In the aftermath of an unusually hot British summer, Fiona Vlemmiks discusses the best treatment options for sun-induced skin pigmentation

Treating Pigmentation

While the joint hottest summer on UK records had a positive effect on the British psyche, the increased levels of UV exposure are likely to have had a decidedly more detrimental impact on your clients’ skin.

As a defence against harmful UV rays, the body produces the skin pigment melanin, but an overproduction of this can result in irregular pigmentation and uneven skin tone. This type of irregular pigmentation is likely to appear on the face, hands and décolletage and is often referred to as age, sun or brown spots.

Hyperpigmentation doesn’t usually appear until clients are in their late 20s, but is often the accumulation of several years of unprotected sun exposure.

“Our skin analysis machine is constantly in use post-summer”, says Martine Jarman, director and owner of Cheshire-based SkinGenius Clinic. “It reveals to clients the damage that has been left on the skin once the golden glow of their tan has faded.”

MAKE A PLAN

Although hyperpigmentation can vary in its severity, most cases can be successfully treated with options including active skincare products, LED, laser and IPL therapies, peels and microdermabrasion. Whichever therapy is used, when treating pigmentation, the aim is to boost skin cell turnover, stripping away dead and dying cells at a faster rate to allow new, even-toned cells to take their place. This often involves controlled damage to the problem area, making a thorough client consultation essential.

Louise Taylor, director of Dermalux UK distributor Aesthetic Technology, warns: “Treating hyperpigmentation can be challenging. Pigmentation is an inflammatory condition and creating any kind of trauma to the skin naturally increases levels of oxidative stress and inflammation, which in turn can trigger further production of melanin.”

The first step should be a detailed skin analysis. “The amount of hydration in the skin and its overall health should always be taken into consideration when treating pigmentation, as an impairment in either of these can make the skin unpredictable and a lot more sensitised”, says Rowan Hall-Farrise, international head trainer at QMS Medicosmetics.

Jarman recommends assessing the client’s Fitzpatrick skin type and taking a detailed history, including ethnic background and how the client responds to UV exposure. “Fitzpatrick skin types IV to VI have different levels of epidermal melanin compared to skin types I to III, which can play an important factor when deciding which treatment protocol to follow. Therapists must take account of the tendency towards post-inflammatory hyperpigmentation (PIH).

“Any treatment that causes heat or inflammation in the skin, like laser and light treatments and dermabrasion techniques, could possibly trigger PIH by absorbing too much energy, which could l ead to blistering, permanent changes to pigmentation and hypopigmentation”, she explains.

In addition to skin analysis, the consultation should assess the client’s lifestyle and involve a frank discussion on the level of commitment needed for the treatment plan to be effective. “We will not treat clients for pigmentation if they wish to continue using sunbeds, for example”, says Jarman.

START AFRESH

Microdermabrasion techniques are recommended for the treatment of milder hyperpigmentation. CACI’s Skinbreeze System employs a crystal-free, orbital microdermabrasion application for precision-controlled exfoliation of the superficial layers of the skin. Other systems, like the Crystal Clear Microdermabrasion system, work with a spray of micro crystals to gently remove dead and damaged surface layers of skin with abrasion and suction to reveal new, fresh skin. Benefits of microdermabrasion include minimal to no recovery time.

Exfoliation in the form of professional peels in varying strengths is another effective option. Medium to deeper peels have a better impact on pigmentation but come with greater sensitivity risk and longer downtime for the client. “Professional peels use AHAs and BHAs, superficial agents that break the bonds between the keratinocytes and allow for faster exfoliation of those skin cells, helping to purge pigments from the skin”, explains Jarman.

“The most common AHAs are glycolic and lactic acid, although there are a number of different formulations including latctobionic acid, phytic acid and kojic acid”, she adds.

HEAT AND LIGHT

In simple terms, laser and intense pulsed light (IPL) therapies work by causing targeted heat damage to the pigmentation, breaking down the excess melanin without harming surrounding areas. The 3D-Nanosure system from 3D-lipo works by delivering laser energy, which is absorbed by the pigmentation structure, causing thermal damage. As the skin renews itself, the damaged cells surface and lift away, resulting in improved overall appearance.

“Some small, superficial pigmented lesions such as age spots or sunspots can be thermally destroyed using a high-powered IPL system or a long-pulsed Alexandrite laser, and they often only need one treatment”, says Dr Samantha Hills, clinical director at Lynton Lasers, which offers many suitable systems to treat pigmentation, such as its 3Juve device for facial rejuvenation that uses IPL to treat sun damage.

While many modalities work on the principle of creating controlled trauma to trigger a cellular response, LED phototherapy, the technology used by Dermalux, does not transfer heat, create trauma or use chemicals to promote changes in the skin, explains Taylor: “Phototherapy is the application of low-level light energy via spectrally pure ‘bioactive’ wavelengths to stimulate or regulate biological process with proven therapeutic results.

“The treatment involves exposing the skin to low levels of beneficial light energy from the visible and infrared part of the light spectrum. Specific wavelengths activate key cell receptors and trigger a transfer of beneficial light energy to cellular energy.”

The Dermalux Tri-Wave systems combine blue, red and near infrared wavelengths. For sun-induced hyperpigmentation, Taylor recommends the pre-set pigmentation programme to accelerate cell renewal, repair and inhibit the tyrosinase enzyme, which is responsible for the production of melanin.

JOIN FORCES

Most skin experts agree that a combined approach to treating hyperpigmentation yields the best results. At SkinGenius, clients receive a personalised combined treatment plan involving homecare, professional skin peels and IPL, says Jarman.

“Initially, we start clients on an effective homecare pigment-correction regime, which is based around using five fundamental cosmeceutical products containing active ingredients to prevent future damage but also correct existing damage at a cellular level”, she says.

“A typical pigment treatment plan could take up to four months of clinical treatments using a combination of different modalities, depending on the nature of pigment we are treating.”

Key skincare products to recommend clients for homecare include cleansers with a mild hydroxy acid to gently exfoliate the surface of the skin, and topical active agents containing tyrosinase inhibitors to suppress melanin formation. Jarman also recommends a nighttime dose of stable, high-strength Vitamin A (retinol) to help with cellular renewal.

Finally, it is essential that clients use a broadspectrum sunscreen daily, no matter the season. “Clients need to be educated about the harmful effects of UV, which in many cases means they need to change their attitude towards sun exposure in the future”, says Jarman. PB