Hyperpigmentation results in flat, darkened patches of skin that are light brown to black in colour, and can vary in size and shape. Types of hyperpigmentation include age spots, melasma, and post-inflammatory hyperpigmentation and even lentigo maligna, a form of skin cancer. Hyperpigmentation is one of the biggest skincare concerns today, so if you do have them, know that you are not alone. Read on as Dr Teo Wan Lin addresses your concerns on hyperpigmentation and pigmentation products.
Q1: Do most brightening products target only the top layer of the skin?
It is important to understand from a dermatologist perspective that pigmentation develops from primarily the layer of the skin we call the epidermis. The epidermis itself is further divided into layers, the bottommost layer is known as the stratum basale. It is important scientifically to distinguish that references to the top layer of the skin are actually not accurate because the top layer itself is further divided into five different layers. That being said, the origin of pigmentation is typically from the melanocytes. Melanocytes refer to pigment producing cells – this originates from neural crest cells during the development of the central nervous system via the process of embryogenesis. Pigmentation commonly localises to the stratum basale.
Q2: What are the differences between pigmentation products and brightening products?
In terms of brightening products, one does not use the word brightening in dermatology. However, I understand that it’s a colloquial expression of a topical, that when applied leads to removal of pigmentation, i.e. referring to pigmentation products. This would commonly fall under the category of active ingredients that inhibit the production of melanin, a process we call melanogenesis.
Q3: Do most brightening or pigmentation products make you more sun-sensitive?
I think it’s not to say most. If you were to just zoom in on the synthetic skin lightening pigmentation products, then yes. This is because the most prominent would be hydroquinone and retinoids, both of which could be sun sensitising. Tretinoin which is a form of retinoid and hydroquinone, primarily from its irritating side effects. Having irritated skin means you could be more susceptible to sun damage. On the other hand, botanical or nature derived ingredients that have been scientifically proven to help pigmentation, tend to have little to no side effects. For example, there are certain microorganisms like fungus or kojic acid, that is derived from a fungus in nature, which are helpful in inhibiting melanocyte activity.
Q4: What are the active ingredients in these brightening and pigmentation products?
Most of the active ingredients are tyrosinase inhibitors. Tyrosinase is an enzyme that is actively involved in the production of pigment. Brightening and pigmentation products refer to any active ingredient that has been proven to inhibit the process of melanin formation and melanocyte activity. This would include evidence-based ingredients such as hydroquinone. Hydroquinone has both an epidermal and dermal action when it works in certain conditions such as melasma. In melasma, it is important to emphasise that pigmentation can be both superficial i.e. the top layers, or deep i.e. the dermal layers.
Q5: When pigmentation products advertise that they can effectively treat the cause of hyperpigmentation, are we supposed to believe that?
I think it’s really any descriptive that brands can choose to use. The important thing is the active ingredients the product consist of and the ingredient’s validity based on credible sources. You can carry out a short literature review on the ingredients on a scientific database i.e. Pubmed funded by National Institute of Health (NIH) in the US. If it’s an active ingredient that is scientifically proven, you’ll be able to find more than one paper on that ingredient.
Do note that skincare and cosmetics are not regulated by any authority. The Food and Drug Administration (FDA) in the US and Health Sciences Authority (HSA) in Singapore essentially regulates the incorporation of toxics and banned substances in skincare. They however do not validate claims in skincare. Hence, it is important to first research active ingredients listed in the pigmentation products.
Q6: Do pigmentation products tackle the root of hyperpigmentation or simply “slough off the top layers”?
I believe “sloughing off the top layers” refers to epidermal cell turnover which is the turnover rate of the topmost layer of your skin. There are some active ingredients e.g. glycolic acid, which is a type of AHAs that works well for pigmentation due to its ability to interfere with epidermal cell turnover. Topical retinoids also work by regulating epidermal cell turnover, though via different mechanisms. It targets various pathways in the skin to increase skin elasticity, increase collagen formation as well as decrease deposition of pigmentation.
Q7: Are the causes of pigmentation on the face and other areas of the body the same? What are the different types of pigmentation?
It is common for a layperson or a non-dermatologist to assume that an area pigmentation vs another area is the same. But to dermatologists, pigmentation itself is a very broad topic and there are 20 or 30 different types of pigmentation. The common ones are mostly cosmetic, thereabouts 4 or 5 types of pigmentation. The most common type of pigmentation is sun spots which is known as solar lentigo. Solar lentigo is dependent on age, genetics and amount of sun exposure. Another common type of pigmentation is ephelides, ephelides are genetically coded freckles which are more common in individuals with red hair.
The other common type of pigmentation in people of coloured skin would be melasma. Melasma is categorised into different types, depending on the various depths of the deposition of the pigment as well as the location of melasma. Other causes of pigmentation would be post-inflammatory hyperpigmentation (PIH) – a mark is left from a pimple or a surgery. PIH has to be treated differently from melasma, solar lentigo and ephelides. There are other types of pigmentation and even autoimmune diseases such as lichen planus. Lichen planus leads to hyperpigmentation of the skin. It is dangerous for anyone to assume that it’s a cosmetic problem and try to treat that with aesthetic dermatology treatment.
Q8: How do I eradicate dark spots and pigmentation on my face?
Firstly, it is important to get a correct diagnosis and knowing when the pigmentation becomes dangerous. It is crucial to not assume dark spots on your face to just be an aesthetic problem that you can burn or laser off. Dermatologists are trained to distinguish between various types of moles which are not obviously cancerous. Thus one should seek professional help before any assumptions are made.
A typical red herring would be a condition known as lentigo maligna. Lentigo maligna has been infamously diagnosed by dermatologists as an cosmetic pigmentation issue. However, it is a fairly aggressive form of skin cancer, melanoma. Melanoma has the ability to spread to your lymph nodes and if discovered at an advanced stage, at the very minimum, it causes severe disfigurement due to the extent of surgical resection needed. At worst, it can lead to mortality.
Q9: Lipodisq has been incorporated safely and efficiently to deliver potent skincare actives into deep layers of the skin. What are your views on nanoparticle drug delivery?
Lipodisq is a nanoparticle delivery system that is patented by a cosmeceutical company in the UK. To my knowledge, it is something which certain cosmetic manufacturers also utilise in the formulation of their products including pigmentation products to increase the cutaneous absorption of active ingredients.
In terms of nanoparticle drug delivery, I would say data is very much limited to the commercial interest that is driving the technology and hence the patent protections as well. Accordingly, I currently do not know of studies by the international dermatology community that independently verify these claims Nonetheless, from what we see with literature provided by the parent company that has researched this technology, the data does seem interesting and the technology itself, a safe and sound form of topical delivery.
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