Hyperpigmentation is what we refer to as brown discolouration of the skin.
Commonly referred to simply as pigmentation which may include Solar Lentigines (age spots), Freckles, Cafe- au-lait macule, Melasma, PIH (post inflammatory hyperpigmentation). There are many different causes for this increase in melanin hence the many different approaches when treating. UV exposure is the most common cause of Hyperpigmentation.
There are many forms of Hyperpigmentation, correct and thorough consultation is imperative for the best outcome for your client.
For many years we have primarily used the Fitzpatrick Scale to classify our clients skin colour with a scale from 1 – 6. I still highly recommended this scale however,
I would like to mention that we need to think outside the square and be aware
that in modern society we have a large percentage of clients with complex and mixed ethnicities and some will not adhere to the strict criteria of the Fitzpatrick Score. For example, skin that presents as a Fitz I or II may respond to skin treatment as a III if there is a sprinkle of Asian, Indian, Aboriginal, Polynesian etc in their heritage.
When consulting with your client it is essential to have a standard checklist/ questionnaire to work with. The right questions it will help you assertion the type of pigmentation you’re working with. Take the time to listen to your clients answers.
Melasma is classified as a non threatening skin condition that is treated with a medical approach with the support of dermal therapy. As I work in a Medical Clinic I refer my client to our doctors that specialise in Melasma. We treat our patients with prescription compounded fading cream, gentle chemical peels and q-switched Nd:Yag short pulse laser. IPL is not recommended for use with Melasma unless in a specialised clinic when it has a strong vascular component
When treating PIH, again I like to combine both medical and dermal to gain the best outcome. The use of fading creams again can be beneficial as are superficial chemical peels. The use of IPL is not recommended for PIH as we do not want to cause any further inflammation.
With all hyper pigmentation a multi approach of cosmeceutical home care products, medical prescriptions combined with strict sun protection and in salon treatments such as chemical peels, IPL or Laser will give you great results.
The introduction of cosmeceuticals often brightens the skin and ensures a healthy skin which will gain better results from in salon treatments.
I use the Nordlys Ellipse IPL for treating pigmentation such as solar lentigines, freckles, cafe-au-lait. I get fantastic results with often only 1-2 treatments with no to low downtime. I can treat all areas of the body. This is also a great treatment to maintain skin rejuvenation. With monthly chemical peels and an Ellipse IPL treatment every three months your client will maintain amazing skin rejuvenation with a beautiful even skin tone. An added bonus is that most skins suffering from sun damage will also have varying degrees of vascular damage. This will also be corrected with the Ellipse IPL at the same time you are targeting pigment.
Education
The most important thing to reinforce to your client with hyper pigmentation is the use of sun and light protection (infra red, visible light). Physical sun blockvthat has zinc and titanium dioxide is the best because it will stop all the light and wavelengths from penetrating as well as visible light. This is important to wear all the time even if you work indoors. Your client needs to be 100% committed to this if they are serious about getting results. The use of physical coverage eg hat, umbrella, scarf is actually better (unless near reflective surfaces) but it is difficult to get clients to commit to these measures. They need to be reminded that the pigmentation will recur with re-exposure to light.
At the end of your consultation give your client a clear treatment plan, include pricing and a time frame. This will all vary from client to client depending
on budget, desired time spent in clinic, downtime availability (if required) etc. Also ensure your client that together you will reassess this plan as required depending on results achieved along the way. Open communication and listening to your client will be your best tool.
Natalie Maugeri is the Senior Laser and Dermal Therapist, Northern Skin Studio.
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