Ep. 9 - Title The Pigment Playbook

Uneven pigment is one of the most common concerns clients bring into the treatment room, especially in hot, sun-exposed climates. But as Sam Bazile explains, hyperpigmentation is not something “wrong” with the skin. It is the skin doing exactly what it was designed to do protect itself.

This conversation breaks down how melanin is produced, why some clients develop melasma or post-inflammatory hyperpigmentation while others do not, and what is really happening beneath the surface when pigment appears. Sam Bazile makes it clear that treating pigment is not about chasing spots, it is about understanding melanocyte behavior and correcting how pigment is being produced and distributed.

Key takeaways from this episode include:

• Why hyperpigmentation is a protective response triggered by sun, heat, hormones, and inflammation
 • The difference between melasma, PIH, and PIE and how they show up on the skin
 • Why treating pigment requires both suppression and correction, not just lightening
 • How hydroquinone works, why it should be used with intention, and when to take breaks
 • The role of retinoids and exfoliation in clearing existing pigment buildup
 • Why sunscreen alone is not enough and what true broad and triple spectrum protection means

This episode is especially valuable for estheticians and skincare professionals who want a clearer, more strategic approach to treating pigment, as well as anyone struggling with uneven skin tone and looking for real answers beyond surface-level solutions.

Transcript

SPEAKER_01 0:07

Hey y'all, welcome to The Skin Trovert. I'm your host, Sam Bazil. Today I want to talk about something that is pretty common down here in the south, and it affects most of us because we live in a hot, humid climate. It's very sunny here. And a lot of people are on this mission to have beautiful, healthy skin. And an important part of that mission is making sure that your skin is even in color. So today I want to talk about pigment problems. We are going to talk about melanin. Melanin's actually kind of complex. It's in other areas of the body besides the skin, it's in the hair, it's in the iris of the eyes, it's in the nails. But specifically, pigment that is produced in the skin is called melanin. And melanin is produced by pigment cells called melanocytes. Is that normal? Is that unheard of? It is very normal. It's actually the way that your skin protects itself from certain triggers. Triggers can be the sun, hormones, injury, heat, or inflammation. So your body produces melanin to protect itself. Very similar to the way that an umbrella protects you from the rain, is the similar way that your melanocytes produce melanin as a way of protection. So if it's normal and everybody does it, everybody produces pigment, then why do some people have melasma and some people don't? Why do some people have PIH hyperpigmentation and some people don't? I kind of use it like an example of some people have nice, well-behaved kiddos, other people have crazy little nutso ADHD little kids. You get what you get and you don't throw a fit. Same with your melanocytes. Some of us have very calm, very well-behaved melanocytes that just go with the flow and do what they should do. Others have little crazy, hyperactive little ADHD melanocytes that just go nuts. Now, here's the bottom line: there's still a lot that we don't know about pigment, but there's a lot that we do know. So while we're still learning, let's talk about the things that we do know, specifically when those little melanocytes are nutso. So if you have a very well-behaved melanocyte, what does that production look like? Well, let's first talk about where the melanocytes are so you can have a better visual. So you have melanocytes and they look like hands. They have these little finger dendrites and they live down in the basal layer of your epidermis. The basal layer is the very bottom layer of your top layer of skin. So those little melanocytes live down there. And fun fact, one melanocyte provides pigment to 36 surrounding skin cells. Just 36. That's wild to think how many of these little guys you have down there. But anyway, back on track. So down in the epidermis, basal layer of your epidermis, you have these melanocytes that produce pigment when they're triggered. They can be triggered from the sun, hormones, injury, heat, or inflammation. When they're triggered, they just very calmly, very slowly turn on and start to produce pigment. Well, that pigment process is a little bit complex, but basically, that melanin is starts, it's the melanin starts off as tyrosine. Tyrosine turns to L-dopa, L-dopa to dopaquinone. And then at that point, the melanin the melanin decides what it wants to be. It can be U melanin, which is the brown-black pigment that is in most skin, or it can be phaomelanin, which is the red-yellow pigment that is a little bit not as common. It's in more of the lighter eyes, the fairer skin. That's when we see that phaomelanin. But anyway, once it decides what it wants to be, it's packaged up into these little organelles and it's shipped off to the surrounding skin cells. What the heck did I just say? I got you. So you have your little melanocyte. Think of it as like a little pigment factory. And when it's triggered from the sun, hormones, injury, or heat, or inflammation, that little pigment factory turns on and it starts to produce pigment. Once the pigment is produced, it's packaged up into little organelles and it's shipped off in the little shipment trucks. It goes up through the little finger dendrites and it's distributed out to the surrounding skin cells. And in normal, well-behaved melanocytes, that distribution is horizontal. So if it's distributed horizontally, that's nice and even. That's how skin gets its color. But when we have those little crazy little hyperactive melanocytes, that production is a little bit wacky and hayrier. That little pigment factory is like alert, alert, alert, we have a package, we need to go. And it's just producing too much too fast. So since it's too much too fast, it doesn't have time to travel up nice and calmly and distribute horizontally to the surrounding skin cells. It just shoots it up, up, up, up. And you have what I like to call these vertical pigment dirt piles. It's like little dirt piles that are piled up. And when I see the pigment on the surface of the patient's skin, that's just the tip of that big old pile that's underneath. So, in my opinion, when you see these pigment disorders, it's frustrating for patients because they want it to go away. They think something's wrong, but there's nothing wrong. Everybody has pigment and it's normal. We just want that pigment distribution to be horizontal and even. So, in my opinion, if you're going to treat pigment successfully, you need to do two things. First thing you need to do is you need to chill this little dude out. That little melanocyte, he's doing too much, he's too hyperactive, he's crazy. We need him to go to sleep, okay? But that's only half the battle. Because even if he's sleeping and he's not making any more of a mess, I still got all the mess that he made. I still have all these vertical piles. So you also need to clean up the mess. So, in my opinion, the best way to treat pigment is to suppress and clean up the mess. So, how do we do it? Right. And then also, if we have pigment disorder, what does that specifically look like? Because a lot of people don't know if they have different pigment disorders. So when you see uneven pigment on the skin, it can look very different. Maybe some people see freckling and look, they may love freckles. That's okay too. Some people may see pigments a little bit more exaggerated, like you may see things like melasma. Melasma is usually symmetrical and it's on sun exposed areas. So we see it on things like the forehead, the cheeks, the chin, the nose, that upper lip can get it. That is indicative of melasma. Other times you may see something called post-inflammatory hyperpigmentation, or we call it PIH. PIH is usually a result of inflammation or injury. So after the skin has been injured, it kind of leaves some pigment left over. There's also another form of leftover injury pigment called post-inflammatory erythema. That's the reds. So PIH, post-inflammatory hyperpigmentation, is the brown that's left over from injury. PIE, post-inflammatory erythema, is the red that's left over from injury. So again, it's just your melanocytes responding to one of those triggers. So if we're going to treat properly, if we're going to suppress and clean up the mass, what are our options? Well, in my opinion, the gold standard for treating pigment is hydroquinone. And look, it's a little controversial topic. Um, hydroquinone has kind of gotten a bad rap over the years. And it's gotten a bad rap because, in my opinion, I think people have overused it. They've used it inappropriately without guidance, and they've used it in way too high of doses. You know, people will say things that they think they know about it being toxic or all this other stuff, but like anything, you know, like that is bad if you're using it too much or, you know, not controlled. So I want you to treat hydroquinone like a prescription because it is. It should be used as a prescription, it should be guided, and you should be following up if you have patients that are on hydroquinone. Why do people love hydroquinone so much? Well, hydroquinone does two very important things. Number one, it's a suppressor. So it's a tyrosinase inhibitor. It's gonna suppress the melanocyte. It's not gonna kill the melanocyte, it's just gonna kind of put it in a little bit of a twilight sleep, right? It's gonna make them go to Snoozville. That's all. So that's one good thing that it does. The second good thing that it does is it gives this overall bleaching effect, which is what people love. They love that nice bleaching effect because it makes everything so nice and even and pretty. Well, I know a lot of providers just want to give hydroquinone and say, that's it, be done with it. But I'm gonna challenge you to go a step further because, in my opinion, I don't think just using hydroquinone is enough to fix the problem. Because remember, we can't cure them from it. So when we are treating, we want to treat as best as we can to truly help the patient even out their skin tone. So if we treat with hydroquinone only, this is kind of what it's doing. I want you to visualize a white wall. Okay, I've got a beautiful white wall, and I decide, you know what, I'm gonna paint brown spots all over this white wall, and I just go to town, spotting it up. Then I look back and I go, uh-oh, I don't like it. I want it to go away. So one option is to take a bucket of bleach and just splash it on the wall. I want you to think of that as hydroquinone. Will that bucket of bleach splashing it on the wall, will it lighten those brown spots? Sure. But it's also gonna lighten the rest of the wall. Okay. So while I want that bucket of bleach, I want to lighten that wall up, but then I want to come behind it with a magic eraser and just blend it all together so I can get everything one even color. And that's what I would challenge you to do when you're treating with just hydroquinone. And what's gonna be the magic eraser to work hand in hand with that hydroquinone? A retinoid. Retinoids are gonna come in and kind of resurface, they're gonna blend and purge all of that, those pigmented cells. Retinoids are just kind of like the cherry on the top. That's what's gonna clean up the mess. So you've got the hydroquinone that's gonna suppress, and you've got the retinoid that's gonna clean up the mess. They just work beautifully together. Now, is hydroquinone and retinoids our only option? No. And in my opinion, it should not be your only option. You need more tools in your tool bag. Because here's the thing: I don't feel that hydroquinone should be used indefinitely. Okay, that's a controversial topic, but in my opinion, I don't agree with it. And I'm gonna tell you why. I'm gonna give a really bad analogy here, but just go with me. So remember how I said that hydroquinone is almost like putting the little melanocyte in a little twilight sleep, okay? So go with me here. Let's say I kidnap you and I take you to my house, and every day I give you this little low dose of a little sleepy med, okay? I told you this is gonna get weird. Just hang in there. I don't know when the day is gonna come, but the day will come that you become resistant to that medication. And that little sleepy time med is no longer gonna work. And what's gonna happen? You're gonna wake up and freak the hell out. You're not gonna know where you are, you're gonna be kicking and screaming, you're gonna be in a total panic. Well, I want you to think of that being the little melanocyte. You've been having him in that little sleepy state from the hydroquinone. Well, there's gonna come a day. I don't know when that day is because I don't know how you metabolize things, but there's gonna come a day when you are no longer able to be hydroquinoned up, babe, because you're gonna be resistant. And then what's gonna happen? That melanocyte is gonna wake up and freak out. It's gonna start overproducing pigment. And then that's worst case scenario because remember, there's no cure for pigment. So then at that point, you're resistant to the one thing in the world that I love so much that I know is gonna take care of it, and then boom, you have this influx of what we call rebound pigment. So, in my opinion, just take a dang break. Take a break so you can prevent that from happening. That's what I would recommend. And so, if you're gonna take a break, then what? Does the rules change if I'm not using hydroquinone? And the answer is no. You're still gonna suppress and clean up the mess. You're just gonna do it without hydroquinone. So instead of bleaching, we are gonna brighten. Now, there are many different brightening ingredients and brightening options out in the market, but I'm just gonna mention some so you can keep your eye out. So things like tranhexamic acid is a good brightener, um, cogic acid, arbutin, diglucosylgalic acid. Um, there's tons of options out there, but these are gonna be brightening suppressors. Remember, our hydroquinone is a bleaching suppressor. So these brightening agents are brightening suppressors. They are tyrosinase inhibitors that work to suppress the melanocyte and then give that overall brightening effect. And is that the only thing we need? No, because that's just suppressing. What are we doing to clean up the mess? So I love exfoliants, specifically retinoids. Retinoids are just gonna kind of keep that exfoliation going. And are retinoids the only option? No. If you like a more milder treatment, you can do other exfoliants like alpha hydroxy acids, you can do things like um what's the like the lighter enzymes, like um papane, things that are just kind of gently gonna resurface and promote exfoliation. So you have tons of options, but always make sure whether you're treating with hydroquinone or not, that you're suppressing and you're cleaning up the mess. That's the best way to get the overall best possible result that we can. Now, there's something else I do want to talk about, and that's how to prevent sun protection is going to be a big, big factor. Sun protection should be your bestie if you have melasma or hyperpigmentation. Because again, we can't cure it, but we need to kind of keep it at bay. We need to keep it controlled. And I know there's a lot of like misinformation and mixed messages out there on the internet right now. People telling you not to wear sunscreen, girl, be so for real. Wear your sunscreen, okay? Yes, get you some sun. We only have one life. Live it, love it, do it. But just do it responsibly. Live it, life it, love it responsibly. If having healthy skin is important to you, then just do the responsible thing and wear your sun protection. Are all sun protections created equal? That is another issue. And the answer is no, my friend. So here's the deal: when you purchase sun protection, you may see something on the bottle called broad spectrum. What does that mean? Broad spectrum is protecting you against UVA and UVB. What is that? Well, UVA is what we call the aging ray. That ray burns down to the dermis. What lives in the dermis? Collagen and elastin. That's why sun worshippers look like death, because they've literally depleted their body of collagen and elastin. Then you're gonna have UVB protection. UVB is what we've called the burning ray. Why do we call it the burning ray? Because it's the shortest ray. And you would think, oh, well, that's good. It's not burning down so deep. Wrong. It's short and it packs a hard punch. Since it's not, it doesn't have time to lessen by going down deep. You're getting a really hard hit and a short punch. So that is what we call the burning ray because it's the risk, the ray that gives you the highest risk of cancer. So always make sure you have that broad spectrum from UVA and UVB. But if you have melasma, I would challenge you to go a little bit further with your sun protection and make sure that your sun protection has triple spectrum protection, meaning you've got UVA, UVB, HEV, and IRA protection. HEV stands for high energy visible light. This is the blue light that's staring us in the face right now. It's the blue light that comes from the phone, the computer screens, and fluorescent lighting. And in this day and age, we all expose to that, my friends. And it's kind of risky because it goes down to the subcutaneous layer. So it's a deep ray that needs to be protected. So make sure you have HEV protection. And then lastly, IRA or infrared, which is heat. You want to have heat protection. Why? Because heat is a trigger for melasma. Remember, your little melanocytes are going to respond to heat. So heat is an important one to have protection from. So just go a little bit further when you have melasma and you're trying to protect. And when you know you're going to be out in the sun, you have to reapply. A lot of my friends are like, oh no, I put it on this morning before I left the house. It ain't no good after about one or two hours, friends. It's like you have nothing on. So you need to reapply, especially when you're going to be out in direct sunlight for long periods of time and during the worst times of the day, which is between 10 and 2. So make sure that you are using it, reapplying. I used to tell myself to set an alarm. You know, now with these phone alarms, you have an easy way. There's no reason to forget. You can set a little phone alarm to go off to remind you it's reapply time. And this is just a Sam suggestion, but remember, heat is not your friend either if you have melasma. So even if, like I have some people that are like, no, no, Sam, I reapply and I'm under an umbrella. So why am I still getting it? It's heat, friend. You can't escape the heat. So what I would recommend doing is keep something like a little bottle with water in it that you can mist in between reapplying, just to make sure that you're keeping the temp down in your face. And always remember sweat and water resistance. So that way you know you're going to be protected and you don't have anything getting in the way of that. Now, some protection, so important, but I think as providers, we also have a responsibility. If you see something, you say something. Some of you listening may be derms and you have every right to diagnose, treat, but lots of us that don't, like aestheticians, we can't diagnose. We absolutely cannot. And maybe if you are a doctor or you're an NP or you're a PA or you're a nurse, maybe you can diagnose, but you don't have the ability to treat. So we can always refer out when we see something suspicious. I had a big scare with my husband. Um, we were on vacation, we were in Belize, and you know how men they wear like shorts, you know, their bathing suits are shorts. So underneath the shorts, it's like night and day. They're like white as a piece of paper, and then they have these like brown legs because they got farmer tan. Well, when we were out on the beach, he was like, Hey, because it was just us, we were by ourselves, and he's like, I'm gonna hike up my shorts so I can get rid of this farmer tan. Well, y'all, when he did that, I saw this little black mole, and I was like, mm-mm. I said, What the hell is that? And he's like, What do you mean? I said that, what the hell is that? And he's like, That's been there. I said, No, no, no, it hasn't. And y'all, let me tell you, I've been with this man since we were 13 years old. I know from head to toe, inside and out, there's nothing on that man's body that I have not seen. So I knew that had not been there. And yes, he has like, like he's a moly guy. Like he's got little black, freckly looking moles like everywhere. Um, but this one was very different. Uh, this was something that a dermatologist told me a long time ago. And I'll give you this little input. He says if it looks like an ugly duckling, it's a suspicious. We need to get it looked at. Meaning, if it doesn't look like all the rest, it could be something. Because a lot of people that have, like my husband that has all these moles, it's like, how do you know? How do you know what's a bad one and what's a good one? So if they don't, if they don't look like the rest, it's something that we need to get looked at. So anyway, I told him I was like, you're getting that checked when we get home. And he's like, I think you're overreacting. I don't think it's, you know, it's fine. And I'm gonna tell you why I thought it looked, like I said, it didn't look like the rest, but it didn't have even borders. It was kind of jagged on one side, and then it was dark, like almost really, really dark brown. But then in the very center, it was like black, black, black and a little bit raised. So I was like, this is not normal. You need to go get it looked at. And thank God we did because it was melanoma. So when he went to the derm, they were like, nope, we need to take a piece of that. And they biopsied it. Sure enough, it came back melanoma. So what started as, I think it was like, if I had to compare sizes, it started out like about a size of a half of a pencil eraser. It was fairly small, but the chunk of skin that they took out was larger than the palm of that that was, it was actually larger than like from the tip of my hand to the bottom of my hand. It was a huge chunk. But they had to do that to make sure that they get all of the margins. So now he goes back every six months for checks. And yes, he's had to have many more removed since then. But the point is, melanoma is nothing to play with and it can spread and it can get out of control very rapidly, very fast. And unfortunately, because like us here in the south, we are so exposed to the sun, that's how it like morphs. That's how it just kind of gets under control, gets out of control. And I would also encourage your patients, like they need to do skin checks regularly. You know, when they're in our chair or on our table, like we see what we're treating, but we don't see other areas of the body. Remind them they need to check their scalp. They need to check the bottoms of their feet, they need to check in between their toes. If they can't see their back themselves, then they need to have someone check it for them. Give them suggestions to keep an eye on their skin because, you know, we we are treating them and keeping their skin healthy, but their skin is big. It's it's a big organ, it's not just the face. They have skin all over. So we need to be a little bit more proactive and responsible, at least to help guide them where they need to go. So if you see something suspicious, meaning it's changed its shape, it's gotten larger since the last time you've seen them, the borders are not even, maybe it's changing color, or there's like I said, like how my husband's was, it was black, black on the inside and a different color on the outside. Maybe it's raised, or if it's flesh colored and maybe it's like scaly, maybe it it doesn't, you know, it it bleeds or it doesn't go away. Those are all things that are, you know, a red flag and maybe need to be checked out. And don't be afraid. Don't be afraid to say something because I I know I'm speaking for myself, but I'd much rather you tell me, hey Sam, this is looking a little sus, and I go to a derm and they tell me, nope, it's nothing, or they biopsy and it's nothing. Fine. I'd rather it come out nothing than to ignore it and then it end up being something really bad, and it's something that I Could have prevented way early on. So if you see something, say something, be very vigilant at keeping an eye on your skin, keep an eye out for suspicious lesions, moles, and just take care of your skin. You know, it's the largest organ of the body. We forget that sometimes because we think of it as more of like a vain thing, right? But it's the largest organ of the body and it's an organ that requires health. So make sure you're taking care of your sweet skin. You know, nurture it, love it, do what you need to do to keep it healthy. Wear the dang sunscreen. So for today, here's what I would say we need to remember, suppress, clean up the mess if having healthy skin is important to you. Second, if you see something, say something. And third, wear the damn SPF. All right, guys, I hope you've learned something today. I hope this was helpful. I know this wasn't diving into all the specifics of pigment. It's just a general outline because, like I said, there's still things that we're learning to this day about treating pigment. But today, this is the rundown, the basics. I hope it inspires you to dig deeper. I hope it inspires you to learn more about pigment, learn more about treating pigment, and maybe hopefully one day soon we will dig deeper into it together. I am looking into guests to join me on my podcast so we can dig into more specific skin health-related topics. So if there is a guest that you would like to see on my podcast, please let me know. You can reach out to me directly at skintrovertsam at gmail.com. I'm also on all social media platforms as the skintrovert, and I am on all podcast platforms as well. All right, guys, that's it. Go enjoy the sun, love it, but do it responsibly.

SPEAKER_00 23:40

Y'all have a great day. Bye, guys. Think of the skintrovert as your aesthetics roundtable, not a training manual. This podcast is for professional education and discussion. It's not medical advice. Your scope of practice matters, regulations vary, and your license always leads. To continue the conversation, follow the Skintrovert on Apple, Spotify, or any platform that you listen to your podcast.