Hyperpigmentation

Pigmentation of the skin normally varies according to racial origin (see Fitzpatrick phototypes) and the amount of sun exposure. Pigmentation disorders are often more troublesome in skin of colour.

The pigment cells or melanocytes are located at the base of the epidermis and produce the protein melanin. Melanin is carried by keratinocytes to the skin surface. The melanocytes of dark skinned people produce more melanin than those of people with light skin. More melanin is produced when the skin is injured, for example following exposure to ultraviolet radiation. The melaninisation process in dark skin is protective against sun damage, but melanisation in white skin (for example after sunburn) is much less protective.

Hormonal effects of oestrogen during pregnancy or due to medication can cause pigmentation of nipples, vulva and abdomen (linea nigra).

Some skin diseases and conditions result in generalised or localised hyperpigmentation (increased skin colour), hypopigmentation (reduced skin colour), or achromia (absent skin colour).

A Wood lamp may be used to assess pigmentation during the examination of the skin, as pigmentary changes are often easier to identify while exposing the affected skin to long wavelength ultraviolet rays (UV-A).

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Generalised hyperpigmentation may rarely arise from excessive circulating melanocyte stimulating hormone (MSH), when it often has a bronze hue. It occurs:
  • In 95% of patients with Addison disease when it is more prominent on pressure areas, in skin folds, on scars and within the mouth
  • In 90% of patients with haemochromatosis, when it is more prominent on the genitals, in skin folds and on sun-exposed sites
  • Rarely in metastatic melanoma: diffuse melanosis cutis
  • In people treated with afamelanotide
Localised pigmentation may be due to melanin, haemosiderin or externally-derived pigment.
If dark patches are observed, the main diagnoses to consider are:
  • Benign pigmented skin lesions, such as melanocytic naevi (moles), seborrhoeic keratoses and lentigos
  • Skin cancers, such as melanoma and pigmented basal cell carcinoma
  • Post-inflammatory pigmentation due to prior injury, current or prior inflammatory skin disease such as eczema, especially in dark skinned individuals or fixed drug eruption
  • Current or previous superficial skin infection, particularly pityriasis versicolor and erythrasma.
  • Chronic pigmentary disorders, particularly melasma (facial pigmentation)
  • Photocontact dermatitis to certain plants
  • Thickened skin eg acanthosis nigricans or ichthyosis
  • Pigmented purpura due to bleeding into the skin, eg capillaritis, senile purpura, as a sign of venous disease, or after varicose vein surgery or sclerotherapy
If pigmentation affects an exposed site, daily application of broad-spectrum SPF 50+ sunscreen is important to minimise darkening caused by UVR. Cosmetic camouflage can be used.
The following agents can be used to lighten epidermal melanosis, alone or, more effectively, in combination:
  • Hydroquinone
  • Topical retinoid
  • Topical corticosteroid
  • Glycolic acid and other fruit acids
  • Azelaic acid
  • L-Ascorbic acid (vitamin C)
Resurfacing using chemical peels, laser, intense pulsed light (IPL) or dermabrasion may be effective but unfortunately risks further damage to the epidermis and formation of more pigment. Cautious cryotherapy to small areas of postinflammatory pigmentation can be effective but risks causing permanent hypopigmentation.
Cosmetic camouflage using make-up is sometimes the best advice
Generalised reduction in pigmentation at birth (congenital) may be racial in origin or due to albinism. Pituitary failure resulting in lack of MSH rarely results in acquired generalised hypomelanosis. Pallor is much more frequently due to blood loss or anaemia.
Localised hypopigmentation may be due to partial or complete loss of melanin (achromia or leukoderma).
If single or multiple pale or white patches are observed, the main diagnoses to consider are:
  • Congenital piebaldism and Waardenburg syndrome (with deafness)
  • Pityriasis alba
  • Pityriasis versicolor
  • Idiopathic guttate hypomelanosis
  • Progressive macular hypomelanosis
  • Postinflammatory hypopigmentation or scarring
  • Vitiligo
  • Lichen sclerosus
  • Leprosy
The hypopigmentation due to inflammatory skin disorders and infections usually resolves by itself over weeks to months once the underlying disorder has been cleared. There is no effective treatment for achromia due to scarring. The response of vitiligo to therapy is highly variable.

Ellipse IPL for Pigment Spots

Benign pigmented lesions may be genetic in origin but long-term sun damage, in combination with the natural ageing of the skin, is often the major contributor. Examples of benign pigmented lesions: Solar lentigines and ephelides. The lesions can vary in size and colour. It is always important to ensure that the lesion is not malignant before removing it.

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Want to remove pigment spots?

Our skin ages due to our biological age as well as sun exposure and decreased production of collagen. Ellipse treatment of pigmented spots helps you keep a younger and fresher look.

Ellipse treatments of pigmented spots make your skin look smoother by removing age spots and other uneven pigmentation. Your skin texture is also improved and many women report that it becomes easier to apply makeup. Facial treatments are most popular, but other parts of the body can be treated. To do this, short, safe bursts of light (called Ellipse IPL, but often referred to as a laser) are directed at the skin. The system filters the light to ensure the wavelengths used are absorbed by haemoglobin in the fine blood vessels and melanin in the age spots. When cells containing a lot of melanin or haemoglobin are treated, the target heats up and is destroyed within a few thousandths of one second.
Treatments are most efficient in patients with light skin who are not suntanned at the time of the treatment. If your skin is less tanned, the contrast between the age spots/blood vessels and background colour of the skin is greater, making treatment easier. However, Ellipse has pre-programmed settings for different skin types that deliver the correct energy output for your complexion.
A full-face treatment takes less than 20 minutes. You should see an improvement after the first treatment, but up to 3 treatments may be required to achieve the full effect.
No anaesthetics are required, and many patients describe the treatment as practically pain-free, like a flick from a rubber band followed by a sensation similar to the feeling of gentle warmth after a day on the beach.
The light used is completely safe, visible light. It is, however, important to avoid tanning (sun, solarium or self-tanning products) before and during the treatment period. Otherwise your tanned skin will absorb more light, which makes treatment less effective and less comfortable. Generally, no special care is necessary after treatment, but people with sensitive skin may benefit from applying a cold compress (a cold damp cloth) to the face immediately after treatment. After treatment, you should avoid sun exposure for 30 days, even if there is no sign of inflammation in the treated area. Use sun protection (minimum SPF 30) if sun exposure cannot be avoided.
You may notice that the skin looks a little “dirty” for a few days following treatment. After that you will find that your skin looks smoother and fresher. You might choose to have 1-2 annual maintenance treatments in order to keep your youthful appearance.
Clinical trials documenting Ellipse safety and effectiveness were carried out by leading doctors prior to the launch of the treatment, and these were published in respected, referenced medical journals.

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