Pigmentation & Dark Spots

The causes of pigmentation are varied and mostly the routine types which implies that a little bit of care here and there can save our skin from pigmentation and hyperpigmentation.

1. Damage due to the Sun: The most common cause of pigmentation is the sun damage. The damage thus caused is usually recurring and is cyclical in nature. This is because the UV-A and UV-B rays in the sun speed up melanin production in the skin. This melanin then has a tendency to absorb additional UV-Aand UV-B. This process causes inflammation within the skin. The immediate effects of the damage are negligible enough but over a time, they start showing up as tan patches. Also, in the 3-D Facial Analysis that is done at Garg Cosmetic Clinic, we have found that in many patients, there are distinct pigmentation spots on the skin which though not visible to the naked eye, still exist.
2. Skin Cuts and Bruises: As was mentioned in the opening sentence itself, sometimes things as simple as a minor cut or a pimple popping act can result in pigmentation. This is because, as a repairatory response, the skin produces melanocytes which produce melanin at the affected site and hence causespigmentation.
3. Allergic reactions to certain external factors or certain medications (such as retinoids, anti-seizure drugs, hormonal medications, non-steroidal drugs etc.) can also cause pigmentation of the skin
4. Hormonal changes especially around the time of menopause are another major cause for pigmentation. Also, some women experience excessive pigmentation during pregnancy due to excess production of the hormones estrogen and progesterone.
5. Lastly, some people have it in their genes that their melanin production and hence deposition would be more than normal and hence heredity becomes another cause of pigmentation.

As can be inferred from the causes above, Pigmentation can be divided into two broad categories:

Melasma or Chloasma:
Occurs as a result of hormonal influences mainly due to the hormones estrogen and progesterone. They are usually seen as dark and irregularly shaped areas on the face or arms, usually larger in size

• What is Melasma?
  

  Melasma is a skin condition presenting as brown patches on the face of adults. Both sides of the face are usually affected. The most common sites of involvement are the cheeks, bridge of nose, forehead, and upper lip.

Who gets Melasma?
• Melasma mostly occurs in women. Only 10% of those affected are men. Dark-skinned races, particularly Hispanics, Asians, Indians, people from the Middle East, and Northern Africa, tend to have melasma more than others. The precise cause of melasma is unknown.
• Melasma is thought to be the stimulation of melanocytes or pigment-producing cells by the female sex hormones estrogen and progesterone to produce more melanin pigments when the skin is exposed to the sun. Women with a brown skin type who are living in regions with intense sun exposure are particularly susceptible to develop this condition.
• People with a family history of melasma are more likely to develop melasma themselves.
• A change in hormonal status may trigger melasma. It is commonly associated with pregnancy and called Chloasma or the “mask of pregnancy.” Melasma may disappear after pregnancy; it may remain for many years, or a lifetime.
• Birth control pills may also cause melasma.
• Sun exposure contributes to melasma. Ultraviolet light from the sun, and even very strong light from light bulbs, can stimulate pigment-producing cells, or melanocytes in the skin. People with skin of colour have more active melanocytes than those with light skin. These melanocytes produce a large amount of pigment under normal conditions, but this production increases even further when stimulated by light exposure or an increase in hormone levels. Incidental exposure to the sun is mainly the reason for recurrences of melasma.
• It may also be noticed in apparently healthy, normal, non-pregnant women where it is presumed to be due to some mild and harmless hormonal imbalance.
• Any irritation of the skin may cause an increase in pigmentation in dark-skinned individuals, which may also worsen melasma. Melasma is not associated with any internal diseases or organ malfunction.

• How is Melasma diagnosed?
  

  Because melasma is common and has a characteristic appearance on the face, most patients can be diagnosed simply by a skin examination with a Woods lamp. Occasionally a skin biopsy is necessary to differentiate melasma from other conditions.

• How is Melasma treated?
  
• While there is no cure for melasma, many treatments have been developed.
• Sunscreens are essential in the treatment of melasma. They should be broad spectrum, protecting against both UVA and UVB rays from the sun. An SPF 25 or higher should be selected.
• In addition, Antioxidant solutions, physical sunblock lotions, and creams may be used to block ultraviolet radiation and visible light. Sunscreens should be worn daily, whether or not it is sunny outside, or if you are outdoors or indoors. A significant amount of ultraviolet rays is received while walking down the street, driving in cars, and sitting next to windows.
• Any facial cleansers, creams, or make-up which irritates the skin should be stopped, as this may worsen melasma.
• If melasma develops after starting birth control pills, it may improve after discontinuing them.
• Melasma can be treated with skin lightening creams while continuing the birth control pills. A variety of creams are available for the treatment of melasma. These creams do not “bleach” the skin by destroying the melanocytes, but rather, decrease the activity of these pigment-producing cells. Typically, these creams contain Hydroquinone, which inhibits the formation of new pigment. Bleaching creams must be applied for at least 6 months to obtain a worthwhile lightening of pigmentation. Even then, just a “whiff” of summer sun can darken the pigment again and spoil months of hard work. Normally, it takes about three months to substantially improve melasma. Remember, a sunscreen should be applied daily in addition to the lightening cream. Apply the cream first then the sunscreen on top.
• Creams containing Tretinoin and Glycolic Acid are used in combination with hydroquinone to enhance the depigmenting effect.
• If progress is slow a hydroquinone cream with Tretinoin may be used. Tretinoin always causes a degree of pinkness and peeling of the facial skin which can be controlled by starting with a little then building up. A sunscreen must be applied as well. Tretinoin MUST NOT be used during pregnancy.
• Chemical peels and laser surgery with potent lasers such as the Instalite laser (Q switched Nd YAG laser) may help melasma, but results have not been consistent. These procedures have the potential of causing irritation, which can sometimes worsen melasma. Generally, they should only be used by a dermatologist in conjunction with a proper regimen of bleaching creams and prescription creams tailored to your skin type. People should be cautioned against non-physicians claiming to treat melasma without supervision because complications can occur.

Management of melasma requires a comprehensive and professional approach by your dermatologist. Avoidance of sun and irritants, use of sunscreens, application of depigmenting agents, and close supervision by your dermatologist can lead to a successful outcome.

It is important to follow the directions of the dermatologist carefully in order to get the maximum benefit from your treatment regimen and to avoid irritation and other side effects.

Post Inflammatory hyperpigmentation:
Occurs after a skin injury heals and leaves discoloration there. Most common in people who have acne breakouts.

Melanin production and deposition is a response of the internal systems against external stimuli and as such no cure for the same has been developed. However, there are few precautions that can be taken in order to restrict the probably deposition to minimum:

• The first and most basic preventive measure lies in the use of broad spectrum sunscreens. By broad spectrum we mean that the sunscreen should be effective against both UV-A and UV-B with an SPF of 35 or more. Also, Sunscreens shouldn’t be used only when out in the sun. The UV rays are always present in the atmosphereand hence, even though it is rainy or you are inside your house, sunscreens should be worn.
• Be mindful of the allergies or slight irritations that any of the make-up product is causing you. Even a slight itch should be a reason enough to discontinuethe use.
• For ladies who are taking pills for birth control, one of the side effects can be melasma. The idea solution would be to look for alternative methods of control and stop usage of birth control pills. Also, various skin lightening creams containing Hydroquinone with either of Tretinoin

• It starts with the primary consult where the patient’s skin is tested by the dermatologist to determine its type and condition. 3-D facial analysis is done in order to get a more accurate representation of the current condition of the skin.
• Based on the test results a home care regimen is prescribed and the skin is given initial peel preperation
• After 2 weeks, chemical peels – Glycolic / Lactic Acid / TCA / Phenol / Resorcinol / Designer Peel treatments are started. The spacing and number of sessions depends on the severity of melasma and the patient’s skin condition
• If the melisma is resistant to peels, a combination of Laser and Tranexamic acid injections is recommended for obtaining the desired results.
• Oral antioxidants are prescribed in order to boost the skin’s immunity against UV.
• The home care is continued post treatments to maintain the results.

Since melasma treatment largely involves use of chemical peels, the process is harmless with hardly any side effects. However, Laser surgery with potent lasers such as the Instalite laser (Q switched Nd YAG laser) has the potential of causing irritation, which can sometimes worsen melasma. Generally, Lasers should only be used by a dermatologist in conjunction with a proper regimen of bleaching creams and prescription creams tailored to the skin type.

• People should be cautioned against non-physicians claiming to treat melasma without supervision because complications can occur or Glycolic Acid are available and can be used for decreasing the pigmentation. Also, Tretinoin is known to cause a degree of pinkness and skin peeling and hence the correct way to use these creams would be to start with smaller area and quantity first and then gradually increasing both.

PRP or Platelet Rich Plasma is a regenerative procedure in which growth factors, derived from the own body are injected into the concerned area for treating hair fall, allergies, muscular issues or wherever similar surgical interventions are required.

At Garg Cosmetic Clinic, we understand the kind of precision that is required for the PRP treatment and hence our doctors and therapists are trained regularly to keep them updated with the latest techniques to provide the most effective treatment.

The following points state what happens in a PRP procedure:

1. The dermatologist draws a sample of the blood. The amount of the sample taken depends on the size of the area where PRP is to be injected. The amount taken is usually around 10 ml.
2. The blood sample is then centrifuged in a centrifugal machine in order to separate it into its constituents. This step takes around 15 minutes for completion.
3. The separated plasma is then taken into a syringe and injected into the affected area.
4. Often imaging services such as Ultrasound are used to see the exact nerve where the plasma is to be injected lest there should be a wrong injection leading to damage

Are there any side effects of PRP Procedure?
There might be slight swelling, pain and redness for initial 5-6 days but it gradually subsides. There are no other side effects reported till date.

How many sessions would be required for a PRP to be effective?
This is very subjective to the patient in question because everyone has different needs. However, 5-6 sessions over a period of 12-18 months are enough for a long lasting results.

When do the results for PRP start showing?
The results are significantly visible only in the long term because PRP treatment is about improving the nutritional situation of the cells. However, it would be safe to state that 4-6 weeks after the treatment, one can see lesser hair fall and growth of new hair at the treated spot.

Are there any Risks involved in PRP?
As long as the procedure is guided well using imaging processes and the doctor is experienced, there are no risks involved in the procedure. However, an untrained practitioner might inject the plasma into the wrong nerves which may cause serious rupture and damage.