Pigmentation: The dermatology challenge and solution

One of the challenges in dermatology, aesthetics, and cosmetology is treating pigmentation, which appears as spots on the skin. These spots have become a significant aesthetic concern. They don’t disappear completely but can be softened and improved. Regardless, maintaining the skin’s appearance requires lifelong care.

Understanding Skin Structure and PigmentationThe skin's structure resembles interlocking tiles or roof shingles. In the epidermis' base layer, for every ten basal skin cells, there is one pigment cell known as a melanocyte. Skin tone is influenced by various factors, such as melanin content and distribution. Both fair-skinned and dark-skinned individuals have the same number of melanocytes, but these cells' functional activity varies in response to different stimuli, leading to changes in skin color.

Types of Pigmentation

Hyperpigmentation: Darker spots than the natural skin tone.

Location-Based Classification:

Epidermal: Appears on the skin’s surface.

Dermal: Occurs in deeper layers. Causes include sun exposure, hormonal changes, aging, mechanical trauma, skin inflammation, lifestyle, and genetics.

Physiological Pigmentation: Results from the multiplication of melanocytes rather than excess melanin secretion. It appears as skin inflammation, keratoses (a type of raised, fleshy brown skin wart), seborrheic warts, and various skin lesions.

Functional Pigmentation: Triggered by excessive pigment cell activity due to sun exposure, hormonal changes, health/genetic issues, poor nutrition, inappropriate cosmetic treatments, medications, and skin inflammations, leading to permanent color changes.

With age, cellular renewal activity and the “intercellular glue” that enhances skin elasticity and radiance decline. This process leaves skin thinner, more fragile, blotchy, and uneven. Additionally, aging leads to volume loss and changes in skin depth, blood vessel expansion, and tissue contraction. In adolescence, skin inflammation (acne) can leave pigmentation marks.

Hormonal PigmentationThese pigmentations resurface with various changes and triggers and don’t fully disappear. Hormonal changes, skin conditions, and even certain intestinal disorders play a role in pigmentation persistence.

Gender Differences

The skin differs notably between men and women; men's skin is about 30% thicker. Hormonal changes throughout a woman's life—from adolescence to post-menopausal hormone therapies—along with stress, contribute to increased pigmentation.

Suitable Cosmetic Treatments

Effective cosmetic treatments combine various methods tailored to the type of pigmentation, its distribution across different facial areas (such as the forehead, nose, and above the lip), skin condition, and sun damage. There’s no one-size-fits-all solution; only a combination of ingredients—such as melanin-capturing agents like hydroquinone (available by prescription), glycolic acid, alpha-hydroxy acids, lactic acid, mandelic acid, arbutin, retinoids, and tranexamic acid—can provide effective treatment.

The recommended approach is to consult with dermatologists, plastic surgeons, and aesthetic doctors skilled in treating pigmentation issues. Diagnosis includes a combination of deep peels, laser technologies, IPL (intense pulsed light), radiofrequency combined with vacuum and microneedling, RF mesh, ultrasound, cauterization, and lesion excision. Treatment plans should be personalized according to age, gender, skin condition, sun damage, photoaging, and medication. All treatments should be complemented with tailored creams and lotions.

 The author, Dr. Monica Allman, is a specialist in dermatology and serves as the medical director of the Maccabi Aesthetics network.