Askanesthetician's Blog

An esthetician explores skincare issues and concerns

Why Is Hyperpigmentation So Hard To Get Rid Of? June 23, 2016

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One of the more difficult skincare problems to solve is hyperpigmentation or dark spots on your skin.  This is also a very prevalent skincare issue that affects people of all skin tones.   Just where do these frustrating spots come from and how can you get rid of them for good? In this post I want to give you some insight into what causes hyperpigmentation in the first place and how to combat it effectively.

How Does Hyperpigmentation Form?

There are a few different types of hyperpigmentation or dark (brown) spots that can form on the skin.  You can get hyperpigmentation from the sun, from hormones, or as a result of an injury to the skin.  This last type of hyperpigmentation includes the marks that show up on the skin after a pimple heals.  (Please keep in mind that while many people call the red or brown marks that are left on the skin after a breakout heals “acne scars” they are definitely not scars but rather hyperpigmentation)   Certain ethnicities are more prone to hyperpigmentation than others.  Interestingly enough the treatment for hyperpigmentation is the same no matter its source.

I’ve been having an internal debate how technical I should be in explaining how hyperpigmentation forms because it is easy to get very lost among the scientific terms and processes that occur in the skin.  I also feel that such an explanation can be a bit overwhelming for non-science people (I include myself in that category).

I decided to take a middle of the road approach in my explanation.  Here it goes.  Your epidermis (the top layer of your skin) contains melanocytes which produce melanin. Melanin determines your skin color and tone. Everyone has the same number of melanocyctes in their skin; your skin color is determined by the amount of melanin activated in the skin.  Melanin is also the pigment that protects your skin from UV rays.  So when your skin experiences excessive sun exposure or prolonged sun exposure year after year, day after day more melanin is produced in order to protect your skin from the sun’s damaging rays.  A tan is actually a sign of your skin’s “self defense” mechanism kicking into gear.  Sorry to say but with every tan you get you’ve done damage to your skin. Dark spots from the sun can show up in a cluster on one area of your face, perhaps on the side of your face that is exposed to a window in your office or while driving, and can take years to appear after the initial damage has been done to your skin.  Many times as an esthetician I find it hard to convince people to use sunscreen on a daily basis simply because the damage daily sun exposure is doing to their skin is not evident at first.  It can be hard to for people to realize that they need sunscreen everyday when the damage they will see from the sun will only show up 10, 20 years later.  So please remember to apply sunscreen daily in order to prevent hyperpigmentation in the future.

Melasma is the hormonal hyperpigmentation.  Many women develop this type of hyperpigmentation during and after a pregnancy or from using birth control pills.  The hormonal changes that are going on in your body due to pregnancy or the use of birth control pills cause this type of hyperpigmentation to form though exactly what doctors are still not entirely sure.  Sun exposure can make melasma worse. Some lucky women may find that their dark spots fade a bit after giving birth, but for many women this type of hyperpigmentation is an unhappy side effect from a happy life event.

Post inflammatory hyperpigmentation is the red, brown, or even yellow marks that are left on the skin after an injury to the skin or after a breakout has healed. Once again as a defense mechanism, in this case a defense against skin inflammation, the body produces extra melanin.  If there is one positive from this type of hyperpigmentation it is usually the easiest kind to get rid of.

Treatment

First of all it is important to keep something in mind when treating hyperpigmentation – there are no quick fixes for this skin care problem.  You need time, patience, and the daily use of skin care products in order to get rid of hyperpigmentation.  If you have had a dark spot on your face for 6 years you cannot expect it to disappear in just a month.  When I say patience I really mean it.  You need to religiously use the right skin care products at home in order to eventually see results months down the road.  Once hyperpigmentation occurs, with the exception of red marks (and some types of brown marks) left on the skin after breakouts heal, your dark spots have no real desire to go anywhere.  If anyone promises you a miracle cure for hyperpigmentation run in the opposite direction.  Also please don’t put lemon juice all over your face and go out in the sun expecting to fade dark spots.  No matter how many times this skincare hack appears in your Pinterest feed you need to ignore it.  You’ll just end up making your skin more sensitive or even causing burns instead of helping your skin if you follow this “tip”.

One of the reasons hyperpigmentation is so hard to get rid of is because you actually have to treat your skin in two different ways at the same time in order to lighten dark spots.  Though the skincare industry is constantly changing and innovating at the moment the accepted way to treat hyperpigmentation is to shutdown or suppress the production of new melanin, prevent the transfer of new melanin to the melanocyctes, and remove the existing dark spots.  This requires a combination of products to achieve; there is currently no one product on the market that can do all three of these things.  Usually hyperpigmentation is treated with one product that supresses melanin production and another product that brings excess melanin to the surface of the skin and then helps it flake off.

In the United States one of the more prevalent skincare ingredients used to treat hyperpigmentation effectively is hydroquinone.  Hydroquinone is controversial for a few different reasons and has been replaced by a host of other ingredients to brighten dark spots because of the controversy surrounding it.  In order to better understand the controversy about hydroquinone I suggest reading Dr. Leslie Baumann’s article that I have listed below in “sources and further reading”.  There is a lot of misinformation circulating about hydroquinone so be sure to educate yourself on this topic before buying into the anti-hydroquinone hype.

Other skincare ingredients that can help treat hyperpigmentation are:  Vitamin C, kojic acid, licorice, arbutin, and azelaic acid.   A product with one or more of these ingredients is best paired with a retinol (or prescription Retin-A) for best results.  You can also use a product that brightens dark spots in conjunction with an AHA exfoliator though keep in mind a strong exfoliator can actually make hyperpigmentation worse or even cause hyperpigmentation for people with sensitive.  When in doubt see a professional in order to create the perfect skincare regime for your skin.  And above all, apply a generous amount of sunscreen each and everyday!  Use at least SPF 30 and make sure your sunscreen protects from both UVA and UVB rays.  Don’t think that your make-up with SPF is giving you enough sun protection because you’ll never apply enough make-up in order to reach the amount of SPF listed on the product.  So be sure to always apply a sunscreen first and then your moisturizer and make-up.

Other Treatment Options

If you have the money for more expensive in-office treatments getting laser treatments from a dermatologist should produce faster results than using just home care products to treat your hyperpigmentation.  Of course you’ll get the best results from a laser treatment if you take proper care of your skin both before and after the treatment.  Follow the advice the doctor or their esthetician gives you; if they don’t give you any before and after advice go to another office.

You can also see an esthetician or dermatologist for a series of chemical peels that coupled with the correct home care regime can help get rid of hyperpigmentation once again faster than if you were just using products at home.  Just as you need a good home care skincare regime before and after a laser treatment in order to get the best results you need to do the same with a chemical peel.

Sources and Further Reading:

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Skincare Terms Explained: Glycation May 13, 2013

In July, 2012 I wrote a post all about how terrible sugar is for the skin.  This post is going to expand on the term “glycation” and explain what exactly that process is and how it relates to the skin.  But basically, it all comes back to the same thing again – sugar ruins our skin (and our health).

In her book Heal Your Skin Dr. Ava Shamban explains just what glycation is (page 22 in the paperback edition):

As delicious as sugar may seem to your taste buds, it can be extremely destructive to your skin.  A spike in your blood sugar levels – which can come from eating processed foods or foods with too much refined sugar – can leave too much sugar circulating in your body.  A process called glycation and the formation of advanced glycation end products are the results.

Glycation is a process whereby a sugar molecule, such as glucose or fructose, is added to collagen and elastin fibers, proteins found in the extracellular matrix, which surrounds skin cells.  This makes the collagen stiff, as it is now cross linked in an abnormal way.  In addition, the enzymes that normally remodel collagen no longer have access to the protein, and it can no longer be remodeled in a normal continual fashion.  When the process occurs, the skin appears prematurely aged.

Glycation damages collagen in other organs in the body, too, including the blood vessel walls.  When this occurs, the skin doesn’t remodel in the same way as before, prematurely aging the tissue.

Dr. Peter Pugliese discusses the subject of glycation extensively in his book Physiology of the Skin, 3rd edition (written with Dr. Draelos) in chapters 30 and 31.  A lot of the information from the book was also published in two articles in Skin Inc.: Physiology of the Skin: The Impact of Glycation on the Skin, Part I and Part II.  I urge you to read both articles if you want a very in-depth and scientific description of the glycation process (there are also lots of pictures and chemical equations).  Suffice it to say though Dr. Pugliese’s explanations are welcome they can be a bit overwhelming for those of us who still have upsetting flashbacks to high school chemistry (I still cringe when I think about the periodic table; I was a poor chemistry student to say the least) so I’ll just quote the summary here:

Glycation is the non-enzymatic joining of a sugar and a protein, or a lipid. It is a process that occurs naturally in foods, especially when cooked. The Maillard reaction is one of these processes that starts by forming a Shiff base and proceeds to forming multiple chemicals called advanced glycation end-products, or AGEs, that have adverse effects on a person’s biological processes. AGEs can link up with many proteins and denature them or alter them to be nonfunctional, cross-linked collagens, which is an AGE protein complex responsible for stiffness of the skin.
Skin collagen has a long half-life; these cross-linked forms do not go away and are not fully reversible at present. Elastin is another long-lived protein that is easily glycated and lasts a long time. Denatured elastin is associated with slackened skin. AGEs have cellular receptors known as RAGEs that initiate inflammatory reactions when activated by an AGE complex. These reactions tend to be chronic and are associated with arterial diseases, metabolic disorders and rheumatoid arthritis. Once they are started, the AGE-RAGE system will accelerate and perpetuate itself.
In the skin, glycation accounts for accelerated aging, yellowing and stiffness of the skin, and decreased circulation. Skin cannot look young and healthy with glycation products. Treatment is best started with prevention by diet control, reducing total calories, avoiding high sugar foods and not cooking at high temperatures. Supplements such as aminoguanidine, pyridoxamine, carnosine and benfotiamine are excellent glycation preventors. A new class of drugs called glycation breakers is being developed to correct the existing glycation protein complexes associated with many chronic diseases. They will truly be the youth drugs of the future.

In my previous post about the subject of sugar and how it negatively impacts the skin I shared with my readers how hard I have found it to cutback on sugar in my diet.  I also started noticing how sugar lurks in all sorts of foods; I try to read food labels more carefully now.  But after researching this post I realize that I also have to be careful about the method of how I cook my food since foods cooked at high temperatures (broiled, barbecued) can negatively impact your health and skin as well.  I wish I had the will power (and the time) to become a raw food vegan, but in the meantime I’ll still keep working on cutting down on how much sugar I consume.

Further Reading:

Image from rokderm.com

 

 
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