Brief Answer:
Facial Pigmentation Causes and management

Detailed Answer:
Hi XXXXXX, thanks for coming to HealthCareMagic. I see that you are worried about the dark patches developing below the eyes. Let me give you some basic info on that and then we can talk about management.

There are several known triggers for skin pigmentation like this:

A. Sun exposure – this is the most important avoidable risk factor.

B. Pregnancy may provoke pigmentation – in affected women, the pigment often fades a few months after delivery.

C. Hormone treatments seem to be a factor in about a quarter of affected women, including oral contraceptive pills containing oestrogen and/or progesterone, hormone replacement, intrauterine devices and implants. But in other women, hormonal factors do not appear important.

D. Scented or deodorant soaps, toiletries and cosmetics may cause a phototoxic reaction triggering melasma that may then persist long-term.

E. A phototoxic reaction to certain medications may also trigger pigmentation.

F. Pigmentation has been associated with hypothyroidism (low levels of thyroid hormone).


Now, lets discuss management broadly:

Skin Hyperpigmentation can be very slow to respond to treatment, so patience is necessary. Start gently, especially if you have sensitive skin. Harsh treatments may result in an irritant contact dermatitis, and this can result in postinflammatory pigmentation.

General measures

1) Discontinue hormonal contraception.

2) Year-round sun protection. Use broad-spectrum very high protection factor sunscreen of reflectant type and apply it to the whole face every day. Reapply every 2 hours if outdoors during the summer months. Alternatively or as well, use a make-up that contains sunscreen. Wear a broad-brimmed hat.

3) Use a mild cleanser, and if the skin is dry, a light moisturiser. This may not be suitable for those with acne.
Cosmetic camouflage (make-up) is invaluable to disguise the pigment.

Topical therapy

1) Tyrosinase inhibitors are the mainstay of treatment. The aim is to prevent new pigment formation by inhibiting formation of melanin by the melanocytes.

2) Hydroquinone 2-4% as cream or lotion, applied accurately to pigmented areas at night for 2 to 4 months. This may cause contact dermatitis (stinging and redness in 25%). It should not be used in higher concentration or for prolonged courses as it has been associated with ochronosis (a bluish grey discolouration).

3) Azelaic acid cream, lotion or gel can be used longterm, and is safe even in pregnancy. This may also sting.

4) Kojic acid is often included in formulations as they interact with copper, required by L-DOPA (a cofactor of tyrosinase). Kojic acid can cause irritant contact dermatitis and less commonly, allergic contact dermatitis.

5) Ascorbic acid (vitamin C) acts through copper to inhibit pigment production. It is well tolerated but highly unstable, so is usually combined with other agents.

6) New agents under investigation include mequinol, arbutin and deoxyarbutin (from berries), licorice extract, rucinol, resveratrol, 4-hydroxy-anisole, 2,5-dimethyl-4-hydroxy-3(2H)-furanone and/or N-acetyl glucosamine

Other active compounds in use include:

1) Topical corticosteroids such as hydrocortisone, work quickly to fade the colour and reduce the likelihood of a contact dermatitis caused by other agents.

2) Soybean extract, which is thought to reduce the transfer of pigment from melanocytes to skin cells (keratinocytes) and inhibit receptors.

3) Tranexamic acid is a lysine analogue that inhibits plasmin (this drug is usually used to stop bleeding) and reduces production of prostaglandins (the precursors of tyrosine). Tranexamic acid has been used experimentally for melasma as a cream or injected into the skin (mesotherapy), showing some benefit. It may cause allergy or irritation.

Currently, the most successful formulation has been a combination of hydroquinone, tretinoin, and moderate potency topical steroid, which has been found to result in improvement or clearance in up to 60-80% of those treated. Many other combinations of topical agents are in common use, as they are more effective than any one alone. However, these products are often expensive.


I hope this info is useful for you. if you want something more specific, let me know.

Vinay

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