Skincare Case 107

The 37-year-old woman with a Fitzpatrick skin type 5 has dark pigmentation on her forehead and cheeks. The hyperpigmentation developed during her last pregnancy and has remained for the past five years. The use of over-the-counter (OTC) treatments and home care for hyperpigmentation did not show significant benefits. She’s been on oral contraceptive pills (OCP) for two and a half years. The Woods Lamp examination reveals some hyperpigmentation with sharp borders, and some with faint borders.

Causes:

The main causes of hyperpigmentation, especially in the case presented, could be:

1. Melasma: Often linked with hormonal changes, melasma is a common pigmentation disorder that causes brown or gray-brown patches on the face. It’s common during pregnancy and in women taking oral contraceptives due to hormonal fluctuations.
2. Post-Inflammatory Hyperpigmentation (PIH): This could result from any inflammatory event on the skin.
3. Photodamage: Excessive sun exposure can cause uneven pigmentation.

What’s Done Wrong:

1. Insufficient Sun Protection: One of the critical elements in managing hyperpigmentation is adequate sun protection. If the client hasn’t been using a broad-spectrum sunscreen consistently, this could be worsening the condition.
2. Inadequate Treatment: Over-the-counter treatments often aren’t potent enough to treat more stubborn hyperpigmentation.

Office and Home Treatment Options:

1. Topical Treatments: Prescription-strength topical treatments that include ingredients like hydroquinone, azelaic acid, kojic acid, retinoids, and vitamin C may be more effective.
2. Chemical Peels: Peels using glycolic acid or trichloroacetic acid can help lighten hyperpigmentation.
3. Lasers and Light Devices: Intense Pulsed Light (IPL), Q-switched lasers, or fractional lasers can target pigmentation and help lighten the skin. However, these must be done with caution, especially on Fitzpatrick skin type 5, which is more prone to post-inflammatory hyperpigmentation.
4. Microdermabrasion: This procedure can help remove the upper layer of skin, promoting new skin growth and reducing hyperpigmentation.

    

5. Topical OTC Treatments: While they’ve been ineffective so far, some OTC products can help in conjunction with prescription treatments, such as those containing niacinamide, licorice extract, or arbutin.

Prevention:

1. Sun Protection: Daily use of a broad-spectrum sunscreen with an SPF of 30 or higher is essential, even on cloudy days. Wearing protective clothing and hats and seeking shade can also help.
2. Regular Skincare Routine: A consistent skincare routine using products designed for her skin type and condition is important.
3. Regular Dermatologist Check-ups: Since the client has persistent hyperpigmentation, regular check-ups with a dermatologist can help monitor the condition and adjust treatment as necessary.

   Home Care Daily Routine:

   1. Morning: Cleanse the face with a gentle, non-comedogenic cleanser. Apply a vitamin C serum to help with brightening and an even skin tone. Follow up with a moisturizer suitable for combination skin, and finish with a broad-spectrum sunscreen with an SPF of at least 30.
   2. Throughout the Day: Reapply sunscreen every 2 hours if outdoors, and more frequently if sweating or swimming.
   3. Evening: Cleanse the face with the same gentle cleanser. Use a prescribed topical treatment (e.g., hydroquinone, retinoid), if advised by a dermatologist. Follow up with a suitable moisturizer.
   4. Twice Weekly: Use a gentle exfoliant to help remove dead skin cells and aid in the penetration of the topical treatments.

   Please note that she should consult with a dermatologist or skincare professional for personalized advice on product selection and usage, especially given her history of persistent hyperpigmentation.Topical OTC Treatments: While they’ve been ineffective so far, some OTC products can help in conjunction with prescription treatments, such as those containing niacinamide, licorice extract, or arbutin.