Pigmentation

Disorders of Pigmentation

1. Freckles: 

These are small, flat round lesions, which occur in mostly lighter skin types. They tend to turn relatively darker in summer and lighter in winter. Causative factors are sun exposure and genetic susceptibility.

Treatment: Many peels like glycolic and TCA help in lightening freckles. In the case of stubborn variety light systems like the IPL and lasers like the Q switched NdYag can be used. Avoid sun exposure, sunscreen, and skin brightening and lightening cosmeceuticals will help to keep the pigment at bay.

2. Solar Lentigines: 

These are flat pigmented 1 to 3 cm lesions present mainly on sun-exposed areas. They start to appear in the third to fourth decade of life.

Treatment: Daily use of sunscreen is an absolute must. TCA peels, IPL Light systems, and lasers such as Q Switched NdYag can remove them completely.

3. Melasma:

This stubborn pigmentation is seen mainly in women. Men too get affected by this condition but less commonly. Melasma is characterized by a patchy dark or brown discoloration that occurs over the upper lip, cheeks, forehead, and bridge of the nose. The areas affected are usually bilateral and frequently symmetrical. 
Most common causes of Melasma are sun exposure, hormonal changes such as pregnancy, menopause, oral contraceptive pills and familial susceptibility.

Treatment: Melasma is a stubborn condition and usually requires multiple sessions of various treatments. Usually, two or more treatments are combined to give better results. Epidermal (superficial) melasma responds better and faster than Dermal (deep) Melasma to a given treatment. Sunscreens play a very important role in the treatment of melasma. Various depigmenting agents such as Hydroquinone, Kojic acid, Glycolic acid, etc. can be used in the treatment of melasma. 
In addition to the above treatments, superficial peels such as Glycolic acid peels and Salicylic acid peels; moderately deep peels such as 50% glycolic acid and TCA, as well as deeper peels like Cosmelan can help in treating melasma. Lasers such as Q switched NdYag can be used in stubborn cases. Light systems like the IPL, as well as Microdermabrasion, Mesotherapy also gives good results in treating melasma depending upon the depth and intensity of pigment. In all cases of melasma, dermatologists recommend using sunscreens & skin lightening products to maintain the results and prevent recurrences, once the pigmentation has cleared.

4. Post-inflammatory hyperpigmentation (PIH): 

PIH can occur following any kind of mechanical, physical, chemical trauma. An acute or chronic inflammatory process like acne, psoriasis, drugs, cosmetics, friction, also can cause PIH. Following any trauma, the pigment-producing cells produce excess melanin pigment as a part of the healing process.

Treatment: Glycolic Acid Peels, Mesotherapy, Cosmelan Peel, Yellow peel, Lasers like the Q Switched NdYag can treat PIH successfully. Sun exposure is to be avoided. Sunscreens with SPF 30+ daily and skin lightening Cosmeceuticals can be used to treat PIH effectively.

Besides the above common conditions, there are various dermatological disorders and systemic conditions including drugs and medications, which may also lead to pigmentation. Some of the dermatological disorders are:

1. Pigmented Contact Dermatitis

This condition can occur both in men and women. This kind of pigmentation occurs due to frequent and repeated contact with sensitizing allergens primarily present in cosmetic and textile materials. This can be seen as a diffuse or reticulated (lace-like) pattern of hyperpigmentation. This kind of pigmentation is mainly gray/brown such as slate gray, gray-brown to blue brown. If caused by cosmetics, it commonly affects the face and neck. However, it can affect other sites on the body depending on the allergen responsible.

2. Pigmented Photo Contact Dermatitis 

The most common reason for this condition is musk containing fragrances, anti-diabetic medications, and certain antibiotics, etc. Photodynamic substances in cosmetics on exposure to sunlight leave behind reticulated hyperpigmentation. Avoidance of the causative agents, prescribing of lightening agents and some procedures are part of the treatment plan.

3. Lichen Planus Pigmentsosus (LPP) 

LPP is a pigmentary disorder very commonly seen in India. It involves mainly the face, neck, and upper limbs but sometimes can be more widespread. In this condition, pigmentation varies from slate gray to brownish-black. Hyperpigmentation can be diffused or reticulate in the pattern. LPP is rather a difficult condition to treat and it may take months to years for the pigment to fade.

4. Macular Amyloidoses

This kind of hyperpigmentation is very common in Indians. It usually involves both the arms and upper back. This pigmentation usually aggravates by friction, hot showers, and the use of loofah and bathing brushes. This pigmentation is usually brownish-black with a reticulate pattern.

Treatment

All these conditions require a medical evaluation. Regular use of sunscreen and avoiding triggering factors is the mainstay of treatment.  This will be followed by the application of skin lightening products and treatments to lighten the hyperpigmentation.