Pigmentation and uneven skin tone decoded
A lot of patients often ask me to know about the reason for uneven skin tone and pigmentation. Uneven skin tone is a common concern these days and is perhaps one of the most searched online queries when it comes to skin and hair care. Pigmentation around mouth and forehead are one of the leading issues in millennial patients. Both pigmentation and uneven skin tone are multifactorial in nature. To know more about uneven skin tone , we first need to understand how pigment is formed and which factors cause increase in melanin (the scientific term for pigment).
How is melanin or pigment formed in the skin?Human melanocytes are the specialized cells possessing unique secretory granules known as melanosomes which contain melanin pigment. Melanin and melanosomes are the major determinants of skin pigmentation. Melanin-forming enzyme tyrosinase is the major component responsible for melanogenesis, which occurs within the melanosomes. Inside the melanosomes, tyrosinase catalyzes the first two reactions of the biochemical pathway leading to the formation of two types of melanin pigments, eumelanin or pheomelanin. Tyrosinase catalyzes the hydroxylation of tyrosine to form dopa (L-3,4-dihydroxyphenylalanine) and then the oxidation of dopa to dopaquinone. The latter is rapidly converted to the brown-black pigment, eumelanin and phaeomelanin. The exposure of human melanocytes to UV light or melanocyte stimulating hormone increases the production of melanosomes as well as eumelanin pigments.
How Sunlight or radiation cause tanning or pigmentation?UV light of which Sun is the major source increases the melanin synthesis by increasing tyrosinase activity which is actually a protective mechanism ( to protect DNA inside the nucleus of cells). This is what protects our skin from cancer which is so common in countries with fairer skin type. But Tanning is not acceptable cosmetically and may even be very severe in nature.
How do I get pigmented when I donot step outside at all?It is a well-established fact that even visible light spectrum especially Blue light emanating from screens, laptops may be detrimental to skin health. Infra-red radiation from heat and cooking stoves can also increase melanin synthesis. Hence it is mandatory to use a sunscreen even indoors or in front of your system.
Can weight gain lead to pigmentation?Increase in insulin levels is a common factor to why people typically get darker when they gain abdominal fat. Hence to avoid pigmentation , it is equally necessary to exercise and consume a healthy diet. Pigmentation around neck , underarms and folds of the body is known as acanthosis nigricans and resolves only with weight loss.
What is Melasma?Melasma is a commonly acquired condition of symmetric hyperpigmentation which typically occurs on the face. It has a higher prevalence in females and darker skin types. Multiple causes like light exposure, hormonal influences and family history have been implicated in the pathogenesis of this disorder. The most common reason is pregnancy and childbirth in women. Fatty liver in males can also trigger melasma like changes
What is post inflammatory hyperpigmentation(PIH)?Pigmentation developing after an inflammatory skin disorder is very common complaint in patients. There are certain skin diseases which show a tendency to leave behind spots .
Especially Acne vulgaris causes black spots commonly. Dark skin type and tendency to squeeze pimples is the biggest risk factor for developing PIH . Insect bites and even atopic eczema can cause pigmentation.
How to prevent pigmentation and black spots?
As a Dermatologist , I would like to suggest few points to prevent pigmentation and black spots
1) Strict Sun and Radiation protection – Yes, you heard it right. You need to protect from UV light and also Infra red and visible light form sources like natural light, computer screen . It is imperative to use a broad spectrum Sunscreen which protects from UV A, UV B and Visible light. Please prefer a sunscreen with iron oxide to prevent visible light. It might require few sunscreens to be tried before you choose the ‘right 'one.
Here are a few tips to get the best sunscreen for your skin type-
a) Sun protection factor or SPF - it indicates the degree of protection afforded by the sunscreen against UVB. Few indices like PPD or Boots star rating measures the efficacy against UVA. The minimum SPF is 15 and lower SPF values are better suited for Indian skin type as SPF of 50 or more leave behind a whitish cast.
b) Use a gel type sunscreen if you have oily or acne prone skin. One may use a creme based sunscreen for dry and aquafluide emulsion type for combination skin type.
c) Use a non-comedogenic and matte based sunscreen if you are prone to breakouts.
d) Moisturizers containing sunscreen or make up with SPF offer little protection. Always use sunscreen as a make-up base.
e) Sunscreens never trigger pimples although the silicone base makes them appear sticky. always check 'non - comedogenic’ on the label.
f) Always apply two fingertips on the full face including the sides of ear and backside of neck. Always reapply the sunscreen every three hours. Do not forget to wear a scarf or a wide brimmed hat for added sun protection.
2) Oral Antioxidants- They are ‘oral sunscreens’ and hence prevent pigment cells from free radical induced damage. You can include natural sources like citrus fruits, yellow vegetables and lots of fruits in your diet. Omega 3 fatty acid rich foods help improve your skin barrier and help in prevention of premature ageing.
3) Avoid scrubbing or over exfoliation- Mechanical scrubbing can aggravate pigmentation and make it worse. Do not pick or squeeze your pimples. Most of the time I see a lot of people rubbing vigorously their face which increases pigmentation and causes darkening.
4) Please treat your pimples on time to prevent black spots. A delay in treatment can increase the black spots and PIH.
5) Check your nutritional status as deficiency can make your skin dull. Skin is your mirror of inside and reflects your inner health. If your diet is deficient in micronutrients and vitamins , no amount of product or treatment can bring the glow.
6) Avoid ‘DIY’ remedies like homemade scrubs or electronic massagers. Even Derma roller used at home in a wrong way can cause microtears and black spots. Most of these remedies have a short-term benefit , if any but cannot improve the skin health. turmeric , lime and Besan only help in superficial exfoliation and only pharmacologically derived ingredients offer safety with results.
7) Use a Vitamin C preparation daily. It can be used in combination with Vitamin E and hyaluronic acid for best results. Vitamin C helps in preventing free radical mediated damage and has added antioxidant benefit. It also offers SPF of around 15 but best supplemented with a sunscreen. It is better applied in daytime rather than night.
8) Moisturizing the skin daily is also a must. You may choose an oil free, non-comedogenic moisturizer which contains zinc myristate or witch hazel extract which also gives an oil free look. All skin types benefit from a good barrier which prevents age spots or pigmentation.
Pigmentation and black spots require a multimodal approach for best results. Talk to your dermatologist to plan the best treatment for you.