Pigmentation or discolouration of the skin is a symptom rather than a disease in itself. Pigmentation of the skin can be the end result of several internal medical conditions and can also be an early sign skin ageing. Treatment of pigmentation therefore needs a detailed history to rule out all the internal causes of pigmentation, the commonest being hormonal imbalances and thyroid issues.

At, The Skin Centre, we start with a detailed history and examination. We may request for some blood tests to look for internal causes of pigmentation, depending upon the type of pigmentation and once we have diagnosed the problem, we get start treating it.

The commonest and most difficult cause of pigmentation in the Indian context is Melasma. This pigmentation of the skin erodes a persons confidence and self esteem and many people with melasma become reclusive and avoid people due to the low self esteem. This is a very complicated problem and often most people with this problem need the melasma to be treated by various combination treatments.

The treatment options are:

1. Sunscreen: Although I have listed this as a treatment option, this is actually mandatory in all patients with pigmentation of any cause. The sunscreen should be used every 3-4 hours and if you suffer from melasma, I would recommend the use of a sunscreen when indoors as well.

2. Lightening creams: There are many medicated lightening creams available. Of these, the fastest acting creams contain hydroquinone but these creams need to be used with caution as indiscriminate use can be associated with problems and the risk of permanent pigmentation. Several creams contain milder agents like kojic acid and these are slower acting but safer for long term use. We usually prefer the milder creams and use them in combination with a mild exfoliant for better penetration into the skin.

3. Chemical peeling: This can be used in combination with medicated creams to help hasten the response. Several peels can be used. We at The Skin Centre use a combination of glycolic peels, yellow peels and Miami peels on patients depending upon their skin type and requirement. We do not have a fixed protocol and like to assess each patient for their unique skin needs. We often do different peels on the same patient at different times for more benefit.

4. LASER: We often use the Intense Pulsed Light for treatment of pigmentation. This is particularly effective in people with freckles and early pigmentation of ageing. We use this in combination with medicated creams and may also combine this with chemical peels.

5. Mesotherapy: Modern advances have developed active medications which can be injected in the superficial skin to effectively treat pigmentation. We have found this to be very effective in people who do not respond to other treatments. We have used this
with benefit on some of our patients who have been frustrated with other treatments due to lack of response and miraculously, they often respond well to the injections.

6. Tablets: Nowadays, there are many tablets available, some natural which work internally to reduce the pigmentation. They may not be effective if used in isolation but are a good addition to other treatment options.

We almost always use a combination of more than one treatment option to achieve good response to treatment. The ultimate aim of the treatment is to enhance ones self confidence and self esteem so that they can carry out their normal activities without being conscious of their appearance.

Effective treatment of skin pigmentation requires an accurate assessment of the cause and aggravating factors. After a detailed assessment, treatment is directed towards improving the pigmentation using various combinations of medications, chemical peels, LASERs and lifestyle modifications.

Each individual has their own unique skin type and respond differently to treatments. Assessment is made at each session and treatment is tailored to meet individual requirements.