Regardless of the origin, uneven skin tones or dark patches on the skin are a common and stressful cosmetic problem. Treating hyperpigmented (increase in melanin production) spots requires patience and tenacity as they do not fade easily. In order to treat them successfully, your cosmetic dermatologist will have to determine the underlying cause and assess the physiological depth of pigmentary changes in order to devise a protocol that will help manage this issue with favorable outcomes.
Common Types of Localized Hyperpigmentation
- Sun Spots (Solar Lentigos) – Small brown lesions on sun exposed areas of the body and face. Noticed in the older population and a precursor to more serious skin conditions such as melanoma.
- PIPA (Post-inflammatory hyperpigmentation) – Acne and eczema can result in PIPA. These are small irregular darkly pigmented spots that can appear anywhere on the skin where inflammation has taken place. They can cause significant cosmetic distress.
- Dark Eye Circles– A combination of blood vessel dilation and pigmentary changes can cause this common issue.
- Melasma – This appears as an irregular blotchy mask on the face and is a rather chronic and distressing condition noticed in women of childbearing age.
- Tanning Bed Spots– Small dark lesions noticed in people who subject their skin to artificial tanning. These should be looked at immediately as they can become cancerous.
Important Markers that Determine Treatment Outcome
- What is the level (superficial or deep skin layers) and the type of hyperpigmentation? The deeper the melanin deposit, the longer it will take to treat.
- How long have you had the hyperpigmentation? Chronic lesions require a more aggressive approach.
- Do you have a medical condition or hormonal imbalances?
- Did the dark patches appear after you took a certain drug?
- Have you had frequent sunburns or do you visit a tanning salon frequently?
Once your dermatologist has determined the root cause of the issue, various modalities can then be implemented to take care of localized hyperpigmentation. The aim of treatment is to reduce levels of pigment in the skin.
Treatment Plan A for Superficial Hyperpigmentation
(Mild to Moderate)
The pigment is deposited in the upper layers of the skin and treatment outcomes are usually faster. A gentler but persistent approach can yield good results.A combination of two or more applications mentioned below will ensure good results.
- Sun protection is an absolute must. A long brimmed hat, SPF 50+ Broad Spectrum Sunscreens and SPF clothing are the mainstays of treatment.
- A combination of topical creams containing hydroquinone, kojic acid, azelaic acid, tretinoin, Vitamin C and steroids.
- Botanicals such as Licorice extract, Soya and Arbutin.
- Fruit acid peels.
- IPL (Intense Pulsed Light).
- Cosmetic camouflage.
Treatment Plan B for Deeper Hyperpigmentation
(Moderate to Severe)
The pigment is deposited in the deep dermal layers of the skin and therefore requires a more invasive approach if optimal results are desired.A combination of two or more applications mentioned below will ensure good results.
- Sun avoidance and sun protection.
- Laser treatments (Q-switch ruby, Alexandrite and Nd:YAG lasers).
- Localized dermabrasion and/or cryotherapy.
- In-office chemical peels (TCA and Jessner’s).
- Topical depigmenting creams.
- Cosmetic camouflage.
Managing pigmented skin lesions requires time, patience and compliance. It must be noted that although there are multiple treatment option available, the outcomes may vary as will the length of treatment, depending on the various factors mentioned above and your desired level of treatment invasiveness.
One must harbor realistic expectations and allow your cosmetic dermatologist to design the best protocol for you.
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