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Wednesday, October 21, 2009

Lighten Up: Treating and Preventing Hyperpigmentation

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Seeing spots? It’s not your vision, it’s your complexion. This fall, bid adieu to your summer fling with the sun and get your skin looking healthy, radiant and less like that new handbag you’ve been ogling. 

Whether you’ve dubbed them sunspots, brown spots, age spots, or just “those darn spots,” the underlying problem is the same: hyperpigmentation. All year long, every single day, your complexion is accosted by free radicals from UV rays, a primary cause of skin damage. And, while most dermatologists – like my go-to guy Dr. Albert Lefkovitz - preach SPF-lathered, fully clothed prevention, no matter how vigilant you are about application, chances are your skin has been exposed to more UV rays than is healthy. That’s the thing about the sun, it’s everywhere.

UV exposure, however, isn’t the only enemy you’re up against. According to a study by the Lancôme Laboratories, pollution amplifies the harmful effects of the sun – an unfortunate but especially useful finding for smog-guzzling Manhattanites. Other results link stress with the accumulation of melanin, and hyperpigmentation can also develop thanks to post-inflammatory trauma, like acne. And that doesn’t take into account hormonal complications.

Birth control pills, menopause supplements, and even pregnancy can boost the odds that you’ll fall victim to the dreaded “mask.” Pregnancy-related pigmentation – also known as melasma – is typically temporary and clears up post-delivery. Hyperpigmentation related to hormone pills can be trickier to treat since these prescriptions usually increase photosensitivity, meaning your skin will overreact to UV exposure by overproducing melanin.

While avoiding hyperpigmentation may sometimes feel like a losing battle, there’s plenty you can do to rejuvenate your weather-beaten bod. Rather than simply sweeping the problem under a heavy coating of foundation, I strive to help clients prevent and erase spots altogether. In an effort to appease the clattering calls of “just tell me what to do!” we’ve simplified the regimen and broken it down by stages. 

Pigmentation Prevention: Your best offense is always a good defense and you’re never too young to start protecting your hide from hyperpigmentation. Even if you’re not seeing spots now, that doesn’t mean they’re not lurking deep in your dermis, just waiting to surface – particularly if you’re fair skinned or a former sun worshipper.
    • Step 1: Exfoliate weekly. Sweep away the top layer of the skin and remove excess pigmentation with a chemical, manual or fruit enzyme exfoliator once a week. For more information on proper exfoliation techniques and finding your perfect polish, check out our article on “Summer Slough-Off: Four Favorite Fall Exfoliators.”
    • Step 2: Suit up with sunscreen. An SPF 30+ broad-spectrum sunscreen – meaning it protects against both UVB and UVA rays – is the foundation of any anti-spot regimen. I’ve said it before, but I stand behind Julisis' Sun Emulsion SPF 30. Organic and safe for sensitive skin, this mineral sunscreen hydrates and helps prevent premature aging without leaving a telltale white residue. Just remember, reapply every 2-3 hours, no excuses!
    • Step 3: Spot treat while you sleep. Before bed, apply an antioxidant brightener formulated to fortify the skin’s barrier while stimulating cell turnover. I recommend swabbing The Organic Pharmacy's Rose Plus Brightening Complex on clean skin, every single night. Gentle, efficacious and organic, this spot-stopping serum is loaded with fruit acids and enzymes to exfoliate the skin’s surface, and glucosamine and niacinamide to inhibit melanin production and fade burgeoning sunspots. Dr. Lefkovitz’s Alaur Continuous Improvement Super 'A' Retinol also targets photoaging and diminishes discoloration. Retinol – a non-prescription version of Retin-A or Renova - increases the skin’s natural collagen production and fuels cell repair for a more youthful glow. In general, key ingredients to look for in a brightener include caffeine, fruit acids/enzymes, vitamin C, vitamin A derivatives (like retinol), mushroom extract, arbutin, and niacinamide.

Moderate Hyperpigmentation: Characterized by the appearance of isolated sunspots or a scattering of lightly colored spots, hyperpigmentation tends to start cropping up in our mid-30s and 40s, earlier if you spent your teens roasting to a crispy-fried russet. SPF and antioxidants remain an important part of this skincare routine, but more pronounced pigmentation calls for a more potent treatment protocol.
    • Step 1a: Exfoliation for normal to oily skin types. Refresh your complexion everyday with an alpha hydroxy- or glycolic-based product. For non-sensitive skin, I recommend MD Skincare's Alpha Beta Daily Face Peel, which mimics the effect of an in-office peel by buffing off the top layer of skin and reducing the appearance of pigmented marks, minus any recovery time. Exfoliate at night or suit up with SPF post-scrub since glycolic acid can increase photosensitivity, ultimately resulting in more spots.
    • Step 1b: Exfoliation for sensitive skin. MD Skincare’s Daily Face Peel can sometimes cause irritation in hypersensitive skin, so under these circumstances, I suggest sticking with a natural fruit acid- or retinol- based exfoliator. Nuxe's Creme Etincelante Radiance Resurfacing Care initiates a soft peeling action that instantly refreshes the complexion and gently encourages cell renewal for a smoother, brighter texture. As always, sunscreen is a must after exfoliating.
    • Step 2: Spot treat with a custom hydroquinone compound. Part of my day-to-day routine entails coordinating with doctors and dermatologists to create personalized, prescribed topical compounds. For hyperpigmentation, I can formulate a take-home cream comprised of concentrated hydroquinone, an effective skin whitener; Retin-A, a prescription-strength vitamin A derivative that smoothes wrinkles and speeds cell turnover; and a topical steroid and emollient to prevent irritation. I recommend spot treating with a Q-tip right before bed since hydroquinone increases photosensitivity. Most clients see a marked improvement in intensity in as little as four weeks, but remember, this compound is by prescription only. Call me at 212.243.4987 for more info.

Severe Hyperpigmentation: If that spot has cultivated a whole flock of friends, or you’re experiencing persistent melasma, which settles deeper in the dermis, amp up your approach with dermatologist-administered therapies. Not to sound like a broken record, but SPF is also a crucial part of this pigmentation treatment plan.
    • Step 1: Consult your derm about an in-office chemical peel. Unlike an OTC peel (i.e. MD Skincare’s Alpha Beta mentioned above), dermatologists can safely use higher concentrations of a chemical exfoliator resulting in deeper penetration. As per the American Academy of Dermatology (AAD) – and personal experience - the new layer of skin that’s revealed is immediately smoother, less wrinkled, and more consistent in terms of tone and color. Chemical peels increase photosensitivity – which in turn can increase hyperpigmentation – so stay protected post-treatment.
    • Step 2: Spot treat with a custom hydroquinone compound. Refer to Step 2 above in ”Moderate Hyperpigmentation,” for full details.
    • Step 3: Bring in the big guns – a.k.a. laser rejuvenation. According to a promising new study in the Journal of Drugs in Dermatology, 60% of patients who underwent 4-6 sessions of fractional laser resurfacing (using a prototype akin to the Fraxel) saw a 75-100% improvement in pigmentation. The Fraxel precisely targets sun damage boosting collagen production while leaving the surrounding tissue untouched. Dr. Lefkovitz, however, warns that not all skin types tolerate the intensity of this particular laser, which can result in redness and swelling for several days post-treatment. In his own practice, Dr. Lefkovitz relies on the Matrix RF. A sub-ablative laser that harnesses energy from both light and radio waves, the Matrix RF addresses pigmentation both above and below the skin’s surface. And, Lefkovitz adds, “This technology can be fine-tuned and adjusted to better treat the patient’s specific needs,” meaning there’s little to no downtime and it can be used successfully on a variety of different complexions. Laser therapy of any kind should only be performed by a board-certified dermatologist – not an aesthetician or technician. To find a qualified MD near you, visit the AAD.

One final note, if any of your pigmented spots exhibit a marked asymmetry; an irregular, scalloped, or poorly defined border; varied color; a diameter larger than 6mm; or it’s evolving and changing, see your dermatologist immediately. Better safe than spotty!

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