Melasma, sun spots and post-inflammatory pigmentation.
Doctor Tiina Meder: “Skin hyperpigmentation is a common aesthetic problem, but few people know how unfair it is. People of color are more likely to suffer from pigmentation, due to differences in the structure and functionality of the skin, including pigment content and cell distribution patterns.
Hyperpigmentation can be superficial (epidermal) or deep (dermal) or mixed, it can be localized or generalized. Aesthetic medicine is clearly more interested in localized pigmentation, i.e. pigment spots etc.
The most common hyperpigmentation disorder is melasma, which mainly occurs on the face, neck and arms. Women are more likely to get it than men and people of color much more often than whites. The main risk factors are skin phototype (with a prevalence of Fitzpatrick III and IV), genetic background, hormone levels (particularly during pregnancy and while taking hormonal contraceptives) and sun exposure. Simply put, if you are a white male who works from home, your chances of melasma is virtually non-existent, while if you are a dark-skinned woman taking a pill, you can get melasma from even a little sun exposure during your commute.
Melasma can be much more visible if it is superficial (epidermal) and less visible if it is deep (dermal). In very dark or black skin, deep melasma is not visible, only visible with the help of Wood’s lamp. Despite being harmless, melasma often causes significant emotional and psychosocial problems. For example, 94% of Brazilian women diagnosed with melasma report suffering from it, 65% frustrated and 53% even depressed because of their skin condition. Treating melasma is difficult, time-consuming and expensive, so prevention is very important.
The most important rule to prevent pigment spots: screen out risk groups! (Where have we heard this before?). Women with III, IV phototypes and skin color should use sunscreen when IUV is 3 and above (even on a cloudy day check the UV index on your weather app or a weather website). If you are pregnant or on hormonal contraception, and especially if you have a family history of hyperpigmentation disorder, it is good to minimize your sun exposure during the day from 10am to 5pm when you continue to use SPF 50+, at least for the face. A wide-brimmed hat and trendy sunglasses are a must!
Dermatologists also recommend the daily use of antioxidant skin care products to reduce potential UV damage and enhance the skin's natural defenses. The rest of the population can follow the standard recommendations: protect the skin according to the IUV intensity and the standard WHO recommendations.
PIH (post-inflammatory hyperpigmentation) is considered a normal biological response to injury or inflammation. Several skin conditions can lead to PIH, including atopic dermatitis, acne, psoriasis (oddly enough, it is unlikely for rosacea) and skin injuries, including aesthetic treatments such as chemical peels, laser RF treatments, injections and others.
Again, it is more common in people of color and white people with dark skin, while sex is not relevant in this case. PIH can take months or even years to fade, it is easier to prevent than to treat. If you suffer from acne and atopic dermatitis, you should minimize your sun exposure – this is not the time to sunbathe! The use of sunscreens with a high SPF is mandatory and antioxidants/anti-inflammatory products are also recommended for your daily routine. Look for products that contain centella asiatica, aloe vera, green tea, malva sylvestris and resveratrol. Niacinamide and tranexamic acid can lighten the skin while improving the skin's natural resistance and protection.
When talking about sun spots, also called solar lentigines, it is important to understand the difference - these are not classic hyperpigmentation disorders, but rather benign hyperpigmented macules scattered over areas of chronic sun exposure (face, neck and arms). They usually occur in old age, but can appear at a younger age after acute UV exposure (although very rarely before 40). Sun spots are quite common in Caucasian and Asian elderly people, and much less common in people with skin types III, IV and darker. Solar lentigines are characterized by well-defined fringed macules ranging in diameter from a few mm to more than 1 cm. They do not fade with time and are considered a sign of photoaging. They have less impact on emotional comfort than other hyperpigmentation disorders, probably because they are perceived as normal by most. The only way to prevent solar lentigines is to have regular and consistent sun protection from an early age, including monitoring sun exposure, using sunscreen, and maintaining good skin health.”
