Ask Adeela: what to do about dark spots and pigmentation?
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Pigmentation patches are to the skin what Japanese knotweed is to soil: persistent, irritating and nigh on impossible to see the back of. It is one of the most common and stubborn skin issues I treat as a facialist, and a widespread increase in cases – partly due to the boom in cheap air travel and beach holidays, coupled with the stresses of modern lifestyles – mean that the global pigmentation-disorders market is projected to surpass $8.9bn by 2028.
Dark spots primarily occur due to the overproduction of melanin, the pigment responsible for skin colour. When skin is exposed to the sun, it produces melanin, which helps to block UV radiation from damaging the DNA and skin. But excessive melanin can spill between skin cells, resulting in dark spots.
A range of other triggers, such as acne, ageing, nutritional deficiencies, heat or friction trauma, can also cause hormonal melasma or post-inflammatory hyperpigmentation. Environmental stressors like free radicals (unstable molecules seeking their missing electron) generated by UVA and pollution can also set off pigmentation through oxidative stress. There’s also blue light or high-energy visible light (HEV), emitted from electronic screens and smartphones, which penetrates deeper into the dermal layer than UVB rays. (One day of overexposure can undo months of treatment.)
In my experience, pigmentation sufferers have to keep protecting against these triggers – even when it’s under control – to prevent flare-ups. As the Dutch philosopher Erasmus said, prevention is better than cure.
Sunscreen should always be your first line of defence: applied daily, and reapplied every two to four hours. A high-quality sunscreen should have antioxidants alongside filters like titanium dioxide and iron oxide, which scatter light. As I have olive/bronze skin, I have tried countless SPFs in the hope of finding one that doesn’t leave a greasy white cast. Shiseido Expert Sun Protector Face Cream SPF50+ glides weightlessly, without leaving a residue, and becomes more effective when exposed to water and heat. It is my regular go-to.
Free-radical damage can be prevented with antioxidants such as vitamins A, C and E; ferulic, tranexamic and kojic acids; and niacinamide. A daily dose of a potent formula such as SkinCeuticals Discoloration Defense Serum with its multiphase delivery of tranexamic acid, niacinamide and sulfonic acid is a good daytime protection.
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For a one-two punch to amplify results during the day, I recommend layering this serum with a vitamin C-rich cream. Vitamin C is an antioxidant that inhibits tyrosinase, an enzyme involved in the production of melanin, and thus makes hyperpigmentation development more difficult. Natura Bissé C+C Vitamin Cream is formulated with three formats of vitamin C to create a protective umbrella for sun-damaged skin.
While you sleep, the skin doesn’t. It’s regenerating, making night-time the best time to introduce exfoliating and lightening alpha-hydroxy acids (AHAs). To correct dark spots, I suggest an overnight treatment such as Allies of Skin Mandelic Pigmentation Corrector Night Serum to inhibit the production of melanin.
Using a topical retinoid product that treats and fades hyperpigmentation is another good night-time corrective measure. The real results come from high-strength prescribed retinoids, though over-the-counter (OTC) retinols are obviously easier to obtain. Brands such as Dermatica make getting a prescription less daunting. The online process involves submitting image referencing and forms, and analysis by a medical and dermatology team, after which the prescription is delivered to your door. Clear instructions and gradual dose increases mean a smart, affordable and successful approach to treating pigmentation.
Retinol can also be found in single multitasking liquid exfoliants with active ingredients, which I hail as true wonder workers. U Beauty Resurfacing Compound is a blend of a stable form of vitamin C, retinol and AHAs, a combination that streamlines daily skincare and prevents the build-up of dark spots.
Vintner’s Daughter Active Treatment Essence is another multitasker. I discovered its full resurfacing power on a flight, when it leaked into my cosmetic bag and wiped the labels off other products. This fermented enzyme-rich nutrient broth is packed with micro-exfoliating plant acids, stem cells and more than 30 botanicals – use it as a daily pigmentation fighter by spritzing it before applying serums and moisturisers.
Case study: three month in-clinic treatment for pregnancy-induced melasma
Melasma is a specific diagnosis, and it is particularly challenging to treat because it is related to everything from sun damage to post-acne inflammation, heat, hormones, menstrual cycle fluctuations, pregnancy, birth-control medication and stress. Its pathogenesis may also be influenced by psychological or oxidative stress. One common manifestation is during pregnancy. One of my clients had developed pregnancy-induced patches on her forehead and cheeks. There is a difference in the morphology of melasma when compared to dark spots: it appears patchy with ill-defined edges. I treated her over the course of three months.
Pigmentation always requires a series of treatments, from the simple to the complex. In my Mayfair practice, I used peels to exfoliate and resurface, and microneedling, tripolar radiofrequency and topical tranexamic, ferulic and kojic acid serums to remove epidermal melanin build-up. I also prescribed Pigmanorm, a topical skin-lightening cream containing tretinoin, hydroquinone and hydrocortisone, for 10-12 weeks of home care to prevent pigmentation developing.
People tend to be more laissez-faire about sunscreen use when they have an indoor job, but for pigmentation sufferers, reapplication is crucial, particularly if you sit next to or near a window. I instructed my client to be vigilant with suncare.
With the help of these measures, my client’s melasma is now under control and her skin is brighter and more even-toned.