Your skin color, largely the result of genetics, is caused by the melanin made in your epidermis. Interestingly, the skin is not the only part of the body that melanin impacts. It is also found in the hair, eyes, inner ear, brain, and the adrenal gland. (Source). It not only determines skin and hair color, but it can be a general indicator of how much sun a population might have been exposed to over history. Melanin is a complex thing that is rarely fully understood. However, in order to treat your patients’ pigment disorders, or change their pigment for aesthetic purposes, it is critical that you have the knowledge, as their practitioner, to help them. Think about yourself, as you read. And, to learn even more, make sure you are attending the session on this topic at SCALE 2019 Music City.

Defining Melanin

Melanin is a complex polymer derived from the amino acid tyrosine. As described by News Medical Life Sciences,

Numerous steps are involved in the biosynthesis of melanin. The first step is catalysis of the chemical L-3,4-dihydroxyphenylalanine by tyrosinase. A lack of tyrosine can lead to albinism. Tyrosine is only found in a specialized cells called melanocytes, inside which tiny granules of melanin pigment are contained in vesicles called melanosomes. These melanosomes leave the melanocytes and move into other cells in the epidermis. Mostly brown or black in colour, melanin deposits determine the skin pigment which varies depending on the number and distribution of the melanosomes. Aside from determining skin colour, the light absorbent melanin protects the DNA against UV radiation from the sun and it is considered a potential candidate in melanoma treatment.

Some of the different types of melanin include eumelanin, pheomelanin and neuromelanin. Eumelanin is found in the hair, skin and dark areas around the nipples. It is particularly abundant among black populations and provides black and brown pigment to the hair, skin and eyes. When eumelanin is present only in small amounts, hair may be blonde. Pheomelanin is also found in the hair and skin. This type of melanin provides pink and red colors and is the main pigment found among red-haired individuals. This type of melanin is not as protective against UV- radiation induced cancer as eumelanin. Neuromelanin is a form of melanin found in different areas of the brain and loss of this melanin may cause several neurological disorders.

The American Academy of Dermatology points out that:

• Some people make more melanin than others. Everyone has about the same number of cells that make melanin, but not everybody makes the same amount of melanin.
• The more melanin your skin makes, the darker your skin. How much melanin your body makes depends on your genes, which you get from your parents.
• Melanin is why you get a tan or burn. When you go out in the sun, your body makes more melanin. That’s because it’s trying to protect you from the sun’s damaging rays by deflecting or absorbing them. But melanin isn’t strong enough to completely protect you, especially if you have pale skin. By the time you see your skin turn darker or get burned, it’s already damaged, so trying to get a tan is a bad idea. You should always protect your skin from the sun by covering up and using sunscreen.

Pigment Disorders

Hyperpigmentation and hypopigmentation are common pigment disorders that you might see during your career. While other people will come in because they desire an aesthetic change, those with either of the these disorders will be seeking a remedy so that they look and feel normal.

Hyperpigmentation, as noted by the American Osteopathic College of Dermatology, “is a common, usually harmless condition in which patches of skin become darker in color than the normal surrounding skin. This darkening occurs when an excess of melanin, the brown pigment that produces normal skin color, forms deposits in the skin. Hyperpigmentation can affect the skin color of people of any race.” Liver, or age spots, are a common type of hyperpigmentation. Freckles are another. Hypopigmentation, on the other hand, is the lack of color in skin. It can occur due to a disease or a traumatic injury, such as a burn or cut. Where hyperpigmentation is most noticeable in people with light colored skin, hypopigmentation is most dramatic in those with darker skin.

The US National Library of Medicine, MedLine, has a significant number of online resources to help providers and patients learn more about pigment disorders and the treatments that are available. Options range from topical ointments to chemical peels and other technologies. That said, one of the most promising for almost all conditions is the use of lasers.

Laser Treatment for Skin Pigment

Lasers are a double-edged sword when it comes to pigment issues. It can be the cause of, and also the cure for, many cases of hyperpigmentation and hypopigmentation. It is more frequently used for hyperpigmentation, but treatments have proven effective when the skin needs darkening.

To lighten the skin:

Laser therapy can be effective for hyperpigmentation with durable improvement. In one study of 27 female subjects, phototypes II to V, with mixed-type melasma refractory to previous therapies, low-fluence Q-switched Nd:YAG laser treatment was provided at 1.6 to 2J/cm2 with 5 or 6mm spot immediately following microdermabrasion. Daily application of a broad-spectrum sunscreen began immediately post-procedure. Additionally, subjects used a topical skin care regimen of hydroquinone with tretinoin or vitamin C. Treatments were repeated at four-week intervals. Most subjects showed more than 50-percent clearance of melasma one month after the first treatment. Side effects were limited to mild post-treatment erythema, which developed after the microdermabrasion and lasted approximately 30 to 60 minutes. Four subjects noted temporary exacerbation of melasma after inadvertent sun exposure, but this resolved within several weeks of resuming the topical skin care regimen. Remission lasted at least six months.

In another study by Lee et al who evaluated the 1927nm thulium fiber fractional laser for patients with melasma, showed significant improvements in MASI scores and patient satisfaction with their outcomes. The split-face study where 25 patients underwent three consecutive laser treatments on half of the face also showed improvements of melasma on routine skin histology, which was noted… The continued advent of new laser technology, these and other studies are helping clinicians make better and more effective therapeutic treatment plans for patients with skin of color. (Source).

Be sure to follow our blog here and attend SCALE 2019 Music City to get even more up-to-date information on how lasers can help your patients and clients adjust their skin tone.