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 Hyperpigmentation has its origins in one of
two broad categories: induced by products or
procedures (environmental cause), or in the
more natural processes such as aging,
pregnancy (intrinsic cause).
Timing can be instructive. Sudden onset of
hyperpigmentation, that is, a lot of spots
and blotches that show up over a six month
period, marked by the feeling, “I didn’t
have any of this a year ago,” indicates a
strong likelihood that either a product or
procedure (or both) or other environmental
cause has been at work.
If the sudden onset has been recent the
prognosis for reversal is good also. If the
pigmentation came on relatively fast but, is
long standing, then it is probably deep in
the dermis. Approximately 40% of the
pigmentation excess will be in the
epidermis, the remainder will be in the
dermis and therefore, much more difficult to
treat.
In the case of pregnancy, where a melasma/cholasma
- a continuous blotch of darker pigmented
area, uneven in dimensions - occurs, the
pigment will generally ‘wash out’ over a
year.
This is also true in the case of simple
aging, where the onset of hyper-pigmentation
or just plain blotchy, uneven tone and
pigment deposits is a function primarily of
insufficient epidermal protein growth –
recall that the first sign of skin aging is
thinning of the epidermis.
For that reason, and others, you will find
that a common denominator in almost all
sudden onset cases, where an environmental
agent is at work, turns out to be an
acid-based topical regime or series of
exfoliations (micro-dermabrasion, scrubs,
enzyme peels).
In these latter instances, the exfoliations
occurred at a much faster rate than the
epidermis could sustain new, healthy protein
growth. As a result, the skin suddenly lost
its resiliency and softness and took on a
more rigid, parchment look and feel. Further
evidence of this showed up as blotchy,
uneven tone and spots. These can go very
deep.
Which is all to say, hyper-pigmentation is
the visible evidence of a number of
imbalances – the question remains, as in
skin rejuvenation, how to restore the
balance and restore a desirable look.
Before we go to that, a few cautions are in
order.
The sudden onset of a single unraised, spot
of even color tone (pink) is not the usual
esthetic hyper-pigmentation we run across.
More likely, that is a pre-cancerous
atrophic keratosis which has become visible.
The visible evidence is not alarming IF this
is accompanied by a therapeutic regime,
which may in fact have “lighted up” the
spot.
However, if a spot is uneven in dimension
and multi-colored at the same time, or the
spot is slightly raised and has a gray, or
sallow brown complexion then it may signal
the onset of a more dangerous situation.
These need to be biopsied.
Crusty nodes with hyper-pigmentation may be
hypekeratolytic keratosis (what the
physician calls “hyperkeratotic”) which is
also a pre-cancerous condition. Moles and
freckles that have had long standing
residence time, tend to remain benign,
however, those in the skin cancer
susceptible groups (Northern European roots
especially) should be monitored closely.
Many persons in these groups opt to take no
chances and remove the possibility.
In all these situations you will find the
typical skin rejuvenation regime of 302
topical products will work wonders – if
there is also not an acid-based system
working on the skin at the same time or in
the very recent past.
Typically this regime will consist of
washing with one of the 302 Cleansers
and 302 Face & Body Bar, and using
the 302 Drops three times
per week, the 302 C Boost twice per
week and the 302 A Boost once per
week.
Acid-based products are usually tried prior
to 302 regimes and these products or
studio/clinic procedures should initially
show gains. Many times they do not. But in
almost all cases, if the problem is not
eliminated in the first 30 – 60 days, it can
be aggravated by continuing exposure to
acids. Simply put – if no luck at first,
then stop.
That means that if the problem is located in
the upper reaches of the epidermis, acids
have a significant opportunity to address
the issue for a short period of application.
However, once past a certain application
point, the acids will themselves induce the
hyper-pigmentation and this will push the
problem deep into the dermis.
This is also true of over-application of
topicals - topically addicted skin will tend
also to hyper-pigmentation.
Clearly, no acid-based regime should be
introduced during periods of high UV energy
exposure. This is a procedure that should be
attempted in the dead of winter or in very
low UV periods. Sunscreen will not, I
repeat, will not protect against
hyper-pigmentation in those persons who have
had recent exfoliations.
If acid-based exfoliations are too
problematic, micro-dermabrasion or enzyme
peels or even certain scrubs may also have
some initial effect on reducing the visible
evidence of hyper-pigmentation. However,
these treatments also sensitize the skin to
UV energy and in the case of micro-dermabrasion,
only a well trained practitioner should
attempt this. Home treatments using micro-dermabrasion
is an invitation to hyper-pigmentation,
rosacea, dermatitis, eczema, among just a
few. A well administered micro-dermabrasion
regime, in the hands of a competent
practitioner is a very useful treatment. It
is far more benign than an acid-based
regime. It should be actively discouraged
for home use.
To combine micro-dermabrasion with acids,
however, is to ask for problems. To combine
these two with retinoids is to promote
hyper-pigmentation actively.
In sum, hyper-pigmentation is often not a
surface event and cannot be treated that way
for any sustained period (more than 60
days).
Additionally, the nutritional component to
hyper-pigmentation has to be strongly
considered. In the case of intrinsic onset
of the spots and blotches (e.g no acids, no
peels, no topical addiction, no long trips
in the tropical sun, etc.,) there may be a
combination of natural aging AND nutrition
AND medications AND hormonal depletion. The
first and the last of these are related. The
possibility of low hormonal outputs (and
very high hormonal outputs) and the onset of
hyper-pigmentation or hypo-pigmentation will
find a nexus in nutrition. That is, add poor
nutrition to this and you are rolling a rock
uphill.
The use of exfoliating regimes is
problematic, and generally not recommended.
Continuous exfoliation is the classic
“problem/solution” paradigm that creates its
own new set of problems.
For example, once hyper-pigmentation has
been treated with acids, and they have
failed, it is vital never to introduce these
again or you risk even greater
hyper-pigmentation. The skin can become
permanently affected by and reactive to
acids. Don’t risk it.
We recommend a balanced approach with 302
topicals in a rejuvenation program that
takes into account ALL aspects of health.
Optimizing visible skin quality is the
natural result.
Products
to treat hyperpigmentation
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