From brown spots to brighter skin

Solving pigmentation challenges requires a combination of diagnosis, treatment, and personalised care. Dr Ami Shah shares how!

The skincare market in India is expected to grow to $17.1 billion by 2033, with a growth rate of 7.80 per cent from 2025-2033. Skin hyperpigmentation is a common dermatological concern in India.

Pigmentation, often perceived as simple skin discoloration, is a multifaceted issue with various underlying causes, including post-acne marks, hormonal factors like melasma, autoimmune conditions, and lifestyle influences such as insulin resistance. Research highlights the complexity of pigmentation, emphasising the need for a tailored, holistic approach to treatment. Advances in dermatological science have revealed that effective management requires addressing both superficial and deeper causes, combining medical interventions, skin boosters, and personalised care. By understanding the diverse triggers and leveraging research-driven strategies, dermatologists can offer more effective solutions for lasting pigmentation control, enhancing both patient satisfaction and clinical outcomes.

Dr Ami Shah, Dermatologist, Shah Skin Clinic & Laser Center, dives deep into pigmentation and related challenges along with focus on skin boosters and IV Glutathione, in conversation with Shriyal Sethumadhavan.

Causes of pigmentation

Pigmentation is undoubtedly a common condition we encounter in practice, and it requires a highly challenging and tailored approach to treat. For patients, pigmentation often presents as brown patches on the skin, which they generally perceive as just hyperpigmentation.

The most common cause we see is post-acne hyperpigmentation, which arises as a result of acne. Beyond that, hormonal conditions like melasma are also prevalent. About 80 per cent of females present with melasma, and though less common in males (around 20 per cent), it is still a significant issue. Melasma remains one of the most challenging forms of pigmentation to treat, even for the most experienced dermatologists, due to its dependence on intrinsic factors.

Autoimmune conditions, such as Lichen Planus Pigmentosus (LPP), are another cause of pigmentation. For patients, this often manifests as a general darkening or tanning of the skin, though it is not a tan. LPP, in particular, involves dermal pigmentation that penetrates deep into the skin, necessitating a different approach to treatment.

Other causes include uneven skin tone resulting from dehydration, photoageing, and insulin resistance, which is increasingly common. Conditions like Polycystic Ovarian Syndrome (PCOS), driven by lifestyle factors and obesity, play a significant role. High insulin levels in the body stimulate the melanocyte-stimulating hormone, leading to pigmentation. This often appears as stubborn dark patches around the eyes, lips, cheeks, neck, folds, and underarms – affecting not just the elderly but also many young individuals.

Frictional melanosis is another common issue, often linked to conditions like atopic dermatitis, where persistent itching on the face or body leads to pigmentation. Similarly, conditions like macular amyloidosis can result from using loofahs or rough towels, which cause frictional melanosis.

For patients, pigmentation may seem like a simple issue of brown or dark patches. However, it is the dermatologist’s responsibility to identify the underlying cause and educate the patient. This understanding is crucial in effectively addressing and treating the condition.

Boosters for pigmentation

Skin boosters are a combination of products, such as hyaluronic acid, that help boost collagen and elastin production. Additionally, they may include ingredients like glutathione and, more recently, polydeoxyribonucleotides (PDRN) and New Cellular Treatment Factors (NCTF). These components essentially work to improve the overall quality of the skin.

Hyaluronic acid, collagen, and elastin enhance the health and quality of the skin, while PDRN have strong anti-inflammatory properties. Many pigmentation conditions, such as melasma and Lichen Planus Pigmentosus (LPP), involve an inflammatory process in the skin. By introducing these boosters, an anti-inflammatory environment is created, which helps reduce pigmentation.

Glutathione, another common ingredient in skin boosters, is a powerful antioxidant widely known for its ability to assist with pigmentation issues. However, it is important to note that skin boosters alone cannot resolve all pigmentation problems.

Effective treatment requires a combination approach. It starts with diagnosing the underlying cause of pigmentation, followed by improving skin quality with skin boosters. Enhanced skin quality allows other medications and treatments to work more effectively. This combination makes skin boosters an excellent addition to pigmentation management strategies.

Customising for skin types

The diagnosis and the level of pigmentation, whether it is epidermal or dermal, are critical. At our clinic, we follow a specific protocol where every hyperpigmentation case is assessed using a dermascope. This allows us to get a clear internal picture of what is happening in the skin, whether it is inflammatory, frictional, lymphatic, post-traumatic, post-acne, or otherwise.

Once the diagnosis is clear, we explain the process to the patient and outline the medical line of management. However, medical treatment alone has its limitations. Over my 23 years of practice, I have seen the evolution of treatments – from chemical peels to lasers and now skin boosters. We have learned that a combination of treatments often yields the best results.

We discuss the treatment options with the patient, keeping their approval and budget in mind. If multiple treatments are necessary, the patient is informed about their importance and sequence, which builds understanding and compliance. This approach allows us to retain our patients over the long term, delivering satisfactory results gradually.

Addressing acne and marks

Many patients delay visiting a doctor until their acne becomes visible and inflamed, which often leads to post-acne hyperpigmentation, erythema, or even scarring in severe cases.

When treating acne, we address both the active acne and its consequences. For mild cases without significant consequences, medical management with antibiotics, isotretinoin, and topical creams may suffice. However, for more severe cases involving pigmentation or scarring, a combination of treatments is required. This could include lasers, chemical peels, microneedling RF, Dermapen, PRP, and sometimes skin boosters. Each case is unique, so the treatment is tailored accordingly.

Skin boosters play a vital role in improving skin quality, which is essential for effective treatment. For instance, just as muscles need adequate protein to perform well during workouts, the skin also needs hydration, collagen, elastin, and hyaluronic acid for optimal response to treatments.

If the skin is compromised, adding skin boosters can promote growth factors, making medical and laser treatments more effective. Boosters like polynucleotides are selected based on the patient’s needs. Over the years, skin boosters have evolved from simple hyaluronic acid formulations to advanced combinations, providing better results. This has been a learning curve for us and has significantly enhanced patient outcomes.

IV glutathione and pigmentation

IIV glutathione, a powerful antioxidant, is naturally produced by the liver but depletes with age. It combats oxidative damage and can enhance skin brightness to some extent due to its antioxidant properties. However, it should not be considered a standalone treatment for pigmentation or whitening.

Its overhyped use, especially by non-dermatologist clinics, can lead to unrealistic expectations. Glutathione should be viewed as a supportive treatment to strengthen the body’s response to oxidative stress, complementing other therapies like medical management and skin boosters. It is crucial to set the right expectations for patients and educate them about its role in the overall treatment plan.

The most common side-effect is an allergic reaction, which could manifest as urticaria or other symptoms. Administering IV glutathione must be done under the supervision of a qualified dermatologist in a clinic equipped with emergency facilities. Toxicity is rare but can occur if IV glutathione is administered unsupervised or repeatedly without proper monitoring. Safety and supervision are paramount to prevent such risks.