Trouble Spots

Posted: Tuesday 16 November 2010 01:02pm

The dark side of our sun-sational climate is photo-ageing of the skin and its ugly stepsister pigmentation – freckles, sun spots, age spots or uneven discolouration by any other name.

During the height of summer the likelihood of those brown marks getting bigger and browner is that much greater, as is the temptation to hit the panic button and undergo lightening treatments that, under the sun, could make the situation a whole lot darker.

“Wrinkles may get a bad rap, but according to studies, it’s actually discolouration that’s most responsible for making skin look older, ageing it by as much as 10 to 15 years,” says paramedical skin rejuvenation expert Maureen Cole, of Sydney’s Silkwood Medical clinic.

The majority of sufferers are female. “Sun exposure and oestrogen are primary contributors,” says Dr Gabrielle Caswell, President of the Cosmetic Physicians Society of Australasia.

“Freckles tend to occur as a result of sun exposure in childhood but can persist into adulthood and will depend on the individual genetics of each person.

“Genetics are a major factor and those with darker skin in their family tree are more susceptible.

“Things that can increase pigmentation are chemical peels, sunburn and lack of sun protection, some antibiotics, pregnancy and the oral contraceptive pill.”

According to Dr Caswell, pigmentation can occur on the surface of the skin (eg. freckles), epidermal (lighter melasma and chloasma) and deeper dermal (darker melasma).

It can also be caused by inflammation, which can result in scarring pigmentation (for instance, after acne or chemical peels).

Pigmentation can sometimes fade over time and with less sun exposure. However, there are a range of treatments to tackle the condition head-on.

“Skin rejuvenation can be performed on most areas of the body – face, neck, chest, back, arms, hands and legs,” says Maureen Cole. “The number of treatments will depend on skin type. Results will take place in 7-10 days on average.”

Here’s a guide to lightening up – and how to do it wisely over the summer months.

First things first

Some pigmentation, though rare, can be caused by illnesses and these need to be ruled out before any treatment. Be sure to visit a doctor before embarking on any treatment for pigmentation.

Sun protection

Once pigmentation appears, the skin is already injured and so then it’s all about damage control. The ideal scenario, of course, is not to let it happen in the first place!

Prevention, as always, is the best cure and “you can help to prevent pigmentation by using broad spectrum sunscreen (UVA is the main causative agent),” says Dr Caswell. “And don’t forget sunscreen is secondary to shade!”

Adds Sydney dermatologist Dr Mei Heng Tan: “I would advise daily use of a high SPF sunscreen with physical blockers like microfine titanium dioxide or zinc oxide, topical preparations such as [skin lightening agent] hydroquinone, and moisturisers with antioxidants including vitamin C, which combat free radicals in the skin.

“Wear sunglasses and a broad-brimmed hat outdoors as sunlight to the retina in the eye can trigger increased pigmentation on the skin. Try to avoid the bright sun as UV rays can make skin pigmentation darker.”

Chemical treatments

These work to stop the enzyme cycle that forms the pigmentation and are called tyrosinase inhibitors. “This is the enzyme in the pigmentation pathway that needs to be blocked so that the melanocytes don’t cause more pigmentation,” says Dr Caswell.

“Traditionally doctors have used hydroquinone or Kojic Acid but now we have a greater choice of ingredients and Lipochromin 6 is a newer product that can help.  Vitamin A and Vitamin C topically too.”

Adds Dr Tan: “Hydroquinone is the cornerstone of treating pigmentation, and combining it with vitamin A or C will increase its penetration and effectiveness. However, hydroquinone should not be used for more than two to three months continuously as, very rarely, it can cause pigmentation to worsen.”

A highly effective chemical treatment, but so far not available in Australia is Triluma. “I worked in New York and Boston for nine years and I have to tell you that Triluma is an amazing product and every dermatologist prescribes it over there,” she says.

“It contains hydroquinone, a mild cortisone and a retinoid (retin A) . A brilliant dermatologist, Al Kligman, invented the basis of this triple combination cream, widely known in dermatology circles as “Kligmans formula” . It is available by prescription, but has to be compounded by individual pharmacies (so not standardised or as stable) here.”

Peels and microdermabrasion

“If pigment is superficial – confined to the top layers of the skin – then treatments like chemical peels and microdermabrasion are effective,” says Dr Tan. “It is hard to predict if pigmentation is superficial or deep though! If any treatment is too strong it is possible to worsen the pigmentation, as too much energy delivered to the skin can traumatise it and excite pigment producing cells (melanocytes) to cause them to produce more pigment.”

A more evolved form of both treatments, known as MicroLaserPeel, is offered by Silkwood Medical and is “designed to improve the appearance of common skin conditions such as wrinkles, fine lines, acne scars, keratoses or other pigmentary problems,” says Maureen Cole.  “MicroLaserPeel™ is suitable for anyone considering dermabrasion, chemical peels or laser skin resurfacing treatment, but have little time for a long recovery process. The treatment is customised for specific skincare needs.”

According to Maureen, “If you’re looking for more than microdermabrasion or light chemical peels, and have little time for a prolonged healing process, then MicroLaserPeel was designed for you. It is an intra-epidermal laser peel that precisely ablates the outer-most layers of the skin. This “weekend” skin peel treats skin conditions associated with aging and active lifestyle. You can see real improvements in just a few days.” It will leave the skin after the treatment mildly sunburned and will take the weekend to recover and brighten up.

Light treatments

“Intense Pulsed Light (IPL) will treat surface pigmentation only so it is not recommended beyond the treatment of freckles and surface lentigine [also known as sun-, age- or liver spots],” says Dr Caswell. “However, it’s critical that you make sure these are not a type of melanoma so it’s imperative you see your doctor first.

“It’s also extremely important to note that IPL can in fact increase melasma – or so-alled “hormonal” pigmentation – remember that it is light reactive and IPL is light! “This is another reason to ensure you see a trained doctor for any kind of laser treatment.”

Vascular laser

A Yellow wavelength of laser can have a dramatic improvement on pigmentation on Asian skin or melasma that has a contribution of blood vessels, according to Dr Caswell. “Look for a Dual Yellow laser – most of the studies have been conducted on this device.”

Fractional laser devices

“Fractional laser devices, such as the Cutera Pearl Fractional, treat deeper pigmentation buy literally ‘blasting’ the pigment bundles to bits, which the body is then able to cart away and digest”, says Dr Caswell. “The advantages of Pearl Fractional is that it is generally only requires one treatment compared to up to six with other types.  It is best to consult a doctor for this treatment and make sure that you start a pre-conditioning program using medical strength Vitamin A to prepare the skin for growth and repair after treatment.”

Dr Tan is a proponent of the Fraxel Dual fractional laser to treat pigmentation, which has less downtime but may require more than one treatment.

Silkwood Medical also features ScitonProFractional™, one of the newest laser treatments on the market to improve the appearance of fine lines, wrinkles, acne and post-traumatic scars, freckles, age spots and sun damage.

Maureen Cole says: “ProFractional is a quick and comfortable laser procedure with little down time. It is used for improving the overall appearance of your skin.  It uses laser energy to create thousands of microscopic channels in the skin that are surrounded by areas of healthy, untreated skin. The zones of untreated skin invigorate the body’s natural healing process, and the treated areas stimulate production of new collagen. This has the effect of plumping up the skin and smoothing out wrinkles, lines, scars and other irregularities. So if you’re looking for younger looking skin, or to improve scars, wrinkles, or sun damage in a comfortable treatment with a fast recovery, then you may be an ideal candidate. Treatment will leave the skin very sunburned looking and will take three to four days to return to your normal routine.”

Home invasion

Before embarking on an anti-pigmentation home care regime, it’s recommended you see an expert for advice about skincare and trial and error with products may be involved. “It is usually not necessary to buy an entire range, as there is often one standout product in a brand,” says Dr Tan.

“For that reason I don’t recommend particular brands – rather, products I like from different brands. Some of my favourites are Olay Regenerist serum, Prevage by Elizabeth Arden (moisturisers with antioxidants), Clinique’s Even Better Clinical Dark Spot Corrector, Sunsense Daily Face Matt SPF 30+ sunscreen, Skinceuticals Vitamin C cream and Finacea gel/Azclear cleanser.”

Last but most certainly not least

After the trouble, time and expense of undergoing salon and clinical pigmentation treatments, the key is to “definitely need to avoid the sun after treatment for at least three months in order to get the best results,” says Dr Tan. “And this is easier done during the cooler months.”

Concludes Dr Caswell: “You will need to incorporate a sunscreen into your regime. Actinica is a new liposomal sunscreen that sinks into the skin and gives deeper protection and has a greater blocking of UVA rays. It is only available from doctors.”

by Jenni Gilbert

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