Pigmentary changes most often start around mid 20’s and increases with age. It may be more common in women due to hormonal influences (child birth, oral contraceptive pills). Freckles, melasma age spots and many other pigmentary changes are part of the aging process. As aging proceeds, the normal cell turn over mechanism that produces healthy cells slows down. Eventually there will be more pigment cells that surfaces rather than the healthy cells. Sun exposure, hormonal, genetic influences and certain drugs can augment this process.
The most common triggering factor is the ultraviolet A (UVA) and ultraviolet B (UVB) radiation from the sun. The UV radiation triggers off a chain reaction within the epidermis and dermis that stimulates melanocyte formation. The UV radiation from the sun activates the tyrosinase enzyme, which is one of the major biological pathway for activation of melanocyte. Applying sunblock will only help to minimize the harmful effects of sun but it does not confer full protection.
There are many types of hyperpigmentation and they may be present either in the epidermis or dermis. Deeper pigments can be more challenging to treat. Epidermal pigments like freckles and age spots respond very well to a variety of treatments.
Melasma are ususally mixed pigments present in both the epidermis and dermis. They tend to run in families and can be triggered by hormonal changes or pregnancy. Melasma is ‘butterfly shaped hyperpigmentation’and appears as a confluent patch over the cheeks, nose and forehead.
Post inflammatory hyperpigmentation, also known as PIH is usually seen on darker skin types. This is a reversible type of pigmentation that arises over areas of trauma.