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How to Fade Stubborn Pigmentation and Brighten Up Your Skin:

The State-of-The-Art Part I of III

Are you tired of uneven skin tone? Are you bothered by the brownish patches developed after childbirth? Are you troubled by your skin’s persistent darkening after your acne, laser or chemical peel treatments?

If you have stubborn pigmentation on your face, you may have melasma and/or post-inflammatory hyperpigmentation. Especially for Asians or individuals with darker skin, these skin conditions are two of the most commonly seen acquired hyperpigmentary disorders.

If you wish to have brighter looking skin with even skin tone, then this article is for you. This three-part series discusses the nature of melasma and post-inflammatory hyperpigmentation, their prevention, and innovative state-of-the-art solutions to these common, yet bothersome skin conditions.
In order to better understand the solutions, let’s first discuss the nature of these conditions.

Melasma: The Mask of Pregnancy

You have just given birth to your lovely baby and you noticed that you can’t lose the extra fat and your skin tone, especially on your cheeks, is not as even or as bright as before.

You may have melasma or the so-called “mask of pregnancy.”

Melasma is an acquired hyperpigmentation disorder, which often presents as symmetrical but irregular brownish patches with cloud like and diffused pigmentation on the face especially around the cheeks, forehead, temples and even the lip areas.

Many women of Asian descent or those with darker skin type develop this unsightly pigmentation. While there may be a genetic deposition, the true causes of melasma remain unclear.

There are many well-known factors associated with melasma. The closest connection is with hormones. Hormonal conditions accompanying the development of melasma include pregnancy, as previously mentioned, menopause, and low thyroid function.

Melasma is also known to be associated with the use of certain medications such as birth control pills, hormones, or photosensitizing drugs. Individuals who frequently use fragrant cosmetics may also develop melasma. In my experience as a facial plastic surgeon, patients with low antioxidants in their diet also seem prone to melasma well.

Certain other factors definitively worsen melasma. Exposure to sunlight, for example, significantly worsens the condition. Over the years, I have known numerous patients with melasma which got much worse after their vacation in sunny places during the summer. And indeed, in my experience, any inflammation which results in excessive or prolonged redness further exacerbates melasma.

Melasma is the most stubborn skin discoloration of all. Melasma in the superficial layer of the skin called epidermis is much easier to treat, while melasma in the deeper layer called the dermis is much more difficult to cure. As we will discuss later, treatments rely on state-of-the-art prevention and reduction techniques.

So when you have another child, start to take birth control pills, or you are approaching menopause, take aggressive steps, as we will discuss later, to prevent melasma.

Post-Inflammatory Hyperpigmentation (PIH): The Curse of Inflammation

Does your skin get easily hyperpigmented after an injury? Look at your old scratches or acne and if they stay dark for a long time then your skin is prone to PIH.

Darker skin type can easily develop PIH from any inflammation. As such, any condition which produces inflammation can cause PIH. The causes are obviously numerous. Some of the most common ones include acne flare-ups, allergy, irritation from any source including harsh lasers and peels. And just like melasma, both UV irradiation and certain drugs (for example, tetracycline) likewise worsen this condition.

Facial post-inflammatory hyperpigmentation is also challenging to treat but is easier to cure than melasma. Just as in melasma, however, epidermal PIH is much easier to treat, while dermal PIH is much more difficult to remedy.

So next time you get laser and peel treatments for your skin without proper sun protection and skin products preparation, watch out for PIH and think of prevention first!

Combination of Melasma and PIH

Both melasma and PIH can co-exist, since many of the aggravating factors are the same. Treatment is more challenging when these two conditions are present in a patient.

In summary, melasma and post-inflammatory hyperpigmentation are unsightly and challenging skin conditions. In today’s culture where people, particularly women, pursue beauty treatments such as skin whitening and flawless skin tones, the desire for modern and better solutions for all their skin concerns increases.

In the succeeding articles, we will discuss the state-of-the-art methods both to prevent and to fade pigmentation so you can have brighter looking skin!

-George Sun, MD, FAACS