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How to Treat Pigmentation on Sensitive Skin: The Art & Science Explained by a Dermatologist

September 17, 2023
Skin Masters Academy Skincare Formulation Series

If you are wondering how to treat pigmentation on sensitive skin, this tutorial is for you. Part 2 of the Skincare Formulation Series by Skin Masters Academy brings you the delicate art of treating pigmentation while balancing the needs of sensitive skin.

This series is written for advanced skincare practitioners who are interested in the use of cosmeceuticals including non prescription topicals as adjunct therapy for various cosmetic skin concerns. 

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How do you treat pigmentation on sensitive skin?

The needs of both must be balanced. Sensitive skin is caused by a dysfunctional skin barrier, which means that the superficial corneocytes have lost their ability to adhere together. This results in a leaky epidermis. External allergens can trigger immunological reactions resulting in redness, itch, stinging and flaking. Moreover, ingredients used to treat hyperpigmentation can penetrate deeper and quicker if the barrier is breached. It’s key therefore to choose only non-irritating actives that treat hyperpigmentation. This excludes the use of retinol and retinoids for those with sensitive skin. Vitamin C serum formulations should have low acidity—if possible, choose neutral compounds like sodium or magnesium ascorbyl phosphate instead of L-ascorbic acid based vitamin C serums. 

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Which cream is best for pigmentation skin? 

In terms of traditional cosmeceuticals, hydroquinone and retinoid based formulations work best for stubborn pigmentation such as melasma. However, these are particularly tricky to use in sensitive skin types. Hydroquinone is known to breach the skin barrier and also causes a paradoxical rebound phenomenon if used inappropriately. For this reason, dermatologists recommend using hydroquinone based formulations for 6 months maximum—requiring a break in between or there could be a condition known as onchronosis that results. Retinoids are troublesome for those with sensitive skin—they do damage the skin barrier and should be used with care under the supervision of a dermatologist. 

Newer non-prescription alternatives have emerged in cosmeceutical research over the years which include melanogenesis blockers like kojic acid, arbutin and novel inhibitors that we will cover at the end of the tutorial. 

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Which acid is best for hyperpigmentation for sensitive skin?

Traditional chemical peel acids like salicylic, glycolic and retinol peels can adversely affect the skin barrier of sensitive skin types. Lactic acid is a gentler alternative although newer formulations now include plant enzyme peels like pineapple and papaya derived bromelain and papain respectively. Hydrodermabrasion is a form of physical exfoliation which can also improve the surface quality of sensitive skin types. By the infusion of antioxidant serums that contain plant actives, vitamin C—there can be a simultaneous benefit that targets underlying processes responsible for melanin production. 

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    Physiology of Sensitive Skin 

    Sensitive skin is a state of hyper reactivity. Key to understanding this is the concept of barrier function. We already know about the brick wall model of skin, which means that once the skin barrier is damaged, the proteins associated with the structure of this wall also changes. Ultimately, this is what stimulates inflammation, leading to tissue damage. This is further exacerbated by what we call the itch scratch cycle. It is helpful to know that neurological factors play a role when it comes to sensitive skin. 

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    How to Treat Pigmentation on Sensitive Skin Tip 1: Patch Test

    Understand the physiology involved—skin barrier dysfunction is what triggers sensitive skin reactions like itching, redness, flaking and stinging. Knowing what to look out for is important to monitor for adverse reactions when using a new skincare product. Patch testing before using the product on the affected area is key. Use a small amount on an inconspicuous area such as under the jawline and monitor for any adverse reactions overnight. 

    The Sensitive Skin Model

    In dermatology research, the sensitive skin model is what scientists use for testing—essentially a skin model that mimics actual skin barrier damage. 

    With this, researchers proceeded to investigate the effect of cosmeceuticals on the damaged skin barrier. 

    @drteowanlin Physiology of Sensitive Skin Sensitive skin is a state of hyper reactivity. Key to understanding this is the concept of barrier function. We already know about the brick wall model of skin, which means that once the skin barrier is damaged, the proteins associated with the structure of this wall also changes. Ultimately, this is what stimulates inflammation, leading to tissue damage. This is further exacerbated by what we call the itch scratch cycle. It is helpful to know that neurological factors play a role when it comes to sensitive skin How to Treat Pigmentation on Sensitive Skin Tip 1: Patch Test Understand the physiology involved—skin barrier dysfunction is what triggers sensitive skin reactions like itching, redness, flaking and stinging. Knowing what to look out for is important to monitor for adverse reactions when using a new skincare product. Patch testing before using the product on the affected area is key. Use a small amount on an inconspicuous area such as under the jawline and monitor for any adverse reactions overnight. #skincareroutine #skincareactives #skincareactives101 #skincareingredients #skincareingredient #singaporedoctor #dermatologist #singaporedoctors #skincare #dermatologist #tiktoksg🇸🇬 #skincareroutine #skincaretips #skincare101 #skincareproduct #dermdoctor #learningsfun #learnontiktok #sensitiveskin #sensitiveskincare ♬ original sound – Dr.TWL Dermatologist

    List of Cosmeceuticals Identified in Research for Sensitive Skin Treatment 

    The following are a list of extracts that have been identified for its efficacy. We have oat extract, olive leaf extract, brown algae, stachycose and erythritol. These extracts are chosen for

    • their ability to scavenge free radicals
    • inhibit hyaluronidase, the enzyme responsible for the breakdown of a hyaluronic acid

    Hyaluronic acid is an important structural protein in the dermis.

    Art & Science of How to Treat Pigmentation on Sensitive Skin

    How to Treat Pigmentation on Sensitive Skin Tip 2: Ingredients to Avoid

    Avoid acids and retinol/retinoid products. Many skincare products formulated for the treatment of hyperpigmentation include peel acids like AHAs, BHAs as well as retinols. These damage the skin barrier and are not suitable for treatment of pigmentation on sensitive skin types. 

    Which cream is best for treating pigmentation?

    How to Treat Pigmentation on Sensitive Skin Tip 3: Go Low & Slow 

    Apply the product in a gradual, incremental manner. Go slow and low. Non-prescription actives have the potential to cause skin irritation as much as prescription actives in sensitive skin types. If you have sensitive skin and are using a low concentration of glycolic, salicylic or lactic acids for treatment of hyperpigmentation, play safe by starting at a once-a-week frequency.

    Remember tip 1–which is always begin with patch test first if you have sensitive skin. After that you can proceed to monitor your skin for up to a week after you use the product on the target area. I would then increase frequency at a weekly interval i.e. from once to twice a week, then three times a week, alternate days before using it on a daily or twice daily basis. 

    Bacterial Ferment Filtrates in Functional Dermatology

    I want to now draw your attention to what I call functional filtrates. These refer to bacterial ferments such as those from galactomyces and lactobacillus. 

    The Origins of the Discovery 

    Elderly sake brewers were observed to have a wrinkle free, youthful looking skin on their hands which were in constant contact with the sake fermentation process. This was in contrast to their faces which were wrinkled and filled with pigmented spots. 

    Research on the Sensitive Skin Model 

    Clinical studies done by scientists then demonstrated that galactomyces and lactobacillus ferment filtrates were able to improve fluctuations in redness, roughness and pore size. They were also helpfil in alleviating mask-induced skin irritation in the era of mask wearing during the COVID-19 pandemic. 

    The Science behind Bacterial Ferment Filtrates

    How exactly do bacterial ferment filtrates work? First of all, they upregulate ceramide production via filaggrin gene expression which is what we know as the key player in healthy skin barrier function. They are also what we consider Tapinarof or TAMA-like. These have been used as alternative therapeutics for inflammatory skin diseases in dermatology like psoriasis and eczema. 

    Therapeutic Skin Benefits of Ferment Filtrates 

    Ferment filtrates are nature’s very own TAMAs. Beyond that, bacterial ferments have an inherent antioxidant capacity. This additional antioxidant effect is what neutralises damaging free radicals. One of the ways it does it is by blocking key mechanisms in the process of inflammaging, for instance cell senescence, the process of cells falling asleep. By doing so, we are reducing stress in the skin and enhancing skin cell repair. 

    Cosmeceuticals containing bacterial ferments also demonstrate increased caspase 14 enzyme expression, which are essentially enzymes that are activated by the phytochemicals present in plant extracts. There is also increased expression of tight junction molecules. These affect the connections between the cells that make up the skin barrier. This ultimately affects the permeability of the barrier and helps to restore healthy skin function. 

    Are Ferment Filtrates the Answer?

    This may be the key to bridging the gap between the needs of hyperpigmentation sufferers and those with coexisting sensitive or reactive skin. Understanding the science behind cosmetic formulations is a start.

    In summary, we have discussed the latest research in skin barrier function, the basis for functional dermatology actives that target hyperpigmentation. Ingredients tested on damaged skin models in the laboratory setting can be of significant use to those seeking alternative tyrosinase inhibitors.

    Botanicals, phytochemical extracts and bacterial ferment products can target multiple pathways of skin inflammation and reactivity.

    If you have both pigmentation and sensitive skin

    How to Treat Pigmentation on Sensitive Skin Tip 4: Use Moisturiser Liberally 

    The problem with sensitive skin is that it never seems to break out of the vicious cycle of barrier dysfunction-environmental trigger-immune reaction—all of which result in perpetuation of the itch scratch cycle. Pigmentation is most often at the superficial layers of skin, though in conditions such as melasma it can go deeper in the second layer known as the dermis. Skincare actives that treat pigmentation can penetrate deeper if the skin barrier is breached—though by the same reasoning we can expect an elevated risk of skin irritation. Liberal, frequent use of a ceramide-dominant moisturiser can mitigate this risk. 

    Advanced Techniques for Skin Experts How do you treat pigmentation on sensitive skin

    How to Treat Pigmentation on Sensitive Skin Tip 5: Dedicate Time to Masking Properly 

    Masking is truly an underrated skincare step. It might sound simple enough, but it works via the basis of wet occlusion therapy—a well founded dermatological principle. In dermatological therapeutics, wet occlusion is an applied technique that helps treat eczema by enhancing absorption of skincare actives. When a wet layer of textile is applied on skin, this improves the permeability of the skin barrier. However, one caveat is that you should use purely hydrating actives in your face mask and avoid retinols, salicylic acids and glycolic acids. 

    Polysaccharide Face Mask
    A mask made of polysaccharide offers significant benefits over traditional single use sheet masks. First of all, the dehydrated form means it has a longer shelf-life compared to those infused with facial essences. It is also customisable, meaning that you could use your own moisturiser with it instead of purchasing expensive serums or lotions. On its own, polysaccharides are also an effective moisturising ingredient—they create little pockets or “mini-reservoirs” that trap moisture at the skin surface.

    Case Study: Sensitive Skin & Hyperpigmentation

    This case study involving an ideal cosmeceutical regimen for those with eczema and coexisting hyperpigmentation can direct of future research in this field.

    There are a few keys that form the foundation of such a product. The ideal skincare formula targeting sensitive skin and hyperpigmentation includes ceramides, natural moisturising factors and bacterial ferments which addresses hyperpigmentation. Critically, sensitive skin users ought to go retinol and retinoid free— as these are well known to cause skin irritation. 

    Beyond that, I am excited to share with you the exciting world of functional dermatology—one that shows the way to alternative tyrosinase inhibitors and novel melanogenesis blockers—each playing a key role in the future of cosmeceuticals.

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