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Hyperpigmentation /Sun damaged Skin treatment Options

 

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.

 

  1. Post-inflammatory hyperpig­mentation (PIH): This occurs following skin injury from acne lesions, psoriasis, burns, friction and even certain professional skin care treatments. It begins to fade as the skin regenerates itself—a process that can take months or more. On the positive side, PIH generally responds well to treatment.
  2. Lentigines: These are commonly known as liver spots or age spots. Although they do become more prevalent with age—they are found on 90% of light-skinned individuals over the age of 60. Mainly lentigines are related to UV exposure.
  3. Melasma: This is caused by hormonal fluctuations, common, for example, during pregnancy, with thyroid dysfunction, and through use of birth control pills and hormone replacement therapy.
  4. 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.

    Mini-Peel-2-Peel-example

    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.

  5. Freckles: These are brown colored small lesions that are present only on sun-exposed areas in fair-skinned individuals. They appear darker in summer than in winter. They are markers for individuals at risk for sun damage and sunlight induced tumors.
  6. Treatment includes use of sun screens, hydroquinone, retinoic acid, liquid nitrogen cryotherapy etc.

     
    Melasma-invesntory
     

  7. Periorbital pigmentation (Dark circles around the eyes): It is very common and often causes concern in patients. Transient pigmentation under the eyes occurs following lack of sleep, physical strain, mental stress etc., which most often clears once the precipitating cause is corrected. Persistent pigmentation around the eyes could be due to the following; Familial, Atopy, Eye strain, Acanthosis nigricans, Post inflammatory (following dermatitis around the eyes) and Aging. Treatment of periorbital hyperpigmentation is less satisfactory.
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