Pigmentation

The colour of our skin is made of three components – melanin,
collagen, and vasculature (blood vessels). The yellow in skin tone
is imparted by collagen, and the pink shades by the vasculature.
Most pigmentary disorders, however, are associated with excess
melanin. Melanin is a brown pigment produced in the skin by
special cells called melanocytes. Under the influence of sunlight
(UV) and hormonal factors, melanin levels can become uneven
across the skin, resulting in blotchiness, brown spots, and more
seriously, cancer.

Cosmetically, the most common pigmentary presentations are
melasma and Diffuse Sun-related Hyperpigmentation (DSH).
Melasma is a condition which usually occurs in younger women,
and is influenced by both solar radiation and hormones. DSH is
seen more in women over the age of 30, and presents as large
slightly ash-brown areas that appear obvious in strong light and
gives the forehead a dull, lifeless appearance. Melasma and DSH
are caused by skin pigment cells (melanocytes) producing excess
pigment (melanin). 
 
Treatment of both these conditions involves:
1. Melanin inhibitors (compounds that prevent the
melanocytes producing melanin)
2. Sunscreens (used 365 days of the year)
3. Time (treatment usually takes 6-12 months)
 
 
 Topical niacinamide has been shown to suppress the distribution
of pigment from the cells where it is made to the regular skin
cells. Niacinamide is an extremely effective and gentle long-term
maintenance therapy for pigmentation, and can also be used in
conjunction with hydroquinone to enhance the initial treatment
process. It should be used daily under sunscreen.
 
At night, regular use of a vitamin A compound called
retinaldehyde helps to inhibit pigmentation, by blocking pigment-
stimulating enzymes. 
 
Sunscreens are vital in the prevention of pigmentation, because
solar radiation is essential in initiating pigmentary changes. The
most effective sunscreens for preventing pigmentation contain
Zinc Oxide and Titanium Dioxide. Layering different kinds of
sunscreens provides maximum protection from UV light. 
 
Other intensive short-term therapy courses can also help fast-track the reduction of your pigmentation. Options include Vitamin A peels,
prescription-only retinoic acid/hydroquinone creams, chemical
peels, IPL (Intense Pulsed Light), and other laser modalities.