Hyperpigmentation, visible to the naked eye, spots or little spots, darker than the healthy skin surrounding them.Hiperpigmentation is very often caused by sunlight and is often just an accumulation of melanin - a pigment of the skin produced in response to ultraviolet rays. Sometimes, however, a small spot on the skin may be the result of an increase in the amount of not only the dye itself, but also the cells producing it - melanocytes
They can appear on the forehead, cheeks, nose, hands and neckline, rarely on the jaw. In its extreme form, there may be discolorations in the form of strips in the middle part of the face. They affect 30% of women over thirty and 90% after fifties.
Causes of hyperpigmentation:
1) under the influence of solar radiation, there is a spontaneous appearance of hyperpigmentation with a hormonal basis:
- use of oral contraception,
- use of hormone replacement therapy,
- the period of menopause,
- other hormonal treatments,
2) liver disease,
3) adrenal insufficiency,
5) the effect of phytotoxic or photoallergenic substances found in medicines, cosmetics and soaps;
Division of hyperpigmentation:
1) associated with an excessive number of melanocytes in the epidermis
2) related to overproduction of melanin by the correct number of melanocytes:
Freckles (ephelides) are numerous small (sizes 1-5 mm), irregular, light - or dark brown spots formed under the influence of sunlight, which is why they most often appear on the skin of the face and upper limbs. Freckles appear in early childhood, about age 2, then gradually they come, and in older age the number of freckles usually decreases. The freckles are smooth, do not protrude above the level of the skin. The reason for the brown color is excess melanin, with the right amount of melanocytes. The formation of freckles is genetically determined and inherits as an autosomal dominant trait. Freckles occur with the same frequency in women and in men, especially in people with light skin and bright or red hair. Under the influence of sunlight, freckles become darker and more visible.
Melasma (chloasma) is one of the most common hyperpigmentation found mainly in women. They appear most often after 30 years of age. The role of factors that cause the disease is not fully explained. They are irregular, sharply limited brown spots without signs of inflammation, located on the face (forehead, cheeks, upper lips). The symmetry of the outbreaks makes it look like a mask. The most common is the symptom form, occurring during pregnancy, when using hormonal contraceptives (chloasma uterinum) - in 10-20% of women, drugs (eg hydantoin) and during endocrine disorders (hyperthyroidism, ovarian disease). The efflorescence intensifies during intense ultraviolet exposure (including solarium)
The senile lentigines (letingines seniles) have been named because of their appearance similar to those of lentils. They are round or oval, clearly separated from healthy skin, small patches from light brown to almost black. They form in places exposed to UV radiation (also from the solarium), mainly on the face, backs of the hands and neck as well as forearms and lower legs. Most often they appear between 30 and 50 years old. As time passes, these patches can grow and become darker and darker.
Post-inflammatory hyperpigmentation may occur in places where previously acne lesions occurred, some skin rashes (eg chickenpox), sunburn, allergies, injuries.
Dermal: melanin localized in perivascular macrophages in the papillary layer
Mixed: features of epidermal and skin discoloration.
The type of hyperpigmentation can be determined by looking at the skin illuminated with a Wood lamp - it is an integral part of the skin examination.
Places where hyperpigmentation appears mostly:
- Upper lip
The basis for the treatment of discoloration is effective sun protection. It includes limiting exposure to solar radiation in the afternoon hours, using external preparations protecting against UVB and UVA, wearing body protecting clothing. Sunscreen preparations should contain physical filters or a mixture of chemical and physical filters. Effective sun protection should be applied in Poland from April to the end of September. People working under fluorescent lighting should use sunblock creams throughout the year, regardless of the season.
A. Hydroxy acids:
- Alpha - hydroxy acids (eg glycolic, lactic, lemon, oxalic) - glycolic acid is used most frequently; in addition to improving skin tone, accelerates cell renewal, reduces wrinkles, improves hydration and texture of the skin,
- Beta - hydroxy acids (eg salicylic acid contained in Jessner's fluid) - concentrations of 3-5% salicylic acid cause exfoliation of the epidermis,
- Multi-hydroxy acids (eg gluconolactone, lactobionic acid, gluconic acid lactate) - give better clinical results in people with sensitive skin, rosacea, keratosis disorders;
B. Hydroquinone - in a concentration of 2% used to remove and lighten lentil spots, freckles, chloasma, post-inflammatory hyperpigmentation. It has no allergenic properties, does not cause discoloration of healthy skin. The combination of hydroquinone and glycolic acid results in its stronger action even at lower concentrations.
C. Vitamin A derivatives (tretinoin, isotretinoin) - with a strength similar to that of hydroquinone, but must be used for longer. It carries the risk of side effects: pruritus, erythema, exfoliation and dryness of the skin.
D. Kojic acid - blocks the enzyme involved in the synthesis of melanin; it also has antibacterial properties, prevents the formation of free radicals.
E. Azelaic acid - used in the treatment of chloasma, discolorations in the course of rosacea and common acne, phototoxic and photoallergic reactions. It has medium potency, has no effect on freckles, lentigo stains, seborrheic warts and pigment staining.
The laser light is selectively absorbed by melanin, heats the dye-containing cells causing their destruction. The best results are obtained by using Ng: Yag, ruby and light sources (IPL) lasers in the treatment of: freckles, lentil spots, discolored seborrhoeic warts, and drug discoloration.
Peeling - Cosmelan is the most effective whitening treatment compared to depigmentation therapies currently available on the market. It contains brightening factors with immediate effect. It does not have a keratolytic substance.
A method of mechanical abrasion using diamond heads or alumina (aluminum oxide). In terms of the depth of abrasion and effectiveness, it corresponds to a chemical peel and damages the skin to a lesser extent than laser dermabrasion. Used to remove spotted uneven hyperpigmentation.
Treatment with cold gives satisfactory results in the case of senile keratosis, lentil spots, seborrhoeic warts.
Surgical methods - used to remove, for example, melanocytic nevus.