Local dermatologist Dr. Nomphelo Gantsho explains that pigmentation is essentially caused by the excess production of melanin by the melanocyte cells of our body. A number of factors encourage the abnormal increase in melanin production.

“Pigmentation is a dynamic condition. Pigmented facial skin is more common in people with Fitzpatrick prototype IV to VI (Asian, mixed race and African), but it can affect anyone.

“Many men and women across all ages suffer from pigmentation. Even in their early 20s face this problem,” says Gantsho.

It can be caused by chronic sun exposure, IR-A exposure, chemical interactions, inflammation or distressed skin, hormonal fluctuations, and internal skin ageing; for example: 

• Sun damage (Solar lentiges/Sun spots) - on the body parts exposed to the sun.

• Melasma (or chloasma) - often referred to as “mask of pregnancy”.

• Post-inflammatory hyperpigmentation - occurs when the skin is injured or trauma heals and leave the discolouration behind. There are many causes, to name the few acne or irritant dermatitis.

READ MORE: 3 women share what finally worked to clear up their eczema  

Dermatological treatments - anti-pigmentation procedures to consider

For the quickest, safest, and most effective results: always contact your dermatologist first to discuss your specific concerns, expectations and treatment plan.  Always use topical ‘lightening’ products only under supervision of you physician.

Recommended medical combination modalities is useful in speeding up control and maintenance (chemical peels, needling like Dermapen, fractional laser, IPL treatments, microdermabrasion) 

We asked two women to share their pigmentation journeys and the treatments they tried for their specific concerns: 

Zakiyah, 25 - Sun damage (Solar lentiges/Sun spots) pigmentation  

"I decided to try out the much talked about Dermapen miconeedling treatment. I've been noticing small pigmentation spots forming on my cheeks over the past few months (predominantly thanks to me ignoring the importance of using sunscreen), so I had a session done by Nazia Khan from Bella Rose Beauty Salon in Cape Town.

"Dermapen is fast-becoming a popular choice in skin rejuvenation and is used to treat pigmentation, acne scars, stretch marks and fine lines and wrinkles, among other skin concerns. It's become quite praised due to its low-risk and having a minimal downtime. As soon as you receive the treatment, your body responds by producing new collagen, elasticity and skin cells.

"Interestingly, it was previously only used as medical treatments until a few years ago where beauty therapists started offering it as part of skin rejuvenation treatments."

READ MORE: The dos and don'ts of derma rolling

The process

Your face is first cleansed so that it’s makeup and dirt-free. Then, a medical-grade numbing cream is applied to prevent you from feeling any pain and 15–20 minutes later, a serum – suited for your specific skin type and skin condition – is applied. After this, you're ready for the treatment. It lasts around 30 minutes and actually feels a little bit like a massage (thanks to the numbing cream, of course!).

The level of penetration depends on the results you're looking for. The needle depth ranges from 0.5mm up to 2.5mm and the 2.5mm is used mainly for stretchmarks (so it can be used across your body) and acne scarring. The 2.5mm was used on my cheek area. The deeper it goes, the quicker it yields results. It can also be used around and over the lips to help with superficial wrinkles and for slight plumping.

Some people don’t bleed at all during the treatment, or very minimally, but Nazia explained that the quicker you bleed, the better, because it means the needles are pulsating your skin quite easily.

What's the downtime?

There's 24–48 hours of redness and a little bit of swelling you'll experience afterwards. You shouldn't exercise on the day after treatment, and your face will feel extremely tight and dry for the next two to three days. There is also a possibility of mild skin peeling, and clients are advised to not use any active products two to three days before and three to five days after the treatment. 

How many sessions are required?

Ideally you would require a minimum of four and a maximum of six sessions when doing a course. The treatments are done four to six weeks apart, and if desired, you can have the treatment continue every few months for maintenance. 

It's also important to note that while Dermapen breaks down the pigmentation, it doesn’t remove it completely – that’s where your chemical peels come in, although younger people (late twenties/early thirties) oftentimes opt for the former.

Can everyone use it?

Yes, it's for everyone. However, to experience minimal pain, a pregnant woman can only receive the 0.5mm needle treatment as she's not allowed to have the numbing cream applied. 

Cost

R800 per session

Two tips from Nazia:

* The first step in any pigment-reducing regime is the daily application of sunscreen, even during winter.
* For healthy, glowy skin, Nazia always recommends her clients use skincare products that have one of the following ingredients: vitamin C, kojic acid, liquorice or vitamin B3.

Reeza, 31 - Melasma (or chloasma), aka hormonal pigmentation 

"My concerns are purely aesthetic. I don't like having marks on my face that can't at least tell a story.

"I prefer to wear as little make-up as possible (really don't like wearing foundation) and have always worn sunscreen on a daily basis. So it was quite disappointing when I started to see marks.  I'm choosing to start treatment now to prevent it from getting worse, and to see how much of it I can reverse. 

"I asked friends and family for recommendations on who I can see. A friend recommended MASC to me. They use a Visia skin analysis system and I felt that required little commitment from my side. The therapist then recommended that I do their facial peels, SkinTech TCA Peel to be exact. You can either go for one each month or do a set of two that is very intensive. I chose the latter because of time constraints."

How it works

"The therapist ‘paints’ a layer on your face, it dries and then she repeats this twice. The first 2 layers was a bit prickly and hot, but the last layer burned like hell. I almost became religious. Afterwards my skin was extremely tight for a couple of days, like when you have a burn wound. Then it started to peel. Like a snake getting a new skin. 

"About nine days after the peel most of the skin was off, leaving me with soft, slightly pinkish skin. I haven't seen huge results yet, it mostly looks like the tan was removed from my face. Hoping for better results after the second peel (which happens 2 weeks after the first). 

"The therapist said that the melasma will never be fully gone, you can just lighten and manage it (its hormonal pigmentation). But you can continue with peels/microdermabrasion until it's at a level that you're satisfied with."

Ingredients to look for in products

It’s very important to note, there are no quick fixes. 
 
“When you notice any dramatic change in a skin lesion or area of discolouration (spreading, raised, inconsistent colour, sensation) immediately contact your dermatologist for professional advice,” says Gantsho.

Treatment really depends on what is causing the pigmentation. It’s always important to treat the underlying cause first, for example acne.

Melasma can be hormonal, can be seen in people that are using oral contraceptives so in those cases it’s important that a person stops using the oral contraceptive and use the other forms of contraceptive.

Exposure to the sun aggravate any form of pigmentation, therefore it is important to use a sunscreen with an SPF of 30 or more depending on your skin colour.

In recent years, a number of skincare products that claim to reduce hyperpigmentation have emerged. Most rely on one of the following active ingredients to decrease melanin production and reduce the appearance of dark spots: 

• Sunscreen with UV filters (protect) i.e. micro fine zinc oxide

• Antioxidant protection (prevent) i.e. L-ascorbic acid

• HYDROXYPHENOXY PROPIONIC ACID (correct). Inhibits melanin transfer to keratinocyte throughout all the layers of the epidermis (non-cytotoxic derivative of Hydroquinone)

• EXFOLIATING/RESURFACING INGREDIENTS (correct) i.e. Retinols 

• ELLAGIC ACID (correct) Blocks excess melanin by inhibiting tyrosinase at the basal layer

• YEAST EXTRAC T (correct) Strengthens dermal fibroblasts to enhance skin’s resistance against new and reoccurring pigment 

• TYROSINASE INHIBITORS (correct) i.e. kojic acid, oligopeptides, neoglucosamine, alistin, albutin, sabi white, hydroquinone, chromabrite, neocitrate

 
Skincare routine adjustments that would effectively treat these skin problems at home

- Sunblock is mandatory
- Mechanical scrubs
- Enzymatic scrubs
- Always use antioxidant serum and take oral AOX capsules
- Day and night care containing the ingredients mentioned above. 

 Images: Giphy 


Recommended routine and products:

At night:

- one to two weekly evening treatments (pure Retinol 0.5) under doctor's recommendation
- daily treatment (Advanced Pigment Corrector (SkinCeuticals), D-pigment (Avene), Eucerin Even Brighter - serum and cream

Bonnie Mbuli as the new face of Avene Di-Pigment, says she's has also suffered with pigmentation and uneven skintone throughout her life. 

In the morning:

 - Daily antioxidant (e.g. Phloretin CF) for pigment regulation and prevention
 - Daily treatment (e.g. Advanced Pigment Corrector by SkinCeuticals), for lightening intensity of dark spots
 - Excellent UV protection (water resistant Physical Fusion SPF 50) re-apply regularly every 2 hours
 

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