Irregular pigmentation (brown spots) is caused by a combination of individual susceptibility and sun exposure. There are three types of facial pigmentation, which are common concerns for my patients. The first type is chronic sun damage (‘photo damage’), with lots of tiny freckling type pigmentation all over the face. Unfortunately our skin doesn’t forget past sun exposure and ‘clocks up’ the hours going back to your childhood. The second type are distinct pigment spots often referred to as ‘age spots’ (the medical term is ‘solar lentigines’). They often appear on the face and/or the hands. The third type are larger, bizarrely shaped pigment patches called melasma (for example above the upper lip, on the temples or forehead). An important contributing factor for melasma are female hormones such as oestrogen. These can be related to taking a contraceptive pill and pregnancy (hence melasma’s nick name – ‘mask of pregnancy’).
All of these pigment issues can be significantly improved with certain topical treatments. The active ingredients in these products have two main actions: they help the existing pigment to shed off quicker (exfoliation), but they also reduce activity of an enzyme in our skin called tyrosinase. Tyrosinase is the key enzyme needed for generation of new pigment. So the aim of treatment is two-fold: slow down production of new pigment and accelerate shedding of existing pigment.
Having a treatment, which simply increases shedding of pigment (e.g. a chemical peel or laser treatment) without addressing the overactive tyrosinase, doesn’t make any sense!
While prescription strength anti-pigment creams issued by your dermatologist naturally have the strongest effect (that’s why they are prescription…), using over-the-counter products containing kojic acid, arbutin and/or azelaic acid (the latter is in higher concentration also used in prescription creams) can also help.
However, whatever you do, don’t forget the most important two things: sun protection and sun avoidance!! Not only wearing a broad-spectrum SPF50 every single day, but also practicing strict sun avoidance is absolutely crucial if you suffer with irregular pigmentation, as not only UV light, but also infra-red irradiation (i.e. heat irradiation from the sun) and visible light have been revealed to aggravate pigmentation. Remember – one day of excess sun can undo months of treatment.
By the way, unfortunately urban air pollution has also been shown in scientific studies to contribute to irregular pigmentation! So trying to limit time spent in the sun and ideally also the time spent in heavily polluted environments will all help your treatment.
So in summary – achieving the best possible results for your pigmentation issue will always require a team effort between your dermatologist and yourself!