Pigmentation is by far the hardest condition that I’m faced with treating. The main reasons for this are lack of understanding, unrealistic expectations and an unwillingness to follow homecare advice. As an experienced practitioner, I take a lot of time to sit with my clients and educate them on the reasons for their pigmentation and the best treatment options.
Unfortunately, the government is not interested in regulating businesses offering laser & IPL treatments which has led to people making poor choices and going to unqualified practitioners for cheap treatment.
Due to this, we are now seeing an increase in post inflammatory hyper-pigmentation (a darkening of the skin pigment) or post inflammatory hypo-pigmentation (a lightening of the skins pigment) which is irreversible!
Lasers and IPL machines are incredibly high powered and can be extremely dangerous in the wrong hands.
What is pigment?
Everybody’s skin is different, and our skin type is determined by hereditary factors. In the Aesthetic industry we measure skin type using the Fitzpatrick scale. This is calculated by asking a series of questions e.g. How does your skin react to sunlight?
The Fitzpatrick scale ranges from type I-IV:
Type I – Extremely sensitive to sunlight, always burns, never tans, e.g. red hair and freckles
Type II – Very sensitive to sunlight, burns easily, hardly tans, e.g. fair skin with fair hair
Type III – Sensitive to sunlight, sometimes burns, slowly tans to a light brow, e.g. darker skin Caucasian
Type IV – Minimally sun sensitive, burns minimally, always tans to a moderate brown, e.g. Mediterranean or Asian skin types
Type V – No sun sensitivity, rarely burns, tans well, e.g. Hispanic or some black skin types
Type VI – Sun insensitivity, never burns, deeply pigmented, e.g. dark black skin
These pre-disposed skin types effect how dark or light our skin is and how it reacts to sunlight
What causes pigmentation problems?
Pigmentation is most commonly caused by sun exposure. Most people love to have a tan, but it’s our body’s response to the sun and is there as a defence mechanism to absorb the harmful UV rays and prevent burning.
Caucasian skin types are much more likely to burn due to having less pigment in their skin to absorb the sunlight, where as darker skin types have a lot of pigment which absorbs the sunlight meaning they do not burn as easily.
Hormonal factors can cause pigmentation issues. Many of my clients have had hyper-pigmentation following pregnancy due to a fluctuation in hormone levels. This is one of the main reasons pregnant and breast-feeding woman are not recommended to have treatments.
Darker skin types (IV-VI) have much more risk of hyperpigmentation after trauma to the skin. For example, if they cut themselves, the skin can heal back darker as its main pre-programmed defence mechanism is to darken to protect itself.
Understanding & preventing pigmentation
There is a common misconception that having a few laser treatments will get rid of pigmentation for good. This is not true! You need to view pigmentation and its prevention like you would a medical condition.
‘If a patient has high blood pressure then they will be put on medication. As long as the client continues to take the medication, their blood pressure will stay reduced. If they stop taking the medication it will go back up!’
You need to look at pigmentation in much the same way. You can treat the surface pigmentation with treatments such as IPL and peels but if you don’t control the condition at the root cause then it will continue to come back.
Our ‘medication’ for pigmentation is in the form of a pigment regulator. It’s really hard to talk about this without getting too in depth and confusing the hell out of you but I’ll try my best.
I’ve talked before about the layers of the skin, pigmentation is made in the dermal layer (living layer) of the skin. Uneven pigmentation is caused by a DNA change to the cells causing them to become damaged and over produce melanin (this is what gives our skin colour). When the cell is damaged it, it essentially starts leaking melanin (pigment) which travels up through the layers of the skin to the visible surface. So, if we don’t stop the leaky tap then it will continue to return. Pigment regulators are what switch this leaky tap off to stop the root cause. This can then be combined with treatments such as IPL to speed up the reduction of the visible pigmentation.
Is everybody suitable for IPL treatments?
IPL is probably the most well-known treatment for pigmentation, however it absolutely is not for everybody!
Skin types IV-VI are a definite NO for IPL treatments as their skin absorbs the light too much, so they have much more risk of developing hyper or hypo pigmentation.
Anybody with an active tan is a definite NO, this could cause an adverse reaction, no treatment should be taken out for at least 4 weeks after any sun exposure.
Freckles can be treated but it is a completely pointless practice, it’s the skins normal reaction to sunlight and it will come back. As a person with freckles myself that used to hate them, the best thing you can do is learn to embrace and love them!
Fake tan is also a definite no, the Fitzpatrick skin analysis is done based on your natural skin type and settings applied accordingly. Anything that is going to affect the skins natural colour could lead to adverse reactions and a limited result, IPL works best on light skin with dark pigment.
- You must use SPF every day and keep completely out of the sun while undergoing IPL treatment
- Do not lie to your practitioner about if you’d had sun exposure or not, if you’re left with irreversible damage you will not be happy, it’s not worth the associated risks!
- Research clinics that offer the treatment, steer clear of Groupon deals and cheap offers. As the government is not interested in regulating IPL/lasers. This has lead to unexperienced people buying cheap machines and burning or permanently damaging peoples skin! If it sounds too good to be true it almost definitely is! Ask your practitioner if they have at least a core of knowledge in laser/IPL and ideally a BTEC in the safe use of lasers/IPL. You are well within your rights to ask to see accreditation so don’t feel embarrassed to do so.
- If you have a darker skin type, no matter what a practitioner is telling you DO NOT have IPL treatment, the risk of pigmentation changes is far too great. If you get permanent damage, then you are the ones that will suffer.
Types of pigmentation and treatments:
Age spots – seen most commonly on Caucasian skins aged 50+. Age spots are patches of pigmentation caused from sun exposure earlier on in life. They can be treated very effectively with IPL and a pigment regulator. Look for ingredients such as alpha arbutin, glycolic acid & vitamin C. They will return with further sun exposure, so an SPF 50 must be worn everyday and the face should be kept out of the sun in stronger sunlight.
Hyper pigmentation – It is best to stick to pigment regulators which this condition, especially if it’s been caused as a reaction to a treatment. Most cases will need a stronger pigment regulator such as retinol to break up the existing pigment and prevent future damage.
Deep pigmentation such as melasma – This will likely need medical intervention. The best and fastest results are with Hydroquinone combined with tretinoin (a more concentrated form of Vitamin A – Retinol). These need to be prescribed and managed by a doctor as it should only be used for 3 months and will then need a 3-month break. Hydroquinone is a very strong product and gives amazing results, most clients will have a complete clearance of the pigmentation within a month. However, do not be tempted to carry on using it longer than advised. Over use can lead to a darker sort of pigmentation being formed which is completely untreatable. Always do as your doctor says and ideally go to a dermatologist or a very experienced Doctor!
Hypo pigmentation – unfortunately there is no permanent solution for a lightening of pigmentation. However, some people can get very good results with semi-permanent make up. Again, research is key with this and it’s important to find a specialist!
*Key points – the most important thing to prevent pigmentation getting worse or forming in the first place is the use an SPF every day. Damaging UV rays are apparent all the time, even on a grey cloudy day, 80% of the UV rays penetrate through clouds so a daily SPF and keeping your face out of the sun is essential.
If you have any questions or would like any suggestions on clinics in your area feel free to contact me.
Thank you for reading