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Aesthetics Journal
Aesthetics
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Special Feature Hyperpigmentation
Hormonal influences: Most commonly, hyperpigmentation presents itself as melasma as a result of hormonal changes, due to pregnancy or taking contraceptive pills, and can be difficult to treat. As such, it is often referred to as ‘the mask of pregnancy’.1 “If patients are on the contraceptive pill you will have real trouble getting a good result,” says Dr Williams. “It is worth discussing this with the patient to see if they would consider changing their contraception ahead of treatment,” she adds. Post-inflammatory hyperpigmentation (PIH): Following damage to the epidermis or dermis, inflammation can trigger melanocytes to increase melanin synthesis and transfer the pigment to the surrounding keratinocytes.3 Aesthetic practitioner Dr Xavier Goodarzian, founder of the Xavier G. Clinic in Southampton, says, “PIH is luckily easy to treat with skin lightening topicals and generally clears up well.” Although, it is important to note that the pigmentary changes as a result of PIH can occur with greater frequency and severity in Fitzpatrick skin types IV-VI.4
Treating Hyperpigmentation with Peels
Consultation
Practitioners share advice on how to safely and successfully treat hyperpigmentation with chemical peels Sun exposure, hormonal activity and general ageing can all contribute to the development of hyperpigmentation, which is often a significant concern for aesthetic patients. The darkened patches of skin that appear as a result of increased melanin production can vary in size and appear anywhere on the body,1 although, according to the practitioners interviewed for this article, patients generally request treatment for those on the face. “My patients are often hugely stressed by hyperpigmentation; often placing more importance on treating it over lines and wrinkles,” says German board-certified dermatologist Dr Stefanie Williams, who runs Eudelo in London, and notes that hyperpigmentation is the most common reason people visit her clinic. Aesthetic nurse prescriber Kelly Saynor, founder of Renew Medical Aesthetics in Cheshire, agrees, saying, “They can become a bit depressed, in the same way as those patients suffering from acne, and feel the need to cover up their skin.” While lasers are well known as an effective treatment for hyperpigmentation, this article will focus on key considerations when using chemical peels to treat the common aesthetic concern.
Aetiology Hyperpigmentation is a result of an overproduction of melanocytes, the pigment-producing cells that are located in the basal layer of the epidermis.2,3 According to the practitioners interviewed, there are three main causes for its occurrence. These include: Sun exposure: “I have found that the most common form of hyperpigmentation is sun damage,” says Saynor, noting that it can affect patients of any age. If skin is over-exposed to sunlight then it can increase pigment production, leading to hyperpigmentation.1 Aesthetic nurse and founder of MBA Clinics, Petrina Nugawela, explains that sun damage tends to be located superficially, so is fairly easy to treat.
Understanding your patients’ expectations from treatment should be the main priority of any consultation, says Dr Nick Milojevic, aesthetic practitioner and founder of the Milo Clinic in London. Saynor highlights that many of her patients have unsuccessfully tried lots of over-the-counter (OTC) creams and other treatments before presenting to her clinic. “Patients may have over- or underused products, or just been using the wrongs ones,” she says. As such, Saynor emphasises that practitioners also need to find out how long they’ve had the hyperpigmentation, how they feel about it, what treatments they’re prepared to undergo and how much they’re prepared to spend – “Be tactful and go in with trepidation,” she suggests. Once you’ve established their expectations, the practitioners advise that you then need to carefully outline what can be achieved with chemical peels, the side effects that patients will experience and the complications that could occur. Saynor adds that ensuring your patient understands that hyperpigmentation can never be completely eradicated is essential. “We can suppress it with the products we put on topically, but it can come back. As long as patients understand that and comply with your pre- and post-procedure advice then they will be happy,” she says. Then, you can move on to tailoring treatment to your patient’s individual requirements. “The best thing to do is to make sure you understand where the pigment has come from,” says Dr Goodarzian, advising that practitioners should ask for a past medical history, as well as a family history to try to establish an accurate skin type. In addition, he advises practitioners to ask patients what products they currently use on their skin and what treatments they may have undergone in the past. “I would then recommend using something like a Wood’s lamp or an imaging device to look at deeper pigmentation under the skin, to understand and demonstrate to the patient the type and extent of their hyperpigmentation.” Dr Williams agrees, adding, “The first thing I do is diagnose what type of pigmentation it is by thoroughly examining the skin and doing a digital face scan, with a Wood’s lamp where we can look under the skin, as well as on the surface. Once we have a diagnosis we then look at how the patient would be treated.”
Treatment The practitioners agree that having a thorough understanding of the different Fitzpatrick skin types and how they react to chemical peels
Aesthetics | February 2017
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