pregnancy, for example, a case of chloasma may disappear entirely so it is not worth treating it until several months after you have given birth. However, sun-induced hyperpigmentation usually needs a helping hand.

First, make sure your skin is shielded from all of the sun's harmful rays at all times. "It is still very difficult to get the message across that if you don't use adequate sun protection year round you will automatically get skin darkening," says Lowe. That means choosing a sunscreen with broadband protection against both UVA and UVB rays. Next, start prepping the skin with home micordermabrasion products or intensive alpha hydroxy acid-based exfoliators which encourage the skin to shed dead skin cells, making it easier for any products applied afterwards to penetrate to the deeper layers of skin. The treatment products to use next are ‘brightening' serums and creams that contain skin-lightening ingredients such as antioxidants (especially vitamin C), licorice extract, mulberry extract and niacinamide which interfere with the action of the enzymes that cause dark spots to form.

How can I stop it recurring?

Total commitment. "You need to continue using treatment creams and sunscreens indefinitely on a maintenance basis," says Dr Lowe. "I always tell my clients it is pointless having expensive treatments if you aren't prepared to do that."

Ditto avoiding the sun. Maintaining a hyperpigmentation-free complexion may means lifestyle changes: no more excessive stints in the sun and keeping your skin shaded with sunglasses and a wide brimmed hat if you have to be under its glare is a must.

What sort of result can I expect?

"The effects depend on how diligent you are about combining protection with treatment products. You need to use them for at least 6 months" stresses Dr Lowe. It is unlikely they will disappear entirely using off-the-shelf products but you should notice a visible fading.

What about more extreme cases?

For severe or persistent cases it is worth consulting your GP or a trained dermatologist (contact the British Association of Dermatologists; www.bad.org.uk). They may prescribe you more intensive skin lighteners such as retinoic acid or hydroquinone, or a course of treatments.

With the latter, the emphasis should be on treatments that speed up skin cell turnover, encouraging the shedding of the upper layers of skin and along with them the dark spots, such as microdermabrasion or chemical skin peels. Pigmentation-specific IPL (Intense Pulsed Light) or laser treatments are also very beneficial: these expose dark patches to wavelengths of light that attack and destroy the pigment so the skin has to shed and heal it in the same way that it would another kind of wound.

Top pigmentation products

ESPA Super Active Skin Brightening Complex, £45; www.espaonline.com

Skin elicited compliments for being noticeably clearer after six week of using this lightweight serum whose radiance-boosting capabilities come from vitamin C-rich sea fennel, licorice and bearberry.

Clinique Even Better Skin Tone Correcting Moisturizer SPF 20, £32, available nationwide from 1 October

The latest in Clinique's Even Better hyperpigmentation range is this trusty day moisturizer with broadband UVA and UVB protection. The key ingredient is a patent-pending yeast complex based around a fungus that has the ability to break down melanin (which is responsible for skin pigment) in its natural forest habitat. In tests age spots were reduced by 45% after eight weeks.

Dr Nick Lowe Brightening Radiance Complex, £16.59, from Boots

It is reassuring to know you don't have to spend a fortune to get a cream with the ingredients you need to tackle uneven skintone. This one contains skin brightening licorice, reparative niacinamide and the potent antioxidant ferulic acid. Instant effects are a flattering soft gleam and pebble-smooth skin.

NIA24 Skin Strengthening Complex, £70; spacenk.com

A rich, non-greasy cream based around Pro-Niacin, a patented form of niacin (vitamin B3) that has impressive clinical clout. In tests it has proved so effective at counteracting sun damage (patients saw a 90% reduction in hyperpigmentation) that the National Cancer Institute in the US are now investigating its potential to help prevent skin cancer.

Dermalogica ChromaWhite TR range; dermaologica.co.uk

A comprehensive whitening range that remarkably starts to make skin look fresher in under a week. Key products include the Powerfoliant (£51.50), a liquid exfoliator with salycilic and lactic acid to thoroughly eat away at dead skin cells and the C12 Concentrate (£65) which contains a peptide that inhibits the action of the enzyme tyrosinase that is responsible for melanin formation.

Top hyperpigmentation treatments

If you are serious about tackling persistent age spots, you may need to check yourself in at the dermatologist's clinic for an intensive problem-solving treatment. Do your homework first - some of these procedures can be costly while others are painful and carry risks.

Microdermabrasion

What is it? An intensive exfoliating treatment during which tiny particles of a hard, granular substance such as zinc or aluminium oxide or silica are blasted at the outermost layer to remove the dead skin cells and encourage newer, less damaged, skin cells to come from below to form a new surface layer, giving a fresher appearance and minimizing light hyperpigmentation. It takes around 10-30 minutes per treatment and can be performed once a week for 5-10 weeks.

Nitty gritty A low risk procedure, there is no down time and no notable side effects; some may find it mildly scratchy and skin may look a little red immediately afterwards but this soon fades.

Cost £40-70 for half an hour

Chemical Peel

What is it? Peels involve a chemical solution being applied to the skin to remove the outermost layers of skin where hyperpigmentation is most visible. There are three intensities: superficial (which target the epidermis and primarily use glycolic acid), medium (which work on the epidermis and the upper dermal layers and use trichloroacetic acid) and deep (which work on the deeper dermal layers and use phenol or stronger solutions of trichloroacetic acid).

Nitty Gritty With a superficial peel you can expect to feel a slightly uncomfortable tingling sensation during the treatment and to have blotchy, pink skin for a short time afterwards. A medium depth peel usually induces a painful burning sensation and causes the skin to swell; it will then turn dark brown before starting to shed 5-6 days later. Once the peeling process is completed skin will appear red; this usually fades over the next month or two but in some cases it can last longer. Deep peels are not to be undergone lightly: usually performed using local anaesthetic, they are very painful, cause extreme swelling afterwards and require up to 6 weeks recuperation time.

There is a risk that chemical peels may also cause skin bleaching so they aren't recommended for black or Asian skin.

Cost Around £60 for a superficial peel; around £150 for a medium depth peel; around £2000 for a deep peel.

IPL

What is it? Similar to laser treatment, Intense Pulsed Light uses specific wavelengths of light to cause heat damage to the dermis, prompting the skin to heal itself and in doing so shed the damaged layers.

Nitty Gritty It is commonly agreed that IPL feels like having rubber bands snapped against your skin. Each flash of light gives a small shocking stab but it is tolerable and a facial treatment only takes about 15 minutes. Initial skin redness dies down quickly. In some cases there can be blistering and subsequent scarring but it is rare. There is also a risk that IPL may in fact exacerbate pigmentation if skin becomes inflamed so it is important to choose an experienced dermatologist who knows how often to repeat the procedure and how to use it in conjunction with other methods.

Cost From around £100.

Fractional Laser skin resurfacing

What is it? Unlike the traditional ablative lasers that are used for skin resurfacing, fractional lasers only damage certain areas in the zone being treated (like choosing certain pixels on a TV screen). This leaves the areas inbetween completely intact, so, while the results are comparable to traditional laser resurfacing, fewer areas of skin are damaged so there is no down-time.

Nitty Gritty The Fraxel SR, the most common fraxellated laser in the UK and that used by Dr Lowe, is approved by the notoriously stringent US FDA and results can be impressive but there are risks. The procedure can be painful (local anaesthetic is sometimes used) and skin looks raw and sunburned afterwards. In some cases pigmentation may worsen if it ends up inflaming the skin. 3-5 sessions are recommended.

Cost £250 for a small area-£750 for a full face.

 

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