Introduction
Our skin is a remarkable organ. The largest organ in our body. At best its thickness is a few mm, yet it provides us with a physical and sensory barrier, regulation of our temperature and contributes to our hormonal and immune system. Unfortunately though, like the rest of our body, it ages with time, both as a result of intrinsic and extrinsic factors. Of these factors, extrinsic factors, particularly sun and UV exposure, contribute to the majority of ageing. This presents as pigmentation in addition to other facial ageing signs.
The UV exposure that we encounter living in Australia means that our skin is on average, 20 years older than our European counterparts. It is therefore not surprising that pigmentation is one of the most common skin concerns that we encounter.
Symptoms
Pigmentation as a result of sun damage (photoageing) typically presents as uneven brown discoloration on the most sun exposed areas of the face, neck, décolletage and hands.
Causes
There are a number of causes leading to the development of pigmentation on the facial skin, including sun damage (photoageing), melasma, post inflammatory hyperpigmentation, skin cancer and other less common causes. Whilst mostly benign, occasionally serious pathologies such as melanoma can exist.
Photoageing, as a result of sun and UV exposure, is the most significant factor involved in ageing of the skin. Part of this photoageing presents as pigmentation. When our skin is exposed to UV, there is an immediate darkening of our skin colour as a result of oxidation of the pigment (melanin) in our skin. With prolonged exposure to UV, our pigment cells (melanocytes) respond by producing more pigment (melanin) which ultimately leads to ‘tanning’ of our skin. This is a protective mechanism that attempts to ‘protect’ our skin cells from further UV damage.
In our youthful years, the process of making pigment (melanogenesis) and its transport to surrounding cells is smooth and controlled. With chronological age and UV exposure, this process becomes chaotic, leading to pigmentation of the skin. A typical pigmented lesion as a result of sun and UV exposure is called a solar lentigo or ‘sun spot’.
TREATMENT Treatment options for photoageing related pigmentation often requires a combination of treatments to achieve the most desirable results:
1. Strict daily sun and UV protection
This includes the application of a broad spectrum and high SPF sunscreen everyday regardless activities, season, weather or time of day. If used correctly, it the single most effective and financially sensible measure that you can do to look after your skin.
3. Chemical peels
Chemical peels have been used in medical practice for over 100 years and have persisted as a reliable and effective method for managing pigmentation.
4. Picosecond pigment laser
Our pigment laser system (Cutera Enlighten III) uses pulses in the nanosecond (one thousand millionth of a second) and picosecond (one trillionth of a second) ranges and targets pigment by generating tiny shock waves (photomechanical effect) rather than using heat like a traditional laser. With three wavelenths (532nm, 670nm and 1064nm), we are able to target pigment at different skin depths and in all skin types.
2. Prescription skin care
The most important rules when using skin care is to choose the correct ingredients for your skin type and skin concerns, to use the products consistently and correctly in order to get the long-term results and to avoid products that cause inflammation which is a significant accelerator of skin ageing.
There are certain skincare ingredients, both prescription and no prescription, that we can incorporate into your skincare regime that will assist with skin cell turnover (to ‘shed’ surface pigmentation), modify and down-regulate pigment production (reduce melanogenesis) and limit inflammation.
5. Vascular laser
This laser system is helpful in two regards. Firstly, it is a highly effective and fast treatment for pigment in patients with more pale skin (low Fitzpatrick skin type). Secondly, many pigment conditions have an associated underlying vascular component. Treatment of the vascular component is an important strategy in improving these conditions.
6. Cryotherapy
Liquid nitrogen is applied to the pigmented area to lower the temperature in order to destroy the tissue being treated.
HOW ARE WE UNIQUE
We take a different approach to assessing pigmentation compared with a non-medically trained therapist. The first and most important step is to precisely diagnose your sun damage and pigmentation. This requires training, experience and we have additional technologies at our disposal to help us, such as dermoscopy, Wood’s light examination and our specialised skin imaging systems. Occasionally we suggest a surgical skin biopsy to reach the correct diagnosis. Only then should treatment for pigmentation begin.
We are ‘patient focused’ rather than ‘treatment focused’. As we have the full spectrum of treatment of options at our disposal, we focus on tailoring the treatment planning according to what the patient needs, rather than having to make the patient conform to the solutions available.
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