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Skin pigmentation causes and treatments clarified

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Here in New Zealand we love the sun and the bright, joyful vibrancy that summer brings. However with the warm, hazy enjoyment of summer vacations comes a darker side and that side is often branded across our faces in the form of pigmentation. Pigmentation problems are common in New Zealand, often caused by our love of the sun and New Zealand’s overall high UV rates. Sun exposure can cause a number of cosmetic concerns, namely fine lines and wrinkles as well as pigmentation. However, with pigmentation other factors can come into play to form a range of concerns from sun spots, melasma, age spots, seborrhoiec keratosis and pigmented birth marks.

What treatment option is right for me? 

Pigmentation issues vary depending on the natural colour of the skin, fortunately there are effective treatments that work with a range of natural skin tones to deliver transformative results.  

At Palm Clinic, treatments include IPL, Elos Galaxy, laser treatments like Fraxel Dual and in some cases biopsy or skin excision is required to exclude skin cancer such as melanoma.

Top of the most effective list for treating age spots or freckles is medical grade Elos IPL or Fraxel Dual laser. It reduces the top layers of pigment, fading the brown spot without reducing the number of melanocytes. 

Good sun protection is essential after treatment to prevent brown spots darkening again. 

It pays to bear in mind that because there are a range of different causes of pigmentation, treatments will differ depending on what type of pigmentation is affecting your skin. A Palm Clinic doctor can tell you what type of pigmentation you have – you may have a combination of pigment problems. 

What are the most common pigmentation issues? 

Brown Sun Spots

Brown spots, age spots, freckles and dark patches on skin are all the result of excess pigmentation. Brown pigmentation is called melanin and is the result of special cells in the skin called melanocytes. Pigmentation issues can occur as freckles, age spots/liver spots/sun spots, melasma and post inflammatory hyperpigmentation.

Post Inflammatory Hyperpigmentation Treatment

Post inflammatory hyperpigmentation (PIH) occurs after injury to the skin and is far more prevalent in darker skin types such as Maori, Indian, Asian and Pacific Islanders. PIH appears as a dark brown area over the area of previous injury and is due to excess melanin being produced by melanocytes as a result of the inflammation.  

Typically PIH resolves over several months but can persist for 1-2 years and in some cases can last indefinitely. Treatment is generally patience as it will resolve and treatments risk further inflammation and therefore further PIH. However hydroxyquinone can be useful in some patients and others benefit from mild treatments of Elos Galaxy, IPL or Fraxel Dual laser. 


Freckles are small flat brown marks on sun exposed skin and are areas of skin pigmentation that can divide people – some love freckles and see them as signs of youthful vibrancy, while others dislike their random placement, size, mass or darkness. 

The tendency to form freckles is inherited and is often seen in red heads and younger people.

Due to a degree of reactivity with UV exposure, freckles usually fade in winter and reappear in summer and therefore need sun protection. 

They can also be faded or removed by Elos IPL, but will reappear with sun exposure. No treatment can transform a skin which freckles, into one which tans evenly, as further sun exposure can bring the freckles out again, so it is very important to apply a good sunscreen following treatment to maximize and maintain results. 

Age spots

Age spots are larger flat skin spots on the face and hands that appear in middle age after years of sun exposure. They are caused by an accumulation of the cells that make pigment and fade but don’t disappear in winter. If the spot has appeared recently, has an irregular border, has more than one colour or you have any doubts, see your dermatologist for a check. 

Sun spots should always be protected from the sun. They can be faded with creams containing hydroquinone, alpha-hydroxy acids, retinoids and vitamin C. Stronger, quicker options to fade or remove spots are liquid nitrogen, chemical peels, dermal rolling and many lasers. 

Alternatively, the revolutionary new Fraxel Dual laser which partially resurfaces the skin can also be used to remove brown spots. The melanocyte population is reduced making the brown spots less likely to reoccur. Fine lines and skin texture are significantly smoothed at the same time improving the overall appearance of the skin. 


Also known as chloasma, it appears as blotchy pale brownish pigmentation on the face, especially forehead, cheek and upper lip. It is more common on darker skin types and is especially common in women aged 20-40. Associated with pregnancy or taking the contraceptive pill it can also occur in healthy, non pregnant woman taking no medications and in men using aftershave.

Melasma is more stubborn and unpredictable to treat than freckles or age spots because the melanocytes have become sensitized and continue to produce extra pigment with even the slightest hint of sun. Therefore sun protection is an essential part of treatment. 

Consider stopping hormonal medications although it may be many months before any benefit from this becomes apparent. It is important that you see an experienced doctor before embarking on any treatment as melasma is a particularly difficult condition to treat and is often misdiagnosed by beauty therapists who sometimes treat melasma with skin treatments or IPL that may make the condition worse. 

In our experience we have found that Fraxel and IPL results can be unpredictable and in some situations can make melasma worse. For that reason we now treat melasma more conservatively with home care products including fade creams and Vitamin C and Vitamin A peels. 

At Palm Clinic we work with you to deliver the best results for your issues and concerns. No matter what pigmentation issues or combination of issues you may have we can tailor a programme to fit. 

As the sun is the root of many pigmentation concerns, treatment becomes a partnership whereby you must make a commitment to yourself to be vigilant in applying sunscreen and keeping the treated area free from sun exposure so as to maintain and maximise treatment results. 

If you would like book a consultation and find the right treatment option for you, contact the Palm Clinic today.

Consulatation at Palm Clinic with Dr Sam Dunn

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