Hyperpigmentation

One of the most common problems that I encounter in my daily practice is hyperpigmentation. There are a couple of reasons for this:

1. Hereditary factors. People with darker skin (higher Fitzpatrick skin types) are more prone to the development of dark patches (hyperpigmentation). Many of my patients have Mediterranean or east Asian ancestry and are prone to  pigment disorders such as melasma and post inflammatory hyperpigmentation. Patients of Anglo Celtic ancestry may have other pigment issues such as freckles, often related to sun damage.
2. Sun and heat. Ultraviolet (UV) radiation in Australia is intense, even in winter. In fact, this trip to Europe really highlighted to me the difference between our winter and winter in the northern hemisphere. Canberra is situated at a higher altitude making the effect of the sun more intense. It has been recognised recently that it is not just UV radiation that makes melasma worse,  heat in the form of visible light and infrared also plays a significant role. This will only become worse with climate change.

Freckling and brown patches in sun damaged skin (photoageing) of patients with Anglo Celtic ancestry (Fitzpatrick type 1 or 2) may be relatively simple and safe to treat with energy based devices, such as laser or intense pulse light (IPL). However, melasma in higher Fitzpatrick types, are notoriously difficult to manage in the long term. The main treatment is with topical medications to suppress melanocyte function rather than energy based devices.

Many of the patients I encounter have had previous failed treatments and they rarely have long term treatment plans in place. These past failed treatments often consisted of either some kind of laser, such as Fraxel, IPL, or microneedling. It is therefore of no surprise to see their melasma deteriorate over time. In general, energy based devices will make melasma worse in the long run if not used appropriately and without melanocyte suppression with medical topical treatments. Microneedling will convert epidermal melasma into dermal melasma, making it even harder to treat. It seems that non medical clinics which own such devices, have ‘sold’ these treatments to patients without a proper understanding of the pathological basis of melasma.

It is against this background that Bernard and I sought the advice of Dr Vanita Rattan. She is the head of hyperpigmentation clinics in the UK and she specialises in the treatment of pigment discorders, particularly in higher Fitzpatrick skin types. Her expertise came from a unique set of circumstances. She came from a family who owns a cosmeceutical business. She qualified in medicine and she has degrees in physiology and pharmacology. Frustrated by the lack of success using existing cosmeceutical products, she set about developing treatment protocols that will work reliably and safely. It is a challenge indeed as many of the most effective medications are inherently unstable in high concentrations when formulated and therefore have a very limited shelf life. She spent several years both in the laboratory and in a clinical setting. Ater much trial and error and perseverance, she is finally able to achieve her goal.

She is an amazing woman, doctor and mother. Kudos to her for juggling the running of several clinics in the UK, her own research laboratory, manufacturing facility and supply chain, as well as a family with two young children.

We will be working with her to try and bring her treatment protocols and formulations to Australia.

Dr Jennifer Leung

Dr Vanita Rattan