Peeling Practice: Understanding & Treating Hyperpigmentation
This article appeared on dermascope.com’s magazine in September 2021, written by Beatrice Van, certified aesthetics master education & certified advanced aesthetician.
Glowing, smooth, and radiant skin is usually the ultimate visual sign of youthfulness. Yet, in a world where the impacts of harmful ultraviolet radiation, visible light, and oxidative stresses are never-ending, it makes this goal seem intangible to many clients.
Hyperpigmentation is one of the most common skin problems that affect both men and women.
Usually, it worsens with age and is most prevalent in darker skin; although in most cases it is harmless, skin discoloration and pigmentation can cause aesthetic concerns which can influence an individual’s self-esteem.
Hyperpigmentation is localized excess pigmentation of the skin and can be induced by numerous intrinsic factors as well as extrinsic factors. It is also known as a deposition of melanin (pigment) due to the stimulation of melanogenesis.
Melanogenesis is the production of melanin by specialized cells called melanocytes and duplicates in skin, and it is the result of the immune system triggering an inflammatory response, which then triggers melanocyte activity to protect the skin’s deoxyribonucleic acid (DNA) from damage and mutation. This process is instigated by hormonal triggers or dermal inflammation such as heat, trauma, and sun exposure. Damage to DNA also triggers melanocytes, stimulating hormones to produce melanin.
Within the melanocyte, a chain of events occurs, and tyrosinase begins to be released. Tyrosinase is the enzyme that stimulates the melanocytes and thus, produces melanin. The tyrosinase then binds with copper and acts on the levorotatory form of dopa, converting it into melanosomes.
These melanosomes are transported along the dendrites (the arms or cellular projections) that branch out to interact with other cells resulting in hyperpigmentation.
Hyperpigmentation Decoded
In general, hyperpigmentation appears when skin cells start producing larger amounts of melanin, which makes skin appear darker in some areas.
This process is a natural reaction of skin cells protecting themselves from excessive sun exposure, blue light, skin damage, and hormonal changes.
Certain medications can also cause hyperpigmentation as a side effect, such as chemotherapy drugs.
Additionally, pregnancy changes hormone levels and can affect melanin production in some women. Also, a rare endocrine disease called Addison’s disease can produce hyperpigmentation that is most obvious in areas of sun exposure, such as the face, neck, hands, and areas exposed to friction, such as the elbows and knees.
Diagnose, Prevent, and Treat
A dermatologist can diagnose the cause of hyperpigmentation. Although not always possible, hyper-pigmentation preventative measures include minimizing sun exposure, wearing a sun hat and sunglasses, and applying and reapplying sunscreen with a sun protection factor (SPF) of 30 or more daily.
There are several natural and botanical ingredients proven to be effective as lightening and depigmenting agents.
A helpful but possibly harmful ingredient is hydroquinone.
Hydroquinone has been one of the standard ingredients for treating hyperpigmentation. This ingredient inhibits the enzyme tyrosinase and stops the production of melanin.
This prevents dark spots from getting darker and fades dark marks and hyperpigmentation that already exist on skin.
It decreases the production of pigment but can be toxic at high concentrations if used for a prolonged time (three to four months).
In fact, it is banned in some countries and was almost banned in the United States by the Food and Drug Administration.
Prolonged use of topical hydroquinone, without any breaks, can cause ochronosis. Ochronosis is a pathological condition of skin and mucosa. This causes discoloration, which normally appears as a blue-black color.
Ochronosis produces lesions on the sun-exposed parts of skin, which are usually yellow-brown in color.
The treatment of this condition is quite difficult and supportive and preventive care measures are used for treatment. The severity of ochronosis depends on the length of time that skin whitening products are being used.
The more the length of time, the higher the chances are of developing ochronosis. So, it is best to only use topical hydroquinone under the care of a dermatologist or certified skin care professional so that they can properly guide the use of the medication without any adverse effects.
The treatment of hyperpigmentation can also be reduced with skin treatments such as micro-dermabrasion facials, microneedling, lasers, and chemical peels.
Understanding Chemical Peels
Chemical peels are treatments that should be performed by a licensed professional who applies an acid or enzyme solution to skin to deeply exfoliate.
This creates a superficial wound on skin which promotes cellular rejuvenation that will effectively improve skin's texture, color, and health.
Chemical peels have existed since the time of Cleopatra. This famous queen used lactic acid (found in sour milk) and tartaric acid (found in wine) to give herself mild chemical peels. This practice continued through the Middle Ages.
Modern scientists now know that alpha hydroxy acids, which are used today in some mild chemical peels. The main purpose of using acids on skin is to denature the desmosomes, the bonds that connect keratinocytes together and induce a cellular communication cycle that speeds up the cellular renewal process.
Chemical peels are intended to remove the outermost layers of skin. To accomplish this task, an acid is applied to the stratum corneum. The upper layers of the epidermis are impacted with no contact with living tissue. Depending on the acid used, it either destroys the dead cells or penetrates to break the protein bonds which can take up to 12 hours.
Enzymes then dissolve dead skin cells (proteins) using the proteolysis process which is the breakdown of proteins. The result is a smooth texture, better skin hydration, and brighter and healthier skin.
Peel Depth and Chemical Exfoliation
A very superficial peel affects the outermost layer of the stratum corneum — the lightest professional exfoliation offered by a licensed professional.
Advantages include no downtime, it is an ideal choice for first-time peel clients, great for maintaining skin health, and leaves skin feeling tight and bright.
Superficial peels affect the stratum granulosum. They have minimal downtime (one to three days), involve light flaking, reduce fine lines, wrinkles, and pigmentation, control acne, and breakouts, and can be performed every three to four weeks. Medium-depth peels affect the papillary dermis.
These peels require seven to l4 days of downtime. They can also reduce acne, but the skin will be flaky or produce a snake-like shedding effect. Medium-depth peels will improve pigmentation on the surface and underneath skin, as well as improve fine lines and wrinkles. Skin will have a tight feeling for two to five days post-peel, and the treatment can be performed every four to six weeks but not exceeding one to two per year.
A deep chemical peel affects the reticular dermis and can only be administered by a physician.
The treatment comes with extensive downtime (14 days to three months), helps sun damaged skin, and eliminates deep, coarse wrinkles. These kinds of chemical peels can also remove pre-cancerous growths, treat blotches caused by aging and sun, and will produce long-lasting and dramatic results.
Before beginning a series of chemical peels, approach the treatment plan with a progressive (not aggressive) approach. Conduct a thorough client consultation to determine their goals and establish treatment expectations. Determine if there are any possible contraindications such as pregnancy, nursing, immune disorders, phenol allergies, aspirin allergies, Accutane use, Retin-A use, active cold sores or herpes simplex, chemotherapy, radiation, current cancer diagnosis, compromised skin barrier, and active skin conditions such as dermatitis, open wounds, and waxing within two weeks.
A strong skin barrier is key to a successful series. Chemical peels disrupt the acid mantle, and it can take up to four days for skin to return to its natural pH.
Therefore, before any aggressive resurfacing treatments, make sure the client’s skin is exercised. Proper preparation will ensure a better outcome and may reduce the risk of post-inflammatory hyperpigmentation. Pre-conditioning skin two to four weeks prior is recommended, and for clients with more active melanocytes, the professional may even have to extend the pre-conditioning period. Always follow the manufacturer’s instructions to ensure adequate peeling.
Lastly, creating a comprehensive post-care regimen is crucial.
Nourishing and healing skin is the top priority. The skin’s microbiome must be repopulated, so incorporating ingredients that will replenish the lipid barrier, suppress melanocytes, and support the skin’s immune system is key.
While it is true that all skin types may respond differently, there are a few general rules when planning a chemical peel series.
For example, when planning for an alpha hydroxy acid series, it is recommended to start with a less aggressive formulation working to a lower pH (high concentration) over time. The Fitzpatrick skin typing system has become the standard method of classifying clients and is the term used by many skin professionals worldwide.
The depth and type of chemical peel used by a skin care professional depends on the condition of skin, Fitzpatrick type (skin color and likelihood to burn), and skin care habits of the client.
In general, the higher the Fitzpatrick skin type, the more caution that should be exercised to avoid triggering a pigment response.
However, the Fitzpatrick skin type may not be a method that can effectively predict the outcomes across all ethnic groups. Therefore, newer systems are being created.
Starting and Following Up
The best time to start a series of chemical peels is in the fall or winter because clients will be coming down from those sunny hours spent in summer. Their skin is less likely to suffer from the complications that can occur if clients receive too much heat or sun exposure while their skin is in the recovery and healing stage.
Many clients will also find it easier to stay indoors and recuperate during the cooler seasons. One chemical peel treatment will provide deep exfoliation and deliver great results, but depending on the client’s skin concerns and goals, a series of six is often necessary.
Homecare
The treatment of hyperpigmentation is based on removing pigment from the skin’s outer layers, increasing cellular turnover, and decreasing the production of melanin.
Homecare and dietary changes will reflectively reduce all forms of discoloration, sun damage, scarring, and dark marks, leaving clients’ skin looking healthier, smoother, and evenly toned.
One important step in a client’s homecare routine must include the use of sunscreen, Sunscreen is the single most important factor in improving most causes of hyperpigmentation. Look for a physical blocking sunscreen, preferably with zinc oxide as the main active ingredient with at least an SPF 30 to 50 with broad-spectrum coverage. Make sure to explain to clients the importance of using it daily, reapplying every two hours if they are out in the sun and more frequently if they are sweating or swimming.
There are many ingredients and chemical peels on the market that claim to target hyperpigmentation.
Be sure to remind clients that the goal is progress, not perfection.
Treating hyperpigmentation takes time, and there is no quick solution. So, set realistic expectations with clients and wait patiently for brighter and better complexions.
Beatrice Van, an award-winning aesthetics master educator, enthusiastic, positive, self-starter with over 17 years of progressive experience in the beauty industry. In addition to her role as Clinical Master Aesthetics Educator at Spectrum Advanced Aesthetics, she ts the clinical director for Fearless Beauties, a certified advanced aesthetician, makeup artist, and nail specialist.
On her days off, she is off working at Indie Esthetics, helping her clients look and feel like the very best versions of themselves, or off traveling throughout North America as an education ambassador for GND and Fearless Beauties. Her passion 1s to empower both students and beauty professionals to boldly invest in their education, and strengthen their skills while elevating standards in the industry.