The skin is the largest organ of the human body and is the organ that experiences the most exposure to external environmental factors. Over time, this causes our skin to become sensitive to damage and change, and pigmentation is one of those changes.

So, what is pigmentation, and what are the causes? Most of us will develop some kind of pigmentary concern at some point in our lives, and some people are born with pigmented lesions.

Pigmentation changes to our skin are an extremely common skin concern for both men and women and as we age, these changes become more visible. A huge 90% of ageing is caused by over exposure to the sun. Hormonal changes, skin type and trauma to the skin cause also contribute to pigmentation changes.

There are various types of pigmented lesions, but in this post we are going to discuss some of the most common pigmented lesions that you might encounter, including freckles, solar lentigines, post inflammatory hyperpigmentation (PIH), and melasma.

Freckles

Freckles (also known as ephelides) are small discrete pale brown pigmented speak that can be present from childhood, or that develop later in life on areas of the skin that have had the most sun exposure face, shoulders, chest etc. Freckles are most commonly experienced by people with fair skin.

Solar Lentigines

Solar Lentigines are benign (non-cancerous) brown macules that have developed from the sun as a result of over-exposure to UV rays, and they commonly develop on the face and the backs of hands. Solar Lentigines are usually flat but can present slightly raised and round with a defined border, usually between 5mm and 15mm in size.

Post Inflammatory Hyperpigmentation (PIH)

Post Inflammatory Hyperpigmentation (PIH) is a condition that can occur in skin as a result of injury or trauma, medication, or inflammatory disease. Some medical or cosmetic procedures can also cause PIH.  This skin condition shows up as tan, brown, dark brown, or even blue-gray patches and spots on your skin.

Melasma

Melasma (also known as chloasma) is a condition that presents as patches of pigmented skin on the face – most commonly on the forehead, eyes, cheeks, and upper lip. It frequently presents itself in symmetrical pattern (such as around both eyes, or across both cheeks), and can be caused by the contraceptive pill, sun exposure, hormonal changes, and medication. Melasma commonly occurs during pregnancy and is often referred to as “mask of pregnancy”.

Whilst PIH and Melasma can affect anyone, people with Fitzpatrick skin types 4-6 are more prone to these conditions.

How does the sun damage our skin and cause pigmentation changes?

When our skin is exposed to UV rays, (whether that is natural sunlight or artificial UV rays such as tanning beds), it changes colour and produces what we would call a sun tan.

But what exactly is a sun tan?

When our skin is exposed to UV rays, melanocytes (skin cells), which are responsible for giving our skin its natural colour, absorb those rays and produce more melanin. This darkens the skin and gives a “sun tan”.

Many of us feel a sun tan is a good, healthy thing to have, but it couldn’t be further from the truth – when our melanocytes produce more melanin, what they are actually doing is trying to prevent our skin being damaged by harmful UV rays.

Think of our skin cells as putting up little reflective umbrellas to try shade us from harm. However, these little skin umbrellas can give so much protection.

The sun emits three types of UV rays, UVA, UVB and UVC. UVC rays are blocked by the Ozone layer, but both UVA and UVB rays reach the Earth’s surface and penetrate our skin. UVB rays have a short wavelength that reaches our outer layer of skin (the epidermis) and UVA rays have a longer wavelength that can penetrate the middle layer of skin (the dermis).

Small amounts of UV rays are essential for the production of Vitamin D, but this should not be in excess and should be done responsibly. UV rays are a high energy radiation capable of causing damage to living organisms. They also cannot be seen or felt, and are a known carcinogenic to humans (potential to cause cancer in humans). UV rays are unrelated to heat.

Both types of UV rays can cause skin cancers and damage to our eyes, but UVA rays tend to be the cause of typical signs of ageing and UVB rays are what causes our skin to burn.

Ageing and pigmentation changes occur from over exposure to UV rays. Solar lentigines and freckling is caused by the over production of pigment within our melanocytes and whilst the visible characteristics of these skin lesions can be removed with IPLs, lasers and other skin treatments, they cannot undo the damage that has been done to our DNA.

Prevention is Better than Cure

There are several steps you can take to prevent sun damage and reduce the risk of skin cancer.

The first thing you can do is wear a good quality daily facial SPF. Your SPF should be factor 30 or above (50 is better), be a broadband SPF that covers you against UVA and UVB rays and if you can, find a SPF that is both a physical and chemical sunscreen. Lucky for you, the Lynton SPF 50 is all of these things and goes on lovely under your make up (which I have stock of) and doesn’t leave a chalky residue! It’s also 5* Boots Accredited.

You should also apply your SPF generously and apply to any areas of skin that are exposure. Don’t forget your neck, chest and hands if they are exposed daily! It is recommended by Skin Cancer Org that daily sunscreen should be applied on anyone over 6 months of age.

You can also follow the Five S’s of Sun Safety as recommended by Skcin:-

  1. SLIP on a t-shirt.
  2. SLOP on SPF30+.
  3. SLAP on a broad brimmed hat.
  4. SLIDE on quality sunglasses (remember designer brands doesn’t always mean good quality).
  5. SHADE from the sun whenever possible and during peak times.

https://www.skcin.org/sunSafetyAndPrevention/theFiveSsOfSunSafety.htm

It’s also important to keep an eye on any skin lesions that you may have new or old. Follow the ABCDE Rule – Asymmetrical, Border, Color, Diameter, Evolving.

https://www.healthline.com/health/skin-cancer/abcd-rule-for-skin-cancer#:~:text=Takeaway,a%20doctor%20check%20it%20out.

If you do choose to have a skin lesion of any kind removed, please have it looked at by your GP, dermatologist or have it screened first. Please do not assume that your aesthetic practitioner knows whether it is safe to remove any skin lesion before having it double checked by a medical professional first. 

Unfortunately, I no longer offer the Screen Cancer UK Screening Service, but this is available at the Boots in Cribbs Causeway – https://www.boots.com/healthhub/skin-services/mole-scanning-service.