This Cheat Sheet tells you all you need to know about pigmentation - what causes it, how to treat it, and how to prevent it.
Pigmentation is a discolouring of the skin and can be caused by post-acne marks, sun damage, genetics, hormones, or trauma to the skin, and has a different name depending on its cause.
There are a few different kinds of pigmentation. For example, red or brown marks left by pimples after they heal are what we would call post-inflammatory hyperpigmentation. This is different to other kinds of pigmentation such as melasma, which looks more like larger, symmetrical blotches on the face, particularly across the forehead, cheeks, or upper lip.
These are the most common and effective topical treatments to help fade pigmentation.
Hydroquinone is the most effective treatment, and is usually included in a cream.
Most studies indicate that it should be used at a strength of 4-5%, and a prescription from a doctor is required for hydroquinone because it can have side effects.
When applied frequently, hydroquinone breaks down existing melanin and lightens the skin.It does this by decreasing the production of melanocytes, which is a melanin-producing cellin the bottom layer of your skin.
One of the most effective topical treatments is ‘Kligman’s Formula’ which is a combination of prescription grade ingredients: hydroquinone, steroid, and tretinoin. You can chat with your doctor about how and when to use it.
Azelaic Acid is a naturally-occuring acid that can help fade pigmentation. Mild and suitable for sensitive skin, it is also safe to use during pregnancy and breastfeeding. Many people find retinoids (such as tretinoin) to be too irritating for their skin so azelaic acid is a great alternative. The studies haven’t shown exactly how Azelaic Acid works on the skin but it does show that it’s very effective.
Retinoids are used to treat a variety of skin concerns including pigmentation. They are quite powerful, so they can cause minor irritation to the skin when you first begin using them with side effects such as redness, peeling, and dryness.
Retinoids work by increasing skin cell turnover, encouraging your body to shed darker skin cells and bring lighter cells to the surface. Within this process, they also slow the breakdown of collagen and thicken the deeper layer of skin where wrinkles get their start. Take a look at our Guide to Pigmentation or our Guide to Vitamin A to learn about more in-depth clinical studies on the use of retinoids to treat PIH.
Alpha Hydroxy Acids (AHAs) are useful chemical exfoliants that smooth skin texture and help to lighten pigmentation.Alpha Hydroxy Acids work by exfoliating the upper layers of the skin.Look out for serums that contain glycolic acid or lactic acid to help slough dead skin cells, which helps to remove discoloured skin.
Beta Hydroxy Acids (BHAs) can also be effective exfoliants and work in a similar way to AHAs. Look for a face wash with salicylic acid in it to help with gentle exfoliation.
When dealing with pigmentation issues, your skincare regime should be simple. This is really important if you are using a topical treatment to help fade pigmentation, because the treatment can cause irritation to your skin whilst it is working.
Step 1. Cleanse. Wash your face morning and evening with a gentle cleanser.
Step 2. Use your treatment (and then rotate it). In the evening, apply a prescription-grade treatment which should contain a combination of selected ingredients including hydroquinone, hydrocortisone and tretinoin (chat to your doctor about which combination is the best for you).Use this treatment for a maximum of 3 months before switching it with a treatment that contains azelaic acid and niacinamide for 3 months.
Step 3. Moisturise. Keeping your skin hydrated allows you to use your prescription creams regularly. Find a light, non-comedogenic moisturiser that has no additional fragrance. Apply this morning and night.
Step 4. SPF. No matter what you’re trying to treat, when it comes to skincare you should always wear sunscreen! Wear a broad spectrum sunscreen everyday that also includes a physical blocker such as zinc oxide. This will protect against UVA and UVB rays, to prevent pigmentation caused by sun damage and to prevent exacerbation of existing pigmentation.
Step 5. Chemical exfoliant every 3-5 days. Every 3-5 days, use a serum that containsAHAs or BHAs. However, beware of irritation to the skin if using something strong like tretinoin or hydroquinone.
There are a few different causes of pigmentation. Here are the most common:
Melasma is a common form of pigmentation, and although it can affect anyone it’s more common in women than men. It can be caused by hormonal changes and is most commonly associated with pregnancy. The changes in hormones cause changes in the body’s melanin production and dark patches to arise on cheeks, upper lip and forehead.
Melasma can also be caused by too much sun exposure and some medications. It is more common in darker skin types as they have an increased melanin production, and often there is a family history.
Sun spots, or photo ageing, is also a common cause of hyperpigmentation. Sunspots are flat, dark, blotches or spots on the skin that occur after long-term sun exposure. Like most other forms of hyperpigmentation, sunspots are harmless. However, if they are raised, change in shape, or change in colour, you should get them checked by a doctor to ensure they’re not cancerous.
Pimples and acne cause trauma to the skin, resulting in red and brown marks or post-inflammatory hyperpigmentation. This is different to long term, textured scarring caused by acne.
Thanks to some great progress in science and skincare, there are a few preventative measures that we can take to minimise the effects of pigmentation.
The best way to prevent pigmentation issues is to stay out of the sun and use sun protection, including a hat, glasses and sunscreen.
UVA and UVB light, as well as visible light, can cause, and also worsen, pigmentation.
UVA light is associated with skin ageing because it penetrates the top layer of the skin, damaging skin cells that sit deeper in the skin tissue.
UVB causes the skin to burn, damaging the epidermis or the outer layer of the skin.
Wear a broad spectrum SPF50 sunscreen everyday, preferably one that contains zinc oxide, to ensure pigmentation doesn’t get any worse and to protect your skin against sun damage.
Take a look at La Roche Posay Anthelios SPF50+ range.
One way to prevent pigmentation is to use antioxidants. Common antioxidants in the skincare world include niacinamide and vitamin C, and we recommend that you include one of these in your skincare regime.
Antioxidants are vital as we age and our skin cells become damaged by exposure to free radicals. Free radicals are caused by pollutants, UV rays, and oxidised cells. They speed up the ageing process by damaging skin cells. This leads to sagging of skin, pigmentation, and other signs of ageing.
Antioxidants combat these free radicals by preventing them from breaking down our skin cells.