Treating post-stress HYPERPIGMENTATION

Skin affected by recent stress requires a unique treatment approach. Dr Ronit Segev, founder of Biofor, explains how to achieve this

Stress – whether mechanical, chemical or psychological – activates the immune system, fuels inflammation and sensitises melanocytes. This results in increased melanin production, leading to post-inflammatory hyperpigmentation (PIH). Examples include medium to deep peels, laser treatments, rashes and invasive procedures.

The treatment approach: less is more

Treating recent PIH requires gentle, gradual care with minimal irritants. Initial treatments should emphasise melanin suppression and avoid any interventions that may further stress the skin. Understanding the “story” of pigmentation, including its triggers, progression and previous treatments, is key to crafting an effective and safe treatment protocol.

Case study: post-stress hyperpigmentation in a Fitzpatrick V patient

A 51-year-old woman with Fitzpatrick V phototype sought treatment for moderate pigmentation (less severe than the one shown in the “before” picture). She was prescribed a high-strength triple combination cream containing tretinoin, hydroquinone and hydrocortisone by the doctor. However, this exacerbated her pigmentation. Seeking help elsewhere, she underwent a traumatic treatment involving alcohol rubbing and steam, further worsening her condition.

When she arrived at another clinic, the therapist recognised that while the original pigmentation was mild and old melasma, the current, much more severe pigmentation was a result of stress. She designed a gentle and gradual treatment plan.

Initial home routine (first month):

• Exfoliation: Amild exfoliator containing 10% lactic acid and 2% salicylic acid was introduced, applied every other day during the first week and once daily thereafter.

• Melanin suppressor: Product with kojic acid and arbutin was applied twice daily to reduce pigment production.

Gradual intensification (second month):

• Exfoliation: The same exfoliator was applied twice on alternating evenings, with a single application on other nights.

• Melanin suppressors: Usage was increased to three times daily for enhanced melanin suppression.

Professional treatment (after three months):

• Peeling: A 16% lactic acid peel was performed at the clinic.

• Exfoliation upgrade: The patient transitioned to a home exfoliator with 1% retinol and 10% lactic acid for deeper peeling and improved results.

By the third month, pigmentation had lightened significantly without triggering further stress responses. This gradual and tailored approach allowed the skin to recover while addressing pigmentation effectively.

Practical takeaways for treating stressed skin

1. Be patient and gentle: Avoid aggressive treatments. Opt for low-strength exfoliators and gradual adjustments to the regimen.

2. Prioritise melanin suppressors: These are vital during the recovery phase to control pigmentation.

3. Adjust treatments over time: As the skin recovers, introduce stronger exfoliators and in-clinic peels cautiously.

Dr Ronit Segev is a biologist and skin researcher specialising in the physiology of the skin and active ingredients to improve aesthetic skin conditions. She is also the founder and chief executive of Biofor.