Dr Vicky Dondos has been treating and educating her clients with her pared back, natural approach to skincare for almost 15 years. As one of the most common complaints that walks through her clinic door, pigmentation is an area in which Dr Dondas has a wealth of advice to share.
You have cells in your skin (‘melanocytes’) specifically designed to produce melanin - the brown pigment that gives you a tan. This is a protective mechanism: the pigment filters out harmful UV rays and prevents the damage caused to DNA, collagen and elastin fibres deeper in your skin. You produce less and less melanin as you age, putting you at a higher risk of DNA damage and skin cancer.
I often hear “but I always wear SPF50 and a hat but it’s still here!” The problem is the damage was done in your childhood. Repeated sun exposure in your younger years has ‘primed’ your skin, lowering its threshold to anything it perceives as trauma - even the slightest inflammation (plucking a hair, a spot, exposure to airborne pollutants) will trigger a deposit of melanin.
Throw in a hormonal wobble - pregnancy, menopause or a stressful period (and this is a very real physiological response) - and your threshold drops even lower, melanocyte behaviour becomes erratic and brown spots appear.
Often these will come and go. But for many, there comes a point where they no longer fade away in the autumn. How to treat?
Sunscreen, sunscreen, sunscreenEvery day. Even if it’s raining. There are UVA rays and UVB rays; UVB rays cause sunburn and are particularly active when the sun shines. But UVB rays are hitting your skin every day, even when it rains. They pass through your windscreen and windows. And they penetrate 40x deeper into the skin, destroying collagen and elastin fibres, causing DNA mutations and uneven pigmentation.
Use SPF50 if you can but 30 will do – there’s only a 1% difference in protection level (if you use enough and reapply every 2 hours if outdoors or exposed). SPF in makeup is better than nothing, but I encourage my patients to use a separate sunscreen for better protection. Having said that, dual action moisturisers can be a good idea, like Paula’s Choice Resist Skin Restoring Moisturiser SPF50. But they have to be well-formulated to make sure the amount of SPF in the mix is adequate.
There are some tinted sunscreens that really do give cover that might just be enough, such as Epionce Daily Shield Lotion Tinted. They can feel a little thick and pasty, but this is definitely an improving area, with lots of new options coming out here. Ilia super serum skin tint is one I’m waiting to hit UK shores.
Blocking formation of new pigment There are lots of ingredients you can use here. We mainly use prescription-only in the clinic, but I am not a fan of using prescription products ad infinitum. The Ordinary Azeleic Acid Suspension 10% and arbutin are non-prescriptive alternatives that can be used for maintenance after a (minimum 12 week period) of hydroquinone, the gold standard.
These take time to work because you need to wait for the old cells carrying the pigment to be exfoliated away (between 3-6 weeks). There is also no guarantee that you won’t start pumping out excess melanin once you stop using them, especially if you go back out in the sun. If you want to see results and are serious about tackling your pigmentation, I’m afraid you absolutely need to commit to not directly exposing your face to UV rays.
Be very, very careful not to stop abruptly with these ingredients. There is such a thing as rebound hyperpigmentation, as your cells get all excited that they can make melanin again after a period of being suppressed. It’s a natural urge to stop using actives when on holiday so seek advice!
Speeding up your natural exfoliation
Remove the cells that carry excess pigment but be careful here. Firstly, scrubs, peels and leave-on exfoliants may well accelerate the removal of pigment in a good way but they will also excite your skin, potentially increasing the risk of it responding to further stimuli by dumping down more melanin.
Also, you may see a nice temporary lightening as those top cells are removed - but pigment is still being churned out. For the best results you need to go slow and have a multipronged, coordinated POA.
AntioxidantsAntioxidants like vitamin C will support your skin in the fight against free radical damage - the process at a cellular level that triggers pigmentation. I recommend Epionce Intense Defence Serum.
If you go prescription strength, I will also add Vitamin A (retinoids) to help on every level, especially transporting hydroquinone down to deeper levels of skin where more persistent, resistant pigmentation usually lurks!
Obagi Nuderm 12-week prescription skincare systemThis is a prescription-strength method to improve pigmentation, fine lines and dull, sallow skin. It’s a 12-week overhaul that will ‘reset’ your skin. Autumn is the perfect time to do it: post-beach, pre-ski (pre-Covid anyway!). The system can be transformational or a very expensive disaster if not used correctly so we only recommend doing this treatment via our clinic or a leading dermatologist, and make sure you always follow professional advice.