Hyperpigmentation Vs Melasma

1. HyperpigmentationVsMelasma:Causes,SymptomsAndBestTreatment Byadmin -June 2,2023037 Hyperpigmentation-Vs-Melasma Hyperpigmentation-Vs-Melasma Ourhow-toguideexplainshyperpigmentationvsmelasma,thecommonsymptomsofeach,andthebest skincaretreatments to use on clients. Asweheadintosummer,armingyourselfandyourtherapyteamwiththeknowledgetotreathyperpigme ntationvs melasmawill helpyou toprovide your clientswith thebest courseof action. In this helpful guide, we explain what hyperpigmentation and melasma are, how these conditions present themselves,contraindicationstobeawareof,andhowtotreattheskineffectivelyintreatmentandathom ecare. Foramorebespokefocusonhowtotreathyperpigmentationandscarringcausedbyadultacne,thench eckout this handy guide. TableofContents Whatishyperpigmentation? Whatismelasma? What should I cover in the consultation? HowdoIpreparetheskinfortreatment? HowcanIeffectivelytreathyperpigmentationvsmelasma? HowcanI manageclient expectations? HowshouldItailormyhomecareadvice? Lifestyleadjustments Whatishyperpigmentation? “Hyperpigmentationisatermusedtodescribediscolorationontheskinorabnormaldarkeningoftheskin ,”saysMariaRylott-Byrd,facialistandclinicownerbasedinAlaska,andmemberofTheSkinCollaborativ e.“Itisanoverproductionofmelaninfromthemelanocytes,andthattravelsitswayuptothesurfaceofth eskinwhereyouseethatdiscoloration.”Itcanhaveseveralcauses,oneofthebiggestbeingUVdamage .“Thesunisahugecauseofhyperpigmentation,”addsRylott-Byrd. “ItneedsalayerofprotectionwithUVAandUVBprotectionwithbroad-spectrumSPF.Medicationsandh ormonalfactors, suchas pregnancyand oralcontraceptives, canalso havean effect.” Whatismelasma? Melasmaissimilartohyperpigmentationbutisusuallytriggeredbyhormonalfactors,beitthyroiddysfunc tion,pregnancy, orhormonal contraception,as wellas genetics,UV, andmedications. “Melasma appears more in a block formation, whereas hyperpigmentation has a more mottled appearanc eontheskin.AndunderaWoodslamp,themelasmawillappearunchangedunderthelight,”shesays.It ’s also more prevalent in women than men due to the hormonal factors that can trigger it and in ages 25– 40and those with Fitzpatrickskin type three and four. It’salsohardertotreat.“Epidermalpigmentation(solarkeratoses)respondswellandmorequicklytotreat ment,whiledermal pigmentation(melasma orchloasma) usuallytakes longerto lighten. Taylornotesthatmelasmacanpresentinanumberofways,including: Centrofacial,whichappearsontheforehead,cheeks,nose,andupperlip.Thisisprevalentin50–80%of presentationsof melasma andis also knownas the “butterfly effect” Malar, which affects the cheeks and nose Mandibular,whichappearsonthejawlineandchin Erythosispigmentosaface,whichpresentsasreddenedorinflamed.Thisisvascularmelasmaandwillha

2. vearedtinge Extrafacial,whichcanappearontheforearms,upperarms,andshoulders. Whatshould I coverin the consultation? Conducting a thorough consultation with your client is imperative to treat any kind of hyperpigmentation, i ncluding melasma. “It can be genetic, especially peri-orbital and peri-oral. It’s very common that we see a geneticpatterntoit,particularlyinAsianskintypes,”saysDr.IrfanAhamad,aestheticmedicinedoctor,sk inspecialist, and member ofThe Skin Collaborative. “Medication such as tetracycline, antibiotics, naproxen, which is an anti-inflammatory commonly used for osteoarthritisandinflammatoryconditions,andpsychoticscancausephotosensitivity.Therefore,itisvery importantthatwe doathorough consultationto findoutabout anyprescriptiondrugs,” hesays. HowdoIpreparetheskinfortreatment? Tyrosinaseinhibitorsarecrucialfortreatingthisconcern.“WhethertheclientisFitzpatrickoneorsixwen eedtousetyrosinaseinhibitors,”saysSarahHurst,founderofSarahHurstSkinClinicinBrightonandme mber of The Skin Collaborative. “Tyrosinase is the enzyme that increases the melanocyte and melanin pr oduction,” she says, so look to ingredients such as kojic acid, vitamin C, tranexamic acid, azelaic acid, an dlicorice root, which canhelp inhibit melanin production. Moreover,establishingagoodhomecareroutineinconjunctionwithbroad-spectrumSPFisimportanttop repare the skin for any treatment. “I wouldn’t do any type of advanced treatments in the clinic without heal thyand balanced skin,” advises Rylott-Byrd. “I’dlookattheclient’slifestyleandhomecareroutineandbringtogetheraplantohelptheskinhavestron gintegrity.Ifwedolookatadvancedtreatments,thenwe’dwanttopreparetheskinaccordingly;we’vem entionedthetyrosinaseandcreatingthatumbrellaovertheskinwithSPF,andthenweneedtolookatso mekind of exfoliation to shatterthat pigment.” HowcanIeffectivelytreathyperpigmentationvsmelasma? There are many methodologies for shattering pigment and my personal preference is to work with chemic alpeelsandmicroneedling,aswecanuseitacrosstheboard,aslongaswecangetthepreparationtime right,” says Hurst. “This is because you need nice, hydrated skin, so recovery time is going to be minimiz edand we won’t hinderany results in anyway,” she says. Foranenhancedoutcome,youshouldsetupyourclient’spre-treatmentcaretwo-to-fourweekspriortoth eir treatment program, advises Taylor. “For darker skin tones, the longer the homecare the better,” she ad ds. “However, depending on the treatment, you may need to ask them to discontinue the products three t ofive days ahead,depending on the typeof ingredients used.” Whetheryouoptformicro-needlingorchemicalpeels,agentleapproachisfavored.“Startingwithachem icalpeelthatisgentlyexfoliating,andbuildingthosepeelsup,isimportant,”saysHurst.“Whenyougoinf or a deeper peel to get rid of pigmentation quickly, you should also prep the skin thoroughly, firstly at hom eandalsowithmoresuperficialchemicalpeelswithintheclinic,beforemovingontoanythingdeeper.” DrAmadoagrees:“Weusedtotreatpigmentationwithmicro-needlingatamuchdeeperdepththanwed onowadays,butwehavetobegentle,”shesays.“Forhyperpigmentation,I’duse0.5mmbecausewedo n’twant tostimulate thatbasal cell toomuch, asthat cancause more pigmentation.” When it comes to laser, Hurst says it’s not her preferred treatment. “With the higher Fitzpatrick colors, it’s very important to be careful with laser due to the fact that pigmentation can be absorbed, so if you are goi ngtobetreatingpigmentation,it’sbetterifyou’retreatingaspotareaasyoumaybeabletocover overth erest of the skin,” she says. “Buttoovertreatawholeareacanbeverydangerous,particularlywiththeablativelasers.Agentlerform ofIPL may bepreferable, but it wouldn’tbe our treatmentof choice.”

3. To ensure successful treatment for melasma, the underlying triggers need to be addressed and removed wherepossible.“Iftheclientisonthecontraceptivepillandwethinkthismightbeatrigger,thenwe cantr ygivingthemtyrosinaseinhibitors,butyouneedtoworkwiththeclientbecauseyoumightnotnecessarily getthe bestresults on somebodywho hasgot the triggerstill in place,”says Hurst. “Oncethathormonalstimulationhasgone,themelasmawillgenerallysubside,butitcanbestimulatedby the sun moving forward, so you still need to practice homecare, the tyrosinase inhibitors, and SPF,” advis esRylott-Byrd.“Youcantreatitinthesameway,asitisallhyperpigmentation,butyoumightneedtotrea tjust the area, as opposedto the whole face.” But,whetheryou’retreatinghyperpigmentationormelasma,it’simportanttoexplaintotheclientthatthet reatmentprocess is a partnershipbetween you both. HowcanImanageclientexpectations? “A good consultation will explain the science behind it – people are not aware that with two-to-three days of unprotected UV radiation, you will undo everything that you have done for a whole year,” says Dr. Ama do. “Patients need to be committed; if they’re not going to use their SPF or their tyrosinase inhibitors, ther e’snopointindoingchemicalpeelsandmicro-needlinginaclinicbecauseyouwillbefightingagainstital lof the time,” she says. “Onaverage,ittakesabout12monthstoreprogrammethemelanocytes(thecellsthatproducemelanin), soit is goingto be a longprogram and will needto be maintained.” HowshouldItailormyhomecareadvice? There are several ingredients that can support your client’s skincare journey and maintain their results. H urstrecommendskojicacid,tranexamicacid,vitaminC,licoriceroot,azelaicacid,andAHAssuchasglyc olic,lactic, and mandelic. “NiacinamidehasbeenshowntohelpregulatehyperpigmentationandsohasvitaminAbecauseit’ssuch a good skin normalizer, as is green tea,” says Hurst. Dr. Amado also recommends cysteamine. “This ingr edient is also a tyrosinase inhibitor but with no downtime. You can use it long-term and it does not need a prescription,”she says. Usingabroad-spectrumSPFiscrucialtomaintainprogressandpreventpigmentationfromreturning.Whi lemanywillapplythisfirstthinginthemorning,it’simportantthatclientsalsotopuptheirSPFprotectiont hroughout the day. However, some may find SPF irritating for the eye area, or inconvenient to reapply ov ermake-up. “My go-to is a physical mineral powder,” explains Hurst. “Many clients say they avoid putting SPF around their eyes as it runs and causes irritation, so mineral powder is brilliant for that,” she says. For those who wanttotopuptheirUVprotectionovermakeup,sheadvisesaspray,saying,“Therearesomegoodspra ysnow, but ideallyyou want to reapplyevery couple of hours.” Lifestyleadjustments To keep hyperpigmentation and melasma at bay, Rylott-Byrd recommends discussing the client’s lifestyle habits. “It’s not enough to have an SPF on. If it’s a bright sunny day, stay in the shade and wear a big hat andsunglasses.Iseealotofpigmentationjustaboutwherethesunglassesstop,aspeopletendnottobr ingtheir SPF close to theeyes,” she says. It’salsoimportanttotalkthroughanyhormonalfactorsthatcouldbecausingproblems.“Clientsshouldkn ow their triggers. For example, if you know you are susceptible on oral contraceptives, perhaps find anoth ercontraception method,” she says.