Uneven skin tone and hyper-pigmentation is a frequent condition and its treatment is a complicated one. The skin’s coloring is also influenced by genetic heritage and often by internal dysfunctions (liver, kidney and ovary deficiency).

There are several major causes for skin discoloration:

a) sun exposure

b) changes in the hormonal balance during pregnancy or use of the pill

c) trauma to the skin due to improper treatment of acne and blemishes or aggressive acid peels and laser.

Skin pigmentation is the result of too much or too little melanin production. Melanin production is the natural protection of the body against the harmful sun rays and its presence will give the skin a specific color.

The more melanin the body produces, the darker the skin (natural adaptation to environmental conditions developed through generations).

The melanin pigment is produced by specific cells called melanocytes, present in the deepest layer of the epidermis (the germinative layer where cell division also takes place). There are different types of pigmentation; some affect larger areas, some are concentrated in small spots, called improperly liver spots. Liver has nothing to do with it; the cause of dark spots, especially in older people is the consequence of lack of coordination between the production of melanin and the speed of cell division and their ability to absorb the pigment in an even manner.

The treatment of pigmentation is a three step program with no guarantees of success; it requires knowledge and plenty of patience.

The production of melanin is triggered by an enzyme called tyrosinase, so the first step on treating skin pigmentation is the attempt to inhibit this enzyme; the most effective remedy proved to be the use of hydroquinone that will disrupt the synthesis of melanin. A 2% concentration is used by estheticians, a dermatologist will use up to 4% and anything higher is dangerous.

If successful in this first step of eliminating the cause of further pigmentation, we have to concentrate on repairing the prior damage; this second step involves gentle bleaching of the skin. The process is a delicate one and could sensitize the skin, making it more vulnerable to further pigmentation.

A combination of treatments involving natural and chemical agents could be used. Derivates of vitamin A (Renova and Retin-A), as well as arbutin (licorice extract), azalaic acid, kojac acid (from mushrooms and also a derivate of rice during the fermentation process), glycolic acid (from sugar cane), and the use of antioxidants, especially vitamin C, proved somewhat effective.

The success of this step depends on how long ago the pigmentation occurred; the sooner you treat it, the better the results. An aggressive use of bleaching agents could create the opposite effect, so patience and moderation is strongly recommended.

Another way of treating pigmentation, with more immediate results, is by using laser techniques. Removing many layers of the epidermis will make the skin look lighter, but unless the inhibition of tyrosinase enzyme has been successfully accomplished, the pigmentation will resurface in about 3 to 4 months, since the cause of the problem has not been eliminated.

The third step is protection and its importance could never be stressed enough. Just remember that by inhibiting the synthesis of melanin (a natural defense against sun damage) and by bleaching the skin, you make it much more sensitive and prone to ulterior pigmentation. Protection becomes imperative. Sunscreens and sun blocks are a must.

A well known slogan for American Express says: “do not leave home without it”, it applies perfectly to sun protection.