While we may praise our beautiful year-round weather here in Australia, all that sunshine and clear blue skies can take their toll on our skin. The sun’s rays are amongst the harshest down under (Australia receives higher UV radiation levels than other parts of the world due to its close proximity to the equator) and we often have clearer atmospheric conditions (read: limited cloud cover to diffuse the sun’s rays), which is one of the reasons pigmentation is a top skin concern for Australians.
So what can we do to save our skin from pigmentation? We asked two leading Australian dermatologists to share their advice on how to prevent pigmentation and the best treatments to try.
“The sunny weather in Australia puts people at greater risk and the skin can age prematurely, highlighting pigmentation and skin discolouration.”
Dr Ingrid Tall, Australian dermatologist
What is pigmentation?
Pigmentation is when a patch of skin appears darker than your natural skin tone. Common types of skin discolouration include sun damage, dark spots, pregnancy-related melasma, and freckles.
“Pigmentation is the colouring in a person's skin, which is created by the pigment cells or melanocytes,” explains dermatologist Dr Ingrid Tall from Cosmetic Image Clinic. “Skin damage and other conditions may make your skin change colour, usually becoming darker. This occurs as a result of the body producing too much melanin which is known as hyperpigmentation.”
Just to be clear, some melanin is actually good. In fact, Brisbane-based PhD scientist, science educator, and former Registered Nurse Dr Michele Squire says, “Melanin functions to protect skin by absorbing and dissipating UV radiation, thereby preventing free radical formation and skin damage. Melanin is our natural sunscreen - it has an SPF of 3.4, meaning it absorbs about 50-75% of UV light hitting the skin. This is why darker skin tones have more natural sun protection.”
The problem is when we have an overproduction of melanin.
What causes pigmentation?
“Hyperpigmentation can occur when cells known as melanocytes become damaged due to several factors including sun exposure, inflammation, acne, smoke, burns or pollution. It often appears on the face, neck, and décolletage,” says Dr Tall.
The different types of pigmentation
Melanin produces all pigment in normally functioning skin and hair, but mottled brown patches of pigmentation (called hyperpigmentation/dyspigmentation or pigmentary disorders) are usually one of three types, explains Dr Squire:
Photo-ageing related pigmentation: Random spots of pigmentation caused by cumulative exposure to UV light.
Melasma: Patchy brown hyperpigmentation (usually in a symmetrical pattern) that occurs on sun-exposed areas of the face. You may have heard it called ‘the mask of pregnancy’ because it often appears in pregnancy, however oral contraceptives and hormone replacement therapy can also be involved. Although it is a complex pigmentary disorder that has a multitude of causative factors, including hormones, genetics, and skin colour, it is triggered and amplified by UV exposure. Melasma is a frustrating and emotionally distressing disorder as it is chronic and often relapses, especially with continued sun and hormone exposure. It is more commonly seen in people with darker skin tones.
Post-inflammatory hyperpigmentation (PIH): Caused by trauma (injury or inflammation) to the skin, particularly in people with darker skin tones. PIH results from a local overproduction of melanin and appears as dark spots/patches in the same area as the healed injury. These marks can take several months to years to resolve, even with treatment. And they may worsen with exposure to UV (one of the major reasons people with acne should always wear sunscreen!).
How to prevent pigmentation
Treating pigmentation can be costly and timely (not to mention pigmentation is likely to keep reappearing if you don’t take preventative measures) so it’s always best to try and prevent pigmentation in the first place. “Sun exposure is the main risk factor for hyperpigmentation, triggering its appearance, worsening and persistence. No treatment plan is complete without a broad-spectrum sunscreen,” says Dr Squire.
“High-factor sunscreen has been shown to reduce melasma severity by 50%, and reduces its impact during pregnancy in more than 90% of people.”
Dr Michele Squire, Australian dermatologist
“UV protection using the likes of sunscreen, zinc, hats and umbrellas is one of the best ways to prevent skin damage and therefore minimise hyperpigmentation,” adds Dr Tall. “Combine this with the use of the topical vitamins A, B and C gives you the best chance of keeping your skin tone even and youthful.”
How to treat pigmentation
Hyperpigmentation can be a challenging skin concern to treat. Thankfully, there are a number of treatment options available, both professional and at-home.
Dr Tall cites Fraxel Dual Laser as one of the most effective ways to minimise pigmentation. Using a laser wavelength specifically targeted towards pigmentation, this treatment helps fade freckles, post-inflammatory hyperpigmentation, chloasma and melasma. “Fraxel works by running a hand-piece over the skin,” explains Dr Tall. “This Fraxel light energy stimulates collagen and resurfaces the top skin layer. Your skin’s natural rejuvenation process smoothes wrinkles and scars by stimulating collagen. It also targets pigmentation deep within the skin.”
Dr Tall says Fraxel treatments usually last between 15-45 minutes and most patients see the best results after one to five Fraxel treatments. “Fraxel works with your body’s skin cells, so results typically take one to three weeks to take effect,” she adds.
In addition to Fraxel, there are other professional treatment options available, such as peels like Cosmelan, Dermamelan, retinoic acid, and glycolic acid; lights (IPL and BBL); and lasers (Q Switch, Picosecond, Fractional). “They all work in different ways to target and remove the pigmented component of skin, rather than managing the melanin production process,” says Dr Squire. “So they are useful measures if you want a super quick result, or to speed up the effects of topical treatments.”
However, since professional treatments can be expensive and come with significant downtimes of at least two to three weeks, Dr Squire says topical treatments are the best option for treating pigmentation. “Topical treatments like retinoic acid and hydroquinone, plus photoprotection (including religious use of SPF 50 sunscreen) are the gold standard in treating and managing dyspigmentation,” she says.
When it comes to fading creams, Dr Tall notes kojic acid, hydroquinone (“the number one most prescribed and most effective fading cream worldwide”) and arbutin as effective ingredients for inhibiting the production of melanin.