Your Skin Color
There are a variety of factors that determine the color and tone of your complexion. These factors include the thickness of your skin, the density of blood vessels in your skin, dilation of the surface blood vessels, the oxygen content of your blood, the amount of melanin, and any other pigments that have been deposited in your skin as a result of diet or environment. The most important factor in determination of skin color is the amount of melanin.
Melanin is a pigment molecule that is produced by specialized skin cells that are known as “melanocytes.” Factors that determine the amount of melanin you produce include genetic factors, hormones, exposure to the sun, and your race. Dark-skinned people produce more melanin. However, when you are exposed to the sun, your body will produce additional melanin to serve as a natural protection against ultraviolet damage. Unfortunately, the level of protection is limited, so when you are frequently in the sun, melanin doesn’t offer adequate protection.
Common Causes of Hyperpigmentation
Sun damage is manifest in those dark patches of skin that remain after your tan has faded. If you’ve ever had a rash, trauma, acne, or a burn, you may also notice areas of discoloration. These occur when the pigment in your skin migrates, leaving a permanent scar.
Another cause of hyperpigmentation that is fairly common is known as berloque dermatitis. Have you ever noticed a dark spot on an area where you’ve applied perfume or aftershave? Cosmetics, perfumes, and aftershave lotions contain compounds known as furocoumarins. When exposed to the skin, the chemical reaction can result in a dark blotch or spot. If your skin has not been exposed to sunlight, you won’t see any damage.
Melasma is a disorder of hyperpigmentation that is associated with hormonal changes, usually in pregnancy. Sometimes known as the “mask of pregnancy,” dark areas of skin may become more noticeable. Facial melisma, or chloasma, appears as symmetric hyperpigmentation of the skin, most commonly on the upper lip, forehead, and chin. The discoloration can range from very light to dark. Although melisma is most likely the result of hormonal changes, the exact mechanism remains unknown. However, melasma may occur when women are using other hormonal supplements, including oral contraceptives. Sometimes, the trigger for melasma remains a mystery.
If you have melasma from circulating hormones during pregnancy or other reasons, you should consult a dermatologist. There are simple ways to limit the discoloration of your skin, including avoidance of sun exposure and limiting any medications that may have contributed to the problem. A cosmetic dermatologist can discuss steps that you can safely take to prevent melasma from becoming more pronounced.
Melasma can be treated by bleaching with a topical cream containing ingredients like hydroquinone or tretinoin. A cosmetic dermatologist can prescribe an appropriate topical treatment for your skin type. When applying a topical bleaching compound, it should only be applied to the area of discoloration. It may take several months to see results from regular application of a topical bleaching treatment, depending upon the potency of the preparation. The mechanism of action differs among agents, so a good strategy may be use of one agent in the evening and a different agent in the morning. There are also combination agents available by prescription.
Hydroquinone can slow the production of melanin in your skin. Although it can be purchased over the counter in concentrations up to 2%, most dermatologists recommend a 4% preparation. As the concentration increases, there is generally no additional bleaching effect, but higher concentrations can cause skin irritation. Maximum efficacy can be obtained by twice daily use of hydroquinone, but it’s critical to remember sunscreen during the day, as your skin will be photosensitive during treatment. Because of the inflammation that can occur, hydroquinone may be combined with a topical corticosteroid. Up to 70% of patients generally report visible improvement after several weeks of treatment.
Dark pigmentation can recur after treatment. If this occurs, your dermatologist may increase the concentration of your topical medication or may add an additional bleaching product. In addition to itching and irritation, exposure to hydroquinone can make your fingernails turn orange, so when using the medication, avoid contact with the nails.
Retinoic acid is frequently used in dermatology to mitigate the effects of aging and to treat acne. It is somewhat effective to fade discoloration and hyperpigmentation.
Other topical agents include azaleic acid, which inhibits production of melanin in the skin. Seventy percent of patients with hyperpigmentation report improvement within five months of beginning regular treatment with azelaic acid. The compound is also used for treating acne. Other agents used to reduce pigmentation include alpha-hydroxy acids, green tea, and arbutin, a hydroquinone product derived from the bearberry bush.
Use of a topical bleaching agent requires a commitment to apply the compound on a daily or twice daily basis for best results. If you are in a hurry, other treatments for hyperpigmentation include trichloroacetic acid peels, laser treatment, and cryotherapy with liquid nitrogen. Liquid nitrogen is most useful for treatment of small, discrete lesions. If your hyperpigmentation involves a large area, other techniques are more appropriate. Chemical peels create a chemical burn on the outer layer of the skin. As the burn heals, a new outer layer of skin forms. The new skin that forms as you heal will be more uniform and smooth, with even pigmentation. Superficial peels only penetrate the epidermis, but deeper peels, which are more reliable for improvement of hyperpigmentation, penetrate to the depth of the dermis. Deep peels have many benefits, but these are sometimes offset by the need for a more prolonged recovery. There is also a potential for infection when a deep peel is used. It may require as long as three to six months for redness to subside after a deep peel. A series of superficial peels can achieve the same results without the need for an extended downtime. Laser treatments are also a wonderful tool to smooth your skin tone. Depending upon the depth of the laser, the recovery time and results are variable.
If you have developed melasma or other areas of hyperpigmentation, you may want to consult a cosmetic dermatologist for advice about a restoring an even pigmentation to your complexion. Call us today to schedule a convenient consultation with Dr. Mehrabi at our offices in Beverly Hills, Encino, or Glendale.