We all know fashions come and go, but the one trend that hasn’t changed for decades is the desire for a bronzed and healthy skin. This trend, popularized in the 1920s by fashion icon Coco Chanel, was viewed as the sign of health and a degree of wealth and privilege. The trend and desire for the healthy glow has persisted through the decades – from the more affordable access to travel, the advent of the sunbed, and the emergence of advertising and marketing promoting the allure of a bronzed, toned physique equating to beauty.

Despite the proven link between sun exposure and skin cancer, attitudes towards sun tanning show little sign of abating. Eighty percent of the signs of aging are attributed to chronic sun exposure. Overexposure and subsequent damage also increase the amount of melanin production, particularly on the face, resulting in the increase in uneven skin tone and areas of hyperpigmentation.

The influence of social media, as well as Instagram and Snapchat filters, reinforces the ideal that a flawless, even toned, and blemish-free skin equates to youth and beauty. The industry, worth billions of dollars, continues to fuel this ideal with the daily bombardment of the latest trend in removing pigment to achieve this ideal. From makeup to the latest home devices, it’s little wonder that the consumer is confused and unable to filter out the fact from the fad. Many will admit to spending a small fortune on creams and over-the-counter products that promise everything yet deliver little if any improvement.

However, melanin plays an essential role in preventing ultraviolet light induced skin damage. Stimulation of the melanocytes results in the release of tyrosinase, an enzyme that converts tyrosine through chemical reactions to produce melanin. The melanin is then transported by the dendrites to the keratinocytes. Deposition of melanin is determined by whether these dendrites are epidermal or dermal. Hyperpigmentation results from an accelerated increase in production of melanin by the melanocytes. There are multiple factors that increase the incidence of pigmentation, including ultraviolet radiation, hormonal alterations, genetic predispositions, ethnicity, and inflammatory processes. We are now increasingly more aware of the negative impact of environmental pollution and its role in pigment. Constant exposure creates a low-grade inflammatory reaction in the skin, leading to an increase in sensitive, reactive skin, pigmented lesions, and uneven skin tone.

Given the negative psychosocial impact that hyperpigmentation has on individuals, it is one of the major concerns that are present in clinics, salons, and spas. There are various modalities available to treat hyperpigmentation and which modality will achieve the best result is dependant on the causative factor. A detailed skin assessment including medical history and social lifestyle will guide the specialist to the appropriate and effective pathway. The use of a Woods lamp or skin analysis device will help in identifying both epidermal and dermal pigment. This is vital when managing expectations by the client in terms of outcome, resolution, and long-term management. Topical treatments and a series of chemical peels will lighten and lift epidermal pigment. Dermal pigment, however, is more challenging.

Laser therapy is known to be effective in treating hyperpigmentation resistant to topical treatments and chemical peeling. Yet, it’s not just a matter of lifting and lightening the pigment, but regulating and reducing the amount of melanin production and transport to maintain a longer-lasting result. With this in mind, would the same principle apply when using light emitting diode (LED) therapy? There is evidence that LED therapy with visible and invisible wavelengths has positive effects improving ultraviolet damaged skin, including photoaging and actinic keratosis. Red (660 nanometers) and near infrared light (880 nanometers) are effective in reducing erythema and inflammatory reactions in the deeper tissues. As melanin production increases with overexposure to ultraviolet irradiation and inflammatory reactions, the use of red and infrared LED reduces the stimulatory effects on the melanocytes.

Studies by Lee et al (2007) demonstrated a significant decrease in melanin production with a 90% decrease in inflammation and pigmentation after repeated sessions of blue and red LED. Kim et al (2012) analyzed various wavelengths from 415 to 940 nanommeters and reported a significant decrease in tyrosinase with infrared LED with wavelengths at 830, 850, and 940 nanometers. Inhibition of tyrosinase dramatically reduces melanin production. Reducing the inflammation at the melanocytes reduces melanin transfer with the consequence of a reduction in pigmentation. Hyperpigmentation remains a challenging skin disorder that requires patience and commitment from both the skin specialist and the client. No single modality will provide the resolution. LED, however, is a safe, easy-to-use, risk-free, and highly effective additional tool in managing this condition.

References

Lee, S.Y., C.E. You, and M.Y. Park. “Blue and red light combination LED phototherapy for

acne vulgaris in patients with skin phototype IV.” Lasers Surg Med 39, no. 2 (2007): 180-188.

Kim, J.M., N.H. Kim, Y.S. Tian, and A.Y. Lee. “Light emitting diodes at 830 and 850nm inhibit

melanin synthesis in vitro.” Acta Derm Venereol 92, no. 6 (2012): 675-680.

Pam Cushing is a registered nurse with over 35 years of experience in emergency medicine. She has worked in the field of aesthetics for over 15 years, full-time for the last five years. Cushing holds a degree at the master’s level, with commendation, as well as a post-graduate diploma in aesthetic medicine, with merit. She is an independent nurse prescriber in the United Kingdom. Cushing is a consultant educator for a couple of companies educating in injectables, skin resurfacing and chemical peel, microneedling, and LED. She thrives on being able to educate, motivate, and encourage others to grow and develop professionally. She is passionate about skin and the benefits of aesthetics in improving the confidence and quality of lives. Cushing believes our key role is to educate the consumer on appropriate treatment modalities with the focus on maintaining skin health.