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Lifting the mask 11 March 2015 The treatment of hyperpigmentation can be the most challenging or the most rewarding treatment that you can offer in your aesthetic clinic. Effective treatment of hyperpigmentation takes a long term commitment from your patient and yourself in order to achieve the ultimate results. What Causes Pigmentation? Pigmentation can be caused by anything from hormonal changes to overexposure to the sun. It is a condition that can make the skin tone appear uneven and in darker skin types often dull. Most patients suffering with pigmentation on their face need to wear heavy foundation in order to camouflage these marks and feel comfortable in a daily environment. There is a pigment found in our skin called melanin which is responsible for protecting us from harmful ultraviolet rays. Melanin can increase (hyperpigmentation) or decrease (hypopigmentation) beyond normal levels which can change the skin colour. When the skin overproduces melanin which is generally related to sun exposure, acne scarring, female hormonal changes, nutritional deficiency or prescription drugs, hyperpigmentation can takes place. Hyperpigmentation is more typical in patients with type four to six skin colouring. Hypopigmentation is mostly associated with the skin disease known as vitiligo but can also occur as a result from injury. General pigmentation should be considered a warning sign from the body that the affected area has received too much sun exposure. Melanin is part of the skin’s natural barrier defence system that protects the skin against exposure to ultra violet radiation, DNA damage caused by ultra violet radiation is one of the most aggravating factors of excessive pigmentation.  Sunlight is essential for Vitamin D and healthy bone development but daily exposure over extended periods of time can cause major damage to the skin. Sun exposure causes free radical damage to the cells, forcing the aging process to accelerate.  Simply by exposing skin to the sun, the level of vitamin C in the skin drops by 30%, and subsequently free radicals are formed. In addition, ultra violet radiation inactivates the vitamin A receptors which are required for cell replication. Free radicals cause abnormal melanin production and impaired DNA/cell replication. Chloasma and melasma is a very common type of hyperpigmentation that is found on the facial skin of females, this type of pigmentation is generally a localised dark spot found on the forehead, cheeks and around the mouth, the marks are generally symmetrical and found on both sides of the face, this type of pigmentation is caused by an increase in oestrogen production during pregnancy or use of the contraceptive pill combined with exposure to the sun. Another type of pigmentation is senile lentigo which starts to appear with age, from about 50 years. This lesion is generally found on the hands, forearms and sides of face. All of the above forms of hyperpigmentation are impossible to get rid of without treatment. How do you effectively treat pigmentation? Pigmentation can be improved through specialist treatments that can be carried out by medical practitioners and also with targeted creams which have concentrated active ingredients. After a clinical assessment with either a skin scanner or a woods lamp, the medical practitioner can identify the type and the cause of the pigmentation and also the histological level on which the excess pigmentation is located. This is because if the treatment is to be effective it is imperative to work on the deepest level of the lesion.  Once the cause and depth of the pigmentation is understood treatment can be implemented, this could possibly be in the form of a chemical (peel) or a mechanical (liquid nitrogen and laser) exfoliation. In both chemical and mechanical the aim of the treatment is to eliminate the upper layers of the skin that contain the pigmentation and allow the skin to renew itself with more even pigment. Results on pigmentation can be intensified with the use of preparatory treatments before to prepare the skin for the treatment and post treatment that can help to enhance the results even further.  Pigmentation treatments are always best carried out in winter to reduce exposure to the sun and prevent further pigmentation developing. Patients should never go outdoors without a high level of sun protection. Treatments that can be used: Cryotherapy: (liquid nitrogen) this involves the general freezing of the skin with liquid nitrogen. It works by destroying the melanocytes, and exfoliating the skin. The skin will scab and then fall off after about 4-6 days. The skin will remain pinkish for about 6 weeks post and it is essential that the patient avoids sun exposure. This process generally works well on senile keratosis and one treatment is generally required. Lasers: This type of equipment is able to work in a very controlled precise way directly on the accumulations of pigment. This method destroys the melanin responsible for these marks using heat given off by the laser.  The treatment can be applied on the face, décolleté, hands and forearms. The skin will generally be red for 3-6 days post the treatment, the new skin growth after 6 days remains pink for a further few days depending on the depth of the laser treatment and the skin type being treated.  Intense pulsed light therapy: This type of treatment destroys the pigmented area without damaging the surrounding skin. An improvement can be found after about two or three sessions. The treated area tends to become darker first and then thicken and drop off leaving new uniform skin in its place. Peels:  Skin peels are proven treatments for pigmentation and is an easy non-invasive solution. The advantage of a peel is that the active depigmenting ingredients can penetrate the skin and work on the deepest pigmentation and on the melanin production.  They can be either a superficial peel with no real after effect, or a slightly stronger medium depth peel where the shedding will last 2-3 day post peeling. The result with peeling is gradual and the use of homecare products will greatly intensify the results.
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