Skin Pigmentation overview
The Pigmentation (melanin) of your skin is produced by special pigment cells called Melanocytes. Each person has the same number of these Melanocytes in our skin, approximately 60,000 per square inch.
Melanin is produced as small, insoluble granules. Where there are no melanin granules, the skin is white – the more melanin granules, the darker the skin. The variations of particular skin colour – tan, brown, black – depend upon the concentration of these granules in the epidermis.
Variations in the colour or pigment of each persons skin depends on a variety of different factors. These can include the size and shape of the melanocytes, the amount of melanin they produce, the speed at which the pigment is formed, the way the pigment is concentrated in the skin and the colour of the melanin, which can vary from light tan to black.
Most skin pigmentation disorders occur because the body produces either too much or too little melanin, a pigment that creates hair, skin, and eye colour. Melanin protects the body by absorbing ultraviolet light.
The most common cause of excessive skin pigmentation is an increased stimulation in the production of melanin, caused by hormonal changes – with pregnancy or contraceptive pills, sun exposure or combinations of these factors.
People of all races have skin pigmentation disorders. Some disorders, like albinism are rare; others such as age spots / brown spots, freckles and pigmentation (hyperpigmentation and hypopigmentation) are more common.
Conditions & causes of Skin Pigmentation
Melasma appears as a dark, splotchy, brownish pigmentation on the face. It usually affects women but occasionally is seen in young men who use aftershave lotions, scented soaps and other toiletries, which is then exposed to the sun. Melasma usually develops on the forehead, cheeks, or top lip (moustache area) of the face.
It occurs frequently during pregnancy and is more common in brunettes than in blondes. Often called 'the mask of pregnancy', melasma is more pronounced in summer due to sun exposure and usually fades a few months after delivery. Repeated pregnancies, however, often increase the intensity of this pigmentation. Melasma also occurs as a side effect of taking the higher-dose birth control pills and is usually a harmless hormonal imbalance.
Sun exposure can also contribute to a mottled skin pigmentation and sun spots and is usually the result from what we call a 'phototoxic reaction'. This is due to ultraviolet radiation being absorbed by the chemical substance (perfume, cologne, and other types of fragrance) on the skin. This type of pigmentation often extends down to the sunexposed areas of the neck and may be more pronounced on the left side of the forehead, face, and neck due to sun exposure while driving a car.
Age Spots/Liver spots (lentigines) and freckles (ephelides) are tan or brown spots that appear over time on sun exposed areas of skin. These spots are common on the backs of the hand, face and legs. Those who tan extensively will also have them over the shoulders, back, chest and many other areas of skin.
Lentigines are superficial collections of skin pigment called Melanin, which have accumulated within the top layer of skin (the epidermis). Freckles are common in lighter type skin in individuals who sunburn easily. Freckles occur even in children after brief periods of sun exposure. Sometimes, older people who have these lentigo-type freckles also have raised, brown, crusty lesions called Seborrhoeic Keratoses.
Seborrhoeic Keratoses are most often brown but they can differ in colour and range anywhere from light tan to black and can occur in different sizes, ranging anywhere from very small to 2.5 cm in diameter. Seborrheic keratoses may occur in the same areas as freckles but since they are not caused by sunlight, they can also be found on covered areas. The telltale feature of Seborrhoeic Keratoses is their waxy appearance, they look like they have either been pasted on the skin or may look like a dab of melted brown candle wax that dropped on the skin. When they first appear, the growths usually begin one at a time as small rough bumps. Eventually they thicken and develop a rough, warty surface. Almost everybody eventually develops at least a few Seborrhoeic Keratoses as they tend to become more common with age.
Hypopigmentation means the body does not produces enough Melanin. Albinism, for example, is an inherited condition that causes a lack of pigment. Vitilgo affects nearly 2% of the population, but it strikes people 10 and 30 years of age more often, and is more evident in people with darker skin.
Hyperpigmentation is a darkening of the skin. This darkening of the skin may be generalized (happen all over) or localized, causing blotchy skin. Hyperpigmentation can be caused by many factors, from too much sunbathing to drug reactions. Wounds and scars also can develop darker patches of skin.
The mask caused by Melasma may be related to pregnancy hormones, and usually disappears after a woman gives birth. Birthmarks, moles, and aging spots usually are harmless. Some moles, however, can change in size, colour, texture, or start bleeding, which could indicate possible skin cancer.
Skin Pigmentation treatment options
Pigmented skin spots can be treated in a variety of ways. Freezing (with liquid nitrogen), chemical peels, micro-dermabrasion, bleaching agents and lasers.
Lasers are best used for some types of skin pigmentation as they are much more precise and cause little if any damage to the surrounding skin. As Dr Rich has the most up to date lasers available, he is able to offer a variety of lasers and light systems including the XPL (Xenon Pulsed Light), Medlite YAG and Ruby laser as well as other lasers (Alexandrite and Gemini) all of which are capable of safely removing lentigines (brown spots), freckles and other flat-pigmented spots and birthmarks. See Laser Therapy for more information.
XPL is ideal for skin that shows evidence of chronic exposure to the sun's ultraviolet light. "Photo damage" includes changes to the skins texture, irregular pigmentation, and enlarged blood vessels and pores.
Chemical peels can be used to treat a variety of skin concerns including acne, rosacea, fine wrinkling, blotchy pigmentation (brown spots), ingrown hairs, sallow complexion and dry skin. Chemical peels are most often performed on the face but may also be beneficial on the neck, chest, back, hands, arms and legs.
At Dr Michael Rich's – the enRich Dermatology & Cosmetic Surgery Centre, there are five types of chemical peels commonly performed. Glycolic Acid (AHA) Peels, Pigment (PCA™) Peels, Jessner Peels, RA Peels and TCA Peels. See Chemical Peels for more information.
Micro-dermabrasion offers benefits for aged and photo damaged (sun damaged) skin including improvement in fine lines and wrinkles, reduction of brown spots and scars, and an overall tightening of the skin. In addition to its beneficial effects to the outer layers of the skin, it also stimulates collagen production and remodelling in the deeper layers. See Micro-dermabrasion for more information.
Bleaching Creams may be useful for people with fair skin, although hq* can sometimes irritate and redden or darken the skin temporarily. Other topical treatments include the use of Vitamin C products and alpha-hydroxy acid products may all may help speed up the process of fading brown spots in some cases.
If you would like to find out more about skin pigmentation treatments for freckles, brown spots and Melasma contact us for a cosmetic surgery consultation with one of our specialist cosmetic nurses on 03 9500 9500