Pigmentation disorders are disfiguring and disturbing. Hyperpigmented patches in the form of lentigines, melasma, post-acne pigmentation and peri-orbital hypermelanosis are the ones that are commonly come across.
Melasma is an acquired, light or dark brown pigmentation seen on the face, particularly on the cheeks, central forehead, nose and the upper lip. Causes could be familial, pregnancy, use of oral contraceptives, certain medicines like phenytoin, menopause, idiopathic etc. The lesions progress after exposure to sunlight.
The response to treatment depends upon the level of the pigment and the duration of the pigmentation. Treatment includes sun screens, hydroquinone, retinoic acid, azelaic acid, kogic acid, topical vitamin C, chemical peeling etc.
A clinical skin care regimen that incorporates a series of chemical peels or a more aggressive TCA peel, such as the OBAGI Blue Peel has produced excellent results in reducing the appearance of pigmentation as a result of melasma.
Skin lightener (i.e. hydroquinone) and sun protection (minimum SPF 30) are essential. Incorporating an antioxidant to serve as an additional layer of protection from the sun during the day and a retinol at night to aid in exfoliating dead surface skin cells will also be beneficial.
Fraxel restore is probably the best technology to try to treat the melasma. It must be done very lightly at 3 to 4 week intervals.
IPL’s, and all types of resurfacing can improve the appearance of these conditions. IPL treatment can affect deeper pigment. Sometimes the cooling will protect the more superficial pigment and hence this can stay within the skin and also prevent penetration of other lasers.
Treatment includes use of sun screens, hydroquinone, retinoic acid, liquid nitrogen cryotherapy etc.