YES, MOST WOMEN ARE THRILLED THAT THERE are tons of concealers and foundations out there to perfect their skin. But, at the end of the day, most would prefer to wear makeup that enhances their beauty, rather than covers up flaws. For women who suffer from imperfections due to hyperpigmentation—dark marks from acne, liver spots, or melasma, including covering up, or suffering in silence, can truly be a thing of the past. There are highly effective solutions—creams, peels, even lasers, that can erase such flaws. Today's spas are in an ideal position to treat this growing problem.
"Hyperpigmentation is a condition, usually harmless, in which areas of the skin become darker in color than the normal surrounding skin," says David Watts, M.D., F.A.C.S., a skincare expert and plastic surgeon from Vineland, NJ. "This darkening occurs when an excess of melanin, the brown pigment that produces normal skin color, forms deposits in the skin." The three most common forms of hyperpigmentation include: Post Inflammatory Hyperpigmentation (PIH), small localized dark marks caused by trauma from acne, mosquito bites, eczema, rashes, and more; Melasma, a condition in which larger areas of darkened skin (usually on the face or neck) appear due to hormonal shifts from pregnancy or birth control pills; and age spots or liver spots, small dark patches which are not raised that result from sun exposure. They usually appear on the face or hands, but can show up on any part of the body that's been exposed to the sun.
Hyperpigmentation can affect any race or skin type, but individuals with skin of color have a higher risk of developing it and a more prolonged recovery period simply because they have more pigment-producing cells. In instances of PIH, melanin rushes towards the traumatized area. Even minute upsets like mosquito bites, pimples, or ingrown hairs can leave their mark. What's often left behind is a dark spot. Because most Caucasians have considerably less melanin in their skin, their incidences of PIH are much lower than people of color. However, when they do suffer from hyperpigmentation, generally as a result of sun damage, their treatment options are typically more extensive. Sensitive-skin types aside, Caucasian skin can recover from the trauma of professional procedures, such as lasers, peels, and microdermabrasion with fewer consequences than skin of color.
The first line of defense against any type of hyperpigmentation is sunblock. Remind your clients of the importance of staying out of the sun and always using sunscreen. The sun will only intensify darkened areas, so those with hyperpigmentation should use a broad spectrum SPF of 30 or higher every day, rain or shine. It's also a good idea to treat skin that is tan-free. "Tanned skin is more sensitive and reactive than normal skin, with an increased risk of becoming irritated from chemical or laser therapies," says Eliot F. Battle, Jr., M.D., a Washington, D.C.-based cosmetic dermatologist who specializes in treating skin of color. You might also want to begin an aggressive regimen, like peels, laser therapy, or microdermabrasion during the late fall and winter months, when UVB rays are less prevalent. Patients invest their time and money into eradicating hyperpigmentation, so why not shoot for the optimal season, when there are fewer damaging rays that won't interfere with the progress of such treatments.
"The enzyme responsible for melanin production in the melanocyte is tyrosinase. Most topical bleaching agents inhibit the action of tyrosinase," says dermatologist Jeannette Graf, M.D., of Great Neck, NY. "The most popular tyrosinase inhibitor, hydroquinone, is still the only product approved by the FDA to be used as a skin lightener," she adds. There are certainly other effective tyrosinase inhibitors, including arbutin, azelaic acid, and kojic acid. Most of these brightening ingredients are available in both over-the-counter and prescription formulations. Generally speaking, you'll get faster results with stronger formulations, but considering the fact that so many women have sensitive skin, the slow road, or weaker formulations, are often the best route to an even complexion. Dermatologist and skincare expert Jessica Wu, M.D., of Los Angeles, adds, "The combination of Retin-A and bleaching agents can speed up the skin-evening process. Retin-A helps the hydroquinone penetrate better by removing dead skin cells." Adds Graf, "In an ideal situation—with the right diagnosis, proper use of product and sunblock—patients can see a significant change in hyperpigmentation from topical treatments alone." Graf also adds that non-fermented soy extract works well in conjunction with hydroquinone to even complexions. "Those with sensitive skin should start with ingredients like soy, licorice, or arbutin. They're often less irritating than hydroquinone and Retin-A," adds Wu.
Chemical peels or mechanical peels (microdermabrasion) are great partners to topical fade creams in the fight against hyperpigmentation. These exfoliating treatments remove the upper most layers of dead skin, allowing the skin to renew itself or turnover faster, which speeds up the process of eradicating hyperpigmentation. Generally speaking, it takes a series of three to five chemical peels or microdermabrasion treatments to see a difference. Because these forms of exfoliation do cause the skin some trauma, it is a good idea to prep the skin about a month prior to the peel or microdermabrasion treatment with fading creams that include the tyrosinase inhibitors mentioned above. Again, ingredients like azelaic acid, hydroquinone, or kojic acid calm the melanocytes down, so when the skin naturally reacts to the peel or microdermabrasion treatment, there will be less response from the melanocytes.
Lasers most commonly used to treat hyperpigmentation include the KTP, IPL, Q-Switched, Nd:Yag, and Ruby Lasers. The treatment of hyperpigmentation with laser techniques is a fast and growing field, but with skin of color, expertise is an absolute must. "Melanin can absorb the laser light, which is then converted into heat, causing thermal damage and resulting in more hyperpigmentation," says Watts. In the last few years, real progress has been made so that finally laser therapy is a safe and effective option. "But, because such therapy on skin of color is still considered a new frontier of sorts, expertise in both the laser therapy as well as treating skin of color is paramount," says Battle. Because he is one of the pioneers from Harvard that made lasers safe for skin of color, it's no surprise that his facility, Cultura, a medical spa in Washington, D.C., provides monthly hands-on workshops for skincare practitioners on treating skin of color with lasers, peels, and microdermabrasion. With the fall season in full gear, there's no better time to begin treating the hyperpigmentation issues that may be plaguing your clientele. —Pamela Edwards
Pamela Edwards is the fashion and beauty features editor at Essence magazine.