Pigmentation skin care guide

Pigmentation skin care guide

Dr Davin Lim | Dermatologist The Melasma Clinic, Brisbane | Sydney
Best ingredients: Arbutin, ascorbic acid, hydroquinone, Kojic acid
Worse ingredients: Lemon juice, Citrus extracts-oils
Best treatments: Pico lasers, chemical peels, skin care

What creams are best for pigmentation?

There are many ingredients that can reduce unwanted pigmentation. Their success is largely dependent on the cause of pigmentation. Look for the following ingredient list:

Hydroquinone (HQ) is the strongest anti-pigment ingredient. OTC is maximal at 2%, some OTC mask formulations in Australia contain up to 8% Hydroquinone. Dermatologist prescribed creams range between 3 to 10%. In some cases we add tretinoin & an anti-inflammatory with HQ to give Kligman’s formulation. HQ use should be supervised as there are long term side effects.

Vitamin C or ascorbic acid is another pigment buster. It acts in two ways, first as a protectant of UV (free radical scavenger), secondly as a molecule that blocks formation of pigment (tyrosinase inhibitor). Formulations range from 5 to 20%, with L-ascorbic acid being the most powerful isomer. This ingredient should be used in extreme caution in patients with sensitive skin, including eczema, rosacea & acne.

Arbutin can decrease pigmentation as it is an enzyme blocker. There are two forms of this molecule, alpha arbutin, manufactured in a laboratory & beta arbutin, found naturally in many botanicals. This compound is regulated in Australia. There are no long term side effects of this compound, even though it gets converted to hydroquinone.

Kojic acid: Is found naturally. Concentrations range from 1-3%, any higher & the risk of irritant & allergic contact dermatitis exponentially increases. Kojic acid is found naturally & is the most popular skin brightener & whitener in Asian countries. In conservative concentrations there are no issues regarding long term use. This is one of my favourite ingredients to use during the off cycle of hydroquinone.

Azelaic acid: Again this is found in nature. It decreases inflammation & reduces pigment production via the tyrosinase enzyme pathway. Concentrations vary between 10 to 20%, with the gel formulation being the most stable. Super safe ingredient make this the number one choice for treating acne, PIH, & melasma in pregnancy.

Citric, Lactic & Glycolic Acids: These are AHA’s or alpha hydroxy acids & function as a chemical exfoliant. Concentrations range between 2 to 15% in a buffered base with pH of greater than 3.5. No neutralisation is required for OTC creams, lotions, gels & washed.

Botanicals: This group of pigment correctors include bearberry, cranberry, liquorice root extract, ginseng, green tea, & flavonoids. The most studied plant based products for pigment is liquorice root. These natural molecules are invaluable in dermatology, used most often during the off cycle of hydroquinone.

Cysteamine: This skin whitener has received a lot of publicity over the past few years. Regulated in some countries, it can reduce pigmentation & like other pigmentation inhibitors is best for the off cycle or rest period during HQ therapy. Limited as a compounded solution due to the odour.

Retinol/Retinoic Acid: Flexible molecule that reduces pigment production & acts as a superficial chemical exfoliant. Found in many formulations including prescribed Kligman’s through to OTC pigment correctors.

Tranexamic Acid: This trending ingredient modifies the blood vessels that interacts with the pigment producing cells. Best used as a tablet, followed by intradermal injections & lastly topical creams ranging in concentration between 0.5 to 5%. As of 2020 there are limited papers showing efficacy of topicals.

Novel formulations: Include Cosmelan, Meladerm, Melacream, Melarase, Lytera & dozens more masks, & topicals. These formulations contain a mixture of the above ingredients together with proprietary ingredients. I do think they can be occasionally useful during the off period of HQ.

How do I know what is the best ingredient for my pigmentation?

As always a diagnosis is super important. For example sun spots or age spots will require stronger formulations of skin acids or lasers, whilst melasma will generally respond to pigment inhibitors. This is further compounded by your current skin care routine & most importantly your skin sensitivities. Be guided by your skin care expert.

* Disclaimer: I am a procedural dermatologist, my expertise is diagnosing & managing difficult cases of it, including birthmarks, recalcitrant melasma, & unknown causes of pigmentation. Majority of this causes including sun spots, freckles, mild to moderate melasma can be managed by my team of dermal therapists & nurses @cliniccutis

What sunscreens are best for pigment?

Sunscreen is hugely important in preventing & treating hyperpigmentation. It prevents activation of pigment producing cells, leading to brown spots and PIH (post inflammatory hyperpigmentation), which is the hyperpigmentation that develops after acne.

Mineral sunscreens protect your skin by physically blocking and reflecting UV light, which is why they’re also known as physical sunscreens. They offer good protection against UVB & UVA. Chemical sunscreens take about 20 minutes to begin working, mineral sunscreens start protecting the skin as soon as they’re applied. My favourite sunscreens include Melan 130, La Roche Posay & Zinc based SPFs.

What is the best way to treat melasma pigmentation?

This form of pigmentation is super common affecting up to ⅓ of women. The best cream for fading melasma hyperpigmentation is hydroquinone, however this ingredient should be limited to finite timeframes. HQ is rotated with azelaic acid, Kojic Acid, retinol & botanicals. Vascular modulators are second line therapy, followed by lasers.

For more information on how I manage this condition go to @101.skin IG or refer to the YouTube videos & many article write ups, including the melasma homepage.

How do I get rid of dark undereye circles?

This is one of the most complex algorithms to manage as there are many factors that give rise to it. For patients with deep tear troughs, dermal fillers with hyaluronic acid can replace volume & rehydrate skin. Dark circles due to increased blood flow is termed vascular. Lasers & creams that contain peptides, argan oil & caffeine can reduce vascularity in a minority of patients.  Post inflammatory pigmentation can be treated with pigment inhibitors as well as gentle laser toning procedures. Constitutional or genetic pigmentation is extremely difficult to treat.

What are the best creams for acne pigmentation?

There are several standout topicals for PIH secondary to acne. These include-

  • Azelaic Acid as this reduces pigmentation & treats acne.
  • Retinol & retinoic acid also reduces breakouts & addresses PIH
  • AHA’s & BHAs act as exfoliants, speeding up pigment extrusion & unclogging pores
  • Hydroquinone as a spot treatment

How do you treat pigmentation in pregnancy?

Melasma is the most common cause of it in pregnancy, often referred to as ‘The Mask of Pregnancy.’ Sun protection is paramount, creams such as AHAs, low strength BHAs, azelaic acid, liquorice root extract & green tea are all useful & safe in pregnancy.

What are natural ingredients for treating skin pigmentation?

Botanical extracts are the safest & most effective anti-pigment ingredients. These include soy, green tea, alpha arbutin, liquorice root, flavonoids, bearberry & stabilized fruit extracts, including citric acid. These ingredients have been used for centuries, however they are relatively new in the dermatological world of naturopathic topicals.

How long does it take for pigmentation to fade?

It can take 12 to 52 weeks for PIH to fully fade. The length of time it takes for PIH to fade depends on how dark the spot is compared to the surrounding skin. The bigger the contrast between pigmentation & your natural skin tone, the longer it will take to fade. In general red pigmentation, known as PIE is easier to treat compared to brown pigment.

What are the home remedies for pigmentation?

The following is authored for Search Engine Optimization only. In Asia and the middle east, there are many home remedies for pigmentation, some provide promise for fast overnight results, others provide a solution for permanent pigmentation removal without side effects. There are many recipes for treating pigmentation ranging from vinegar, through to turmeric, lemon juice, through to the reported ingredients below. Dermatologist will advise against the use of the ingredients listed, however you have to make up your mind on what is safe & appropriate for you.

  • Raw Potato and Lemon Mask. (Comment: Not safe)
  • Lemon Juice and Honey. (Comment: Not safe)
  • Apple Cider Vinegar and Water.
  • Vitamin E, Papaya and Multani Mitti Mask
  • Turmeric and Milk Mask.
  • Aloe Vera and Honey.
  • Orange Peel Pack.

Whatever you do, don’t combine lemon juice or citrus juice including lime with UV, this results in a phyto photodermatitis and PIH that may last 1-3 years.

How do dermatologists treat pigmentation?

A firm diagnosis is required prior to pigment correction. There are over 150 causes of it, including age related, sunspots, melasma, PIH, birthmarks, drug induced. Etc Based upon the cause of pigmentation, dermatologists can prescribe targeted skin care, chemical peels, lasers & BBL.

What is the main cause of pigmentation?

A common cause of hyperpigmentation is an excess production of melanin. Melanin is a pigment that gives skin its colour. It’s produced by skin cells called melanocytes. Several different conditions or factors can alter the production of melanin in your body, including genetics, hormones & UV exposure. Conditions like melasma, freckles & race related pigmentation are genetically determined. Whilst PIH or post inflammatory hyperpigmentation is primarily due to conditions like acne.

Davin’s ProTip on Pigmentation Creams

Above all, the biggest factor in determining therapy and prescription patterns is the diagnosis. This is essential. THere are well over 150 causes of pigmentation, ranging from birthmarks, constitutional, through to acquired causes including PIH, melasma, & drug induced. Traditional pigment reducing topicals such as HQ or hydroquinone carry safety concerns over long term use, additionally medium to high concentrations are irritating on the skin. Be guided by your skin care expert as to what to use.

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