What is pigmentation?

Hyper Pigmentation – Melasma

Melasma, also known as hormonal pigmentation, is a considerable problem for South African women. It is a chronic skin condition that occurs on the face in the form of brown patches and is a dynamic (active) condition that needs lifelong management.

There are many possible causes of pigmentation disorders, which are marked by changes in melanin, the pigment in skin. These may include progesterone (the Mirena), photosensitizing medications, thyroid dysfunction, stress and dysbiosis (an imbalance in your gut flora caused by too few beneficial bacteria and an overgrowth of bad bacteria, yeast, and/or parasites).

There’s overwhelming evidence that certain medical conditions are key players in your overall health and are the root cause of pigmentation problems. Failure to address these conditions will lead to failure of your Hormonal Pigment treatment plan and also lead to chronic disease.

Melasma is more prevalent in darker-complexioned individuals though persons of any race can be affected due to the intense sun exposure in South Africa. This condition is seen most frequently in young women from the age of 28 years but can also be seen in men.

Why do you think skin pigmentation is a problem that affects so many South African women?

With approximately 91% of South Africans being black it is not surprising that pigmentation problems are common in SA. Hyperpigmentation is a common condition seen in all skin types but most prevalent in black patients. In black skin any inflammation or injury to the skin is almost always accompanied by alterations in pigmentation, i.e. either increased or decreased pigmentation. The increased amount of melanin in these groups is responsible for the pigmentation disorders.

What are the main causes of skin pigmentation?

In order:

  1. Melasma
  2. Acne
  3. Eczema
  4. Drug reactions
  5. Contact dermatitis

Melasma

The mask of pregnancy (hormonal related) this occurs commonly in women (90%), and men 10%. It is exacerbated by use of contraceptive pills and injections, pregnancy, sun exposure and certain pills used for treating seizures or fits (they are phototoxic i.e. make the skin more susceptible to sun damage). Some people are more likely than others to get melasma e.g. people with darker skin tones including Africans, Coloureds, Asians, Middle Eastern, Mediterranean and African Americans. Those living in areas of intense sun exposure, and those who have a blood relative with melasma. The main risk factors for men seem to be sun exposure and a family history of melasma.

Postinflammatory pigmentation (PIH)

This skin condition is the commonest, resulting from acne (pimples), eczema, contact dermatitis, drug reactions and lichen planus (a poorly understood skin condition that causes itchiness and pigmentation on sun exposed areas and sometimes on the trunk). In some people it may be associated with hair loss beginning on the hairline.
Black women and men are more prone to melasma and postinflammatory pigmentation because they have more active melanocytes than those with light skin, thus they produce more melanin which is a pigment that protects us against the dangers of UVR. This pigment is produced by cells that are found on the lower layers of the skin called melanocytes.


What are some of the lifestyle factors that contribute to the problem of pigmentation?

  • Exposure to strong UVR rays between 11am – 3pm (working outdoors, driving, or sporting activities)
  • Sun tanning
  • Using incorrect cosmetic products which irritate the skin and worsen melasma and other skin conditions

How can one prevent skin pigmentation?

Sometimes the causes of pigmentation are genetic (e.g. Melasma) and therefore can’t be prevented but can be controlled when it does occur.
General measures include:

  • Use certifiable 100% natural and organic skincare products that are free from synthetic chemicals (these would include SLS, Parabens, Mineral oil, synthetic fragrance and colour.)
  • Minimise sun exposure (because UVR rays make pigmentation worse).
  • Avoid being outdoors between 11am – 3pm.
  • Use protective clothing.
  • Be in the shade.
  • Use a broad spectrum sunscreen – Preferably a mineral-based sunscreen like Sunumbra P.
  • People with pimples should avoid picking them as continuous trauma that’s inflicted by picking causes more inflammation and worsens acne marks.

Is pigmentation a problem many people try and treat themselves incorrectly?

Yes this is in fact the main challenge. In a recent study that we conducted looking at 900 African and Indian women in Durban we found that 67% of patients who used skin lighteners had genuine problems with pigmentation and only 33% used skin lighteners for the purpose of lightening normal skin. More than 30% had skin damaged as a result of using skin lighteners. Almost half of them were not aware of the dangers of using skin lighteners.

Can a topical product work to reduce skin pigmentation?

Yes, most of the time dermatologists use topical products to treat pigmentation. Treatment would depend on the extent and depth of pigmentation. At times dermatologists are able to halt or reduce the pigmentation but are unable to clear it completely. Generally if the pigmentation is due to inflammation of the skin it is just a matter of time before it clears on its own.

How can one treat skin pigmentation?

There are a number of safe and effective products on the market that are used to treat pigmentation in addition to above general measures. Kigelia (African Sausage Tree extract) has been used for decades to treat sun related pigmentation. It is used for its skin caring and healing properties. Kigelia assists with uneven skin tone, reduces dark marks and has a nurturing effect on the skin. Kigelia extract promotes skin elasticity, reducing fine lines and wrinkle depth. It firms the skin. Kigelia improves nutrient supply to the skin resulting in healthier looking skin.


What is your advice to women who have skin pigmentation?

I think we need to remember that the best skin is the one that you were born with. If you are white, pale skin means healthy skin and using tanning booths and sun tanning is extremely dangerous for your skin.
If you are black and you live in Africa, you have the best skin to protect you against the dangerous UV rays so do not try and change your skin colour.
Use a broad spectrum mineral sunscreen (containing zinc oxide) that protects against both UVB and UVA. Avoid the sun during peak times of 11am – 3pm.
Read labels and remember your skin is too precious. Do not buy products without ingredient labelling; beware false labelling. There are many products on the market (R25m industry).

Use products from companies that keep up with research and development and look out for the following compounds:

  • Mercury: dangerous.
  • Hydroquinone: dangerous
  • Phenol: dangerous.
  • Corticosteroids/steroids: Should only be used under the supervision of a dermatologist for certain specific skin conditions like eczema.
  • Do not use the ff steroid creams (vates) for treating pigmentation or acne (e.g. elocon, persivate, dermovate, movate, advantan, betnovate, locoid, cutivate, procutan, topivate).

What are the side-effects of using the wrong products?

  • Irritation to the skin causing more inflammation and irritation resulting in further pigmentation as mentioned above.
  • Most products from street vendors and salons contain high concentrations of hydroquinone, steroids, mercury and phenols. Please beware!
  • Steroids can cause acne, pigmentation, stretch marks, skin infections, excessive hair on the skin, thinning, and easy bruising of the skin which is irreversible. Hydroquinone can cause irreversible damage to the skin and a condition called ochronosis.
  • Mercury can affect pregnant women and cause neurological disorders in the baby.
  • Prolonged use of dangerous skin lighteners may result in skin cancer.
  • Unsupervised use of skin lighteners is very dangerous and may result in irreversible damage to the skin.

Our skin has a 28 day renewal cycle – can you explain?

New skin cells are ‘born’ every day and they take 28 days to reach the ‘top of the skin’. When we use a product like Pradiance which contains Kigelia, one should start to see results after 28 days. Some people can see the pigmentation ‘break up’ at first and sometimes there is a tiny bit of flaking in small patches which is the healing process ‘getting rid’ of the excess pigmentation marks/scar tissue/sun spots. With the knowledge of knowing how gently but deeply the Kigelia works, this is a good sign but is not the same for everyone.