The type of pigmentation ill be discussing in this blog is hyperpigmentation. This is when the pigment is brown and darker in colour. There are 2 main different type of pigmentation that I deal with in my clinic. Epidermal pigmentation and dermal pigmentation. 1 sits in the top layers of the skin and is usually easier to treat and dermal pigment sits deep in the dermal junction of the skin and can typically be very hard to treat. It also depends on your skin natural colouring if pigment is hard to treat or not. Lighter skin pigmentation is usually a lot easier because its safer to use lasers and the lasers are less likely to stimulate pigmentation. Darker skins are much more sensitive to heat and can have long repercussions if treating it wrong with certain types of lasers. If you have a darker skin type you will have to be more patient in controlling or removing the pigment.

Epidermal pigment will show as the following – freckles, sun spots, Dermatosis papularis nigra (DPN), and post inflammatory hyper pigmentation PIHP. Freckles and sunspots will be most familiar to people. DPR is typically found on a darker skin type and presents as a darker colour and the skin is raised. Diathermy is my go to treatment for these types of lesions and it can be a very easy process.
PIHP is when the skin is injured and then once healed it leaves a dark mark. This is most commonly seen after acne and typically on a skin that produces more pigment already. It can also be found in your dermal junction and that can be from skin treatments like lasers or even skin needling. sunspots can be easily treated in a lighter skin type but can take more sessions on a darker skin type and may not be able to be fully removed. If sunspots are stubborn this will mean that they aren’t just sitting in the epidermis they will have formed deep down in the dermis.

The most common Dermal pigment is melasma. This is a very tricky pigment to treat and on some people it is more about control than removal. Melasma is stimulated by inflammation, heat, hormones, sun exposure and certain foods. You should be on a pigment inhibitor at all times and always use spf. The treatments that are most suitable for this pigmentation is Q switch and Pico. You will need to be treated on very low setting and have multiple treatments. These lasers don’t use heat and there is no distruption to the epidermis.

How do we tell ig pigment is sitting dermal or epidermal? Using a woodslamp or Image software like visia. This will help us as clinician know what treatments are safe and be able to create a treatment plan that will work for your type of pigmentation. I would always recommend clients wanting to combat pigmentation to be on a pigment inhibitor like p bright and a good spf. I would also warn my
clients about prescribed hydroquinone. You may see an improvement but once you are off the cream in most cases there is a pigment rebound and it becomes much worse.