Pigment spots

Pigment is also called melanin. Melanin is made by pigment cells (melanocytes) using the amino acid tyrosine in the lower basal layer of the epidermis. Tyrosine is cleaved by an enzyme tyrosinase and depending on your skin type, eumelanin and pheomelanin are formed.

Eumelanin is brown-black and it protects us against ultraviolet light (photo-protective). Pheomelanin is yellow-red, photo-reactive and does not protect against ultraviolet radiation. Light-skinned people Fitzpatrick skin types 1 (red hair/blue eyes) & 2 (blonde hair/blue eyes) produce more pheomelanin and burn faster in the sun. Dark skin types 3-6 (dark brown black hair/brown eyes) have mainly eumelanin, evenly distributed in the skin and are resistant to the sun.

Still in the melanocytes, melanin is then packaged and transported in melanosomes. Via bulges in a melanocyte, the packed melanosomes leave to keratinocytes (a single melanocyte is roughly ‘connected’ to 40 keratinocytes). The movement of keratinocytes from the lower part of the epidermis to the surface results in a dark shade.

Pigmentation is an uneven distribution of locally over stimulated melanin

It is caused by excessive exposure to sunlight, hormonal changes, such as contraceptive medication or in menopause, skin irritation from aggressive chemicals, various skin conditions, such as acne, eczema or psoriasis and also by medicines (Antibiotics: tetracycline / doxycycline / minocycline, heart medication : amiodarone). Pigmentation can appear on any part of the body, but most commonly on the face, hands and neck, and is considered undesirable for cosmetic reasons.

With a freckle, the amount of pigment cells (melanocytes) are equal, only more pigment is produced.
A liver spot, also known as a sun spot, actually has nothing to do with your liver. In the medical world, a liver spot is also called lentigo. Lentigines (plural) contain both more pigment cells and more pigment. The pigment cells are evenly distributed in the lower layer of the epidermis.
In moles, there are also more pigment cells, but unevenly distributed and accumulated in the skin.

The three are more distinguishable under the microscope (biopsy).

Freckle

Freckles, known in the medical world as ephelides, are benign spots. They are mainly located on the face and sunlit areas such as the upper body, forearms and lower legs. They are created by sunlight. That is why they become darker in color during the summer period and just lighter in the winter months. Most people recognize freckles very easily. They are more common in people with lighter hair color and skin type (red and blond hair).

Lentigo

Lentigines are brown spots and are also caused by sunlight. These stains will not go away on their own. They can arise from puberty, then they are called lentigines simplex. Lentigines solaris or lentigo senilis (liver spot or age spot) are also benign variants that develop at a later age. You often see them on the backs of the hands and on the cheeks.

Moles or birthmarks

Birthmarks can be present from birth and increase over the years. They can be of different colors: black, brown, red or even skin-colored. The shape also varies from smooth, raised to spherical. A light brown birthmark is difficult to distinguish from a freckle or lentigo. Birthmarks can suddenly increase from puberty, and existing birthmarks can also grow and increase in number during pregnancy.

lubricate

During the day, use mineral sun protection with a minimum of SPF30 and cosmetic ingredients that reduce pigment spots. There are also some cosmetic skin care ingredients that can stimulate your skin such as Vitamin A, C, Vitamin B3 (Niacinamide), Arbutin, Kojic Acid, Resveratrol, Licorice root, Hydroquinone. Do not buy bleaching creams yourself. They sometimes contain substances that can be harmful to the skin with prolonged use. A recent study suggested that uncontrolled hydroquinone use (over the counter products), can cause skin cancer. Consult with a skin therapist or possibly your doctor or pharmacist if you want to apply a bleaching cream.

There is also such a thing as camouflage therapy. When pigment spots are very dark, make-up may not conceal it sufficiently. The skin therapist can use camouflage therapy to make color creams that match your skin in order to conceal your pigmentation spots.

Peelings

Another option is chemical peeling. The peeling is done under the supervision of a skin specialist and stimulates the skin to flake off faster and to renew itself. As a result, spots will fade faster and pigment will become lighter.

Lasers

Superficial pigment can be treated well with the laseror with IPL. The heat from the laser/IPL is absorbed by the pigment. The heat that is released during this process causes the pigment grains of the pigment spots to breakapart. The body cleans up part of it itself and part becomes a scab that falls off after 1,5 weeks. The latest laser technique is the PicoWay laser, which has a pulse duration of ^10-12 seconds. Thanks to these ultra-fast pulses, this laser is able to pulverize the pigments in the skin into the smallest particles, making it easier and faster for them to be cleared by the body. Compared to the older nanolasers, fewer treatments are needed to satisfactorily bleach pigment spots. The PicoWay is currently also the safest laser for people with tinted skin. Asian, Hindu and even negroid skin types.

Microneedling

In microneedling, very small holes are made in the skin with the dermapen. This ensures that a skin renewal process is started and the skin will renew itself. Because it is done in a controlled way, the chance of new pigment formation is quite small, even in people with darker skin types.

Glutathion supplement

Glutathione is thought to inhibit pigment on several mechanisms. It inhibits the production of pigment in the melanocytes (pigment cells), and the strong antioxidant effect of glutathione also has an inhibiting effect on pigment production.

In a 2012 randomized placebo-controlled study of 60 volunteers, the volunteers received orally administered glutathione at a dose of 500 mg per day for 4 weeks. It resulted in a lighter skin color of the face and forearms. In itself, glutathione as a supplement is safe, but more research is needed regarding the long-term effects.

In terms of diet, fruits, vegetables and meat are sources of natural glutathione.

Polypodium leucotomos extract (PLE).

PLE is a fern extract and belongs to the Polypodiaceae family. It has antioxidant and immunoprotective effects. In a double-blind randomized study with placebo, 40 people with melasma were divided into 2 groups and followed for 3 months. One group received a placebo, combined with SPF50+ and hydroquinone 4% cream and the other group received PLE extract (2 x a day 480 mg), SPF50+ rubbing and also hydroquinone cream 4%. Conclusion after 3 months: the group with PLE, sun protection and hydroquinone 4% cream is significantly better.

Tranexamic acid – medicine

Tranexamic acid is a synthetic form of the amino acid “lysine. It is a medicine commonly used to prevent bleeding from trauma, surgery, childbirth, heavy periods, and nosebleeds. An off-label use of tranexamine is the treatment of melasma. However, this is under strict medical supervision and with blood tests.

Treatment of melasma with oral tranexamic acid has been described in studies. In one study, a dose of 250 mg twice daily for 6 months resulted in excellent or good improvement in 65% of patients. The use of tranexamic acid to lighten dark spots on the skin carries a potential risk of thrombosis. During tranexamine treatment, it is advised to stop contraception.