HYPERPIGMENTATION - SUN SPOTS, AGING-SPOTS

The treatment of facial hyperpigmentation – better known as “aging spots” or “sun spots” is one of many reasons why women, and increasingly men, are seeking out medi-spas.

Dr. John Goldhar M.D., a dermatologist for the last 31 years and a cosmetic dermatologist since 1981, is the medical director of CosMedix MD in downtown Toronto explains hyperpigmentation - what it is, what you should know and how he treats it.

WHAT IS FACIAL HYPERPIGMENATION

Facial pigmentation is a mixed bag of conditions that have an underlying genetic basis and are often triggered by environmental factors such as sun exposure or medication ingestion. Some of the common pigmented lesions that we see are freckles (ephilides is the medical term for these), and lentigenes-also known as liver spots, as well as the thicker, stuck on areas called Seborrheic keratosis (known as barnacles in Australia). Another common condition is melasma - the so called "mask of pregnancy" -that consists of tan or light brown areas seen on the cheeks, forehead and upper lip in women who are pregnant or have been on the birth control pill or in men and women who have used scented products on the face and get sun exposure. Moles are often pigmented but so are certain types of skin cancer and therefore any new pigmented lesion or old lesion that changes in colour, size or shape should be checked by a dermatologist.

WHAT YOU NEED TO KNOW

Today, many dermatologists are acutely aware of not only the medical nature of their specialty but also the cosmetic demands of the patients. The Cosmetic Dermatologist has many tools at his/her disposal to treat conditions and the decision on the appropriate modality depends on the age, skin colour, tolerance to ‘down time’ and the financial constraints of the client.

After assessing the condition and making sure that there is no medical danger present (occasionally a biopsy of the skin may be necessary to determine this), the dermatologist must decide on a treatment that will improve or cure the problem with as few side effects as possible. For example, liquid nitrogen may be useful in the removal of some pigmented spots but if it is used on Oriental or Mediterranean skin types, it can leave dark patches-called post inflammatory hyperpigmentation (PIH) - that may take months or years to clear. Fortunately, many dermatologists have access to potent, medical-grade lasers, chemical peeling solutions and Intense Pulse Light units that can achieve the desired results with a very low risk of side effects.

POSSIBLE TREATMENTS

Treatments of various problems depend on a number of factors and an individual assessment of each patient is necessary. Over the years, our clients have found the following to be effective: the first step, however, is to prevent as much environmental damage as possible and a sunscreen with a minimum SPF of 30 is essential. It has recently been found that the addition of various anti-oxidants such as vitamin C, E, caffeine (yes, it's true), chamomile essential oil and gorgonian extract (these ingredients can all be found in sunscreens) may enhance the effectiveness of a sunscreen. Remember to reapply the sunscreen if you are swimming or perspiring and also remember to apply to the exposed areas such as the ears, lips and scalp.

Fraxel Laser ™ A leading edge laser technology to address the facial hyperpigmentation problem, the Fraxel Laser is a resurfacing laser that treats about 20% of the skin with each session. Generally about 3-5 sessions are necessary. This laser can effectively improve even stubborn melasma (hyperpigmentation associated with pregnancy) in addition to elastosis (sun-induced texture and colour changes) of the skin.

In addition to treating pigmentation problems, Fraxel can be used to improve both deep and shallow acne scarring on the face and trunk, severe elastosis of the face and lines and wrinkles due to aging.

Intense Pulse Light (IPL) Effective at removing hyperpigmented patches on the face, chest, back and extremities, Intense Pulse Light is particularly effective when there is a vascular component such as in rosacea or chronic sun-induced spots. Following the treatment the treated skin will gentle exfoliate for 3-4 days until the brown areas have disappeared. IPL can NOT be used on tanned skin as this can result in a PIH (post inflammatory hyperpigmentation) problem.

Peels (also called the Chemical Peels)- Since hyperpigmentation can occur at different depths of the skin it is often necessary to use different types of peeling should be at least a 70 percent concentration with multiple treatments. We usually see the gradual lightening of even long term darker areas with repeated treatments. Sometimes however it is necessary to go to deeper levels to solve the problem and this may require the use of stronger solutions. In addition to the peel, topical creams containing kojic or azalaic acid can be used to enhance the speed of clearing the pigmentation.

One should be cautious with the use of Hydroquinone ( a common ingredient in lightening creams) because it is often slow reacting and can, in fact, result in a different type of hyperpigmentation. Several peels are usually required for maximum results and high SPF sunscreens must be used following each treatment.

Dr. John Goldhar can be reached though Cosmedix MD or e-mail info@cosmedixmd.com