From chemical peels to laser deals, there are quite a few options to treat pigmentation. Sometimes, though, improvement can be a more realistic endpoint than cure

In my last two articles, I explained the various causes of pigmentation. Now I will discuss the treatment options available. I can only discuss the general principles of treatment here but the best treatment for your skin and condition can only be decided by your doctor.

In most cases, pigmentation is due to the accumulation of a natural dye called melanin. Imagine you are in a boat in the middle of a lake and you suddenly notice a hole through which water is gushing in. What can you do to prevent the boat from sinking? You can try to close the hole to prevent further water from coming in, and try to empty the water already inside. The treatment of most pigmentation is similar. You have to prevent further deposition of melanin and try to take out the melanin already deposited in the skin except in cases where there is no further deposition (the hole is already plugged). Melanin deposited in the superficial layers of the skin can be reduced by peeling off the superficial layer of the skin in a safe manner so that the new cells formed to replenish the lost cells will be less pigmented. This technique is called chemical peel and it has several other advantages as well.

Chemical peels vary in depth of exfoliation. Certain chemicals in the peel can have specific properties. However, the vast majority of the peels just do basic exfoliation and the additives just make the process attractive and aesthetically pleasing. Chemical peels can be used as a treatment for conditions other than pigmentation like acne and acne scars. Chemical peels with beta hydroxyl acids are beneficial for acne. A deeper pigmentation requires a deeper peel. However, there are several types of pigmentation that do not respond much to peels. Your dermatologist may be able to advise you better on this. If you do not have acne or other concerns like pigmentation, a periodic superficial peel can be an ideal anti-ageing measure too. Some peels (low concentration Alpha Hydroxy acid or AHA peels) are available as home care kits and are as effective as most of the expensive ‘anti-ageing’ remedies. However, peels for acne and pigmentation are better performed under supervision of an experienced dermatologist.

Once in two to four weeks is the optimum interval for peels. Make sure that you give a gap of at least seven days between a peel and other cosmetic treatments. Certain creams are recommended prior to a peel to increase its efficacy though it is not always absolutely necessary. The outermost layer of the skin has sun-protection properties. Hence, peels will make you more sun sensitive as the superficial cells are removed. Sun protection is very important for a few days after the peel.

Microdermabrasion and laser can also be used to remove already deposited pigment. Microdermabrasion is a mechanical way of exfoliating skin using crystals as opposed to chemical exfoliation in peels. Aluminum oxide crystals are commonly used for this purpose. Laser treatment for pigmentation may be more effective than other techniques but it is aggressive and not suitable for all types of pigmentation. The bottom line is that removal of deposited pigment is difficult and often incomplete. Now I will describe how the hole in your sinking ship can be plugged or how we can prevent the body from depositing further melanin.

One can identify the cause of pigment deposition in some cases. If you know the cause, avoiding the same is the logical first step. If you know you are allergic to hair dye, you have to either stop using the dye or find another dye you are not allergic to. Each time you develop allergy, the area will become more and more dark. If you are allergic to your fairness cream, it can give you the opposite result.

Several medications can be used to reduce the pigment production. Most of these medications work by blocking the enzymes involved in melanin synthesis. Some of these medications are not safe for long-term use. Hence, it is important to adhere to your doctor’s recommendation on the use of these products.

Again, the bottom line is most of these medications cannot completely and sustainably block pigment production. Hence in many cases of pigmentation, improvement is a realistic endpoint than cure.

Most of the pigmentations on the exposed areas can be exacerbated by sunlight. Using a sunscreen is a cliché probably less important than understanding the need for physically avoiding the harsh desert sun.

I am sure I’ve left one important question unanswered so far. Why can’t we use medications that can completely and sustainably block pigment production? If you do that you will develop white patches, considered a much more serious cosmetic disfigurement by many, and that will be the topic for my next series.

(Dr Bell R Eapen is a Dubai-based specialist dermatologist with Kaya Skin Clinic. Write to him at wknd@khaleejtimes.com)