The challenges of pigmentaion
Pigmentation Challenges: Understanding, Causes, and Treatment Approaches
Pigmentation disorders are among the most common dermatological concerns, often presenting as hyperpigmentation, melasma, post-inflammatory hyperpigmentation (PIH), or diffuse uneven skin tone. The key questions for both patients and clinicians remain: Why does pigmentation occur? How can it be corrected? And what products or treatments effectively reduce it?
How Pigmentation is Formed
The primary pigment in human skin, melanin, is synthesised through a process called melanogenesis. Central to this process is tyrosinase, a copper-containing enzyme (classified as type III copper-containing oxidoreductase), which catalyses two critical reactions:
Monophenolase activity – the hydroxylation of L-tyrosine to L-DOPA.
Diphenolase activity – the oxidation of L-DOPA to dopaquinone, which then undergoes enzymatic and non-enzymatic reactions to form melanin (Hearing, 2011).
Melanin production is influenced by multiple factors, including optimal enzyme activity at a skin pH of approximately 6.5, temperature, and the presence of specific monophenols and diphenols (Chang, 2012).
Causes of Pigmentation
While ultraviolet (UV) radiation and hormonal changes are well-known triggers for hyperpigmentation, emerging evidence suggests liver function can also play a role.
Chronic liver disease (CLD) and liver fibrosis have been associated with facial pigmentation changes, often termed “hepatic face” in clinical contexts. This presentation may include:
Dry skin
Olive or sallow complexion
Periorbital hyperpigmentation
Decreased skin elasticity
The pathophysiology is thought to involve oxidative stress and inflammatory cytokine activity, both of which can stimulate melanogenesis (Liu et al., 2015). Although the link between CLD and conditions such as melasma and PIH remains under investigation, pigmentation may, in some cases, serve as an external marker for underlying systemic health issues (Llamas-Velasco et al., 2017).
Treatment Approaches
Effective management of pigmentation requires individualised diagnosis and treatment planning. Factors influencing outcomes include:
Fitzpatrick skin type – Darker skin types (IV–VI) have a higher risk of PIH and may respond more slowly to treatment.
Duration and depth of pigmentation – Older, dermal pigment is more resistant to removal.
Lifestyle and environmental exposure – Tropical climates, outdoor activities, and inadequate sun protection can worsen pigmentation.
Common clinical interventions include:
Laser therapy (e.g., Q-switched Nd:YAG, picosecond lasers) – effective for some pigmentary disorders but requires caution in darker skin tones (Kwon et al., 2019).
Microneedling – stimulates dermal remodelling and may aid pigment dispersion.
Chemical peels – agents such as glycolic acid, TCA, or salicylic acid to target epidermal pigment.
Plasma fibroblasting – emerging modality for skin tightening and pigmentation reduction.
Skincare and Post-Treatment Maintenance
Post-procedure care is crucial to prevent recurrence and protect treatment results. This includes:
Topical tyrosinase inhibitors -e.g., hydroquinone, kojic acid, arbutin, and azelaic acid (Solano, 2020).
Broad-spectrum sunscreens -ideally containing physical blockers (zinc oxide, titanium dioxide) and formulations that dissipate heat to reduce post-inflammatory pigment stimulation.
Topical and oral antioxidants -e.g., vitamin C, vitamin E, polyphenols, and glutathione to combat oxidative stress.
Lifestyle modifications -sun-protective clothing, reduced UV exposure, and improved nutrition.
Key Takeaway
Pigmentation correction is rarely a one-session process. Lighter skin types may see faster results, sometimes in a single aggressive treatment, while darker skin tones often require slower, gentler protocols to minimise complications.
Ultimately, professional guidance from a dermatologist or qualified dermal therapist with a skin science background is essential for safe, effective, and lasting results.
