Pigment problems solved

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By PAIGE HERMAN and MARIE KUECHEL
newbeauty.com
Tuesday, May 15, 2007

Irregular pigment comes in many forms from sun-induced spots to hormonally caused melasma that manifests as dark splotches on the face. The key to treating these conditions is controlling the pigment-producing cells, but exfoliation treatments play a role in minimizing the appearance of existing pigment in the skin.

Topical lightening products

Over-the-counter and prescription lightening products are often the first step in treating pigment-related issues. Although controversial, hydroquinone continues to be one of the most popular active ingredients, but naturally derived azelaic and kojic acids can deliver results as well.

The key to achieving a good outcome is using the product on a consistent basis. Many prescription topical treatments such as Tri-Luma combine lightening agents (in this case, hydroquinone) with tretinoin to boost the skin's cell turnover rate. Tri-Luma also includes a steroid to minimize irritation. Dermatologists often prescribe Epiquin Micro as well, which contains 4 percent hydroquinone and retinol, which also reduces fine lines and wrinkles. Topical antioxidants such as vitamin E and vitamin C help protect against free radical damage, which also can exacerbate the appearance of pigment. Prescription topicals start at about $60.

Another treatment, the Cosmelan mask, combines in-office and at-home treatments and contains kojic and azelaic acids to inhibit tyrosinase, a basic enzyme that plays a role in melanin formation.

The first stage is performed in the office, where the skin will be cleansed and the yellow-colored mask is applied. Patients are then sent home and instructed to leave the mask on for four to eight hours. The second stage of the process involves applying another cream at home for the next few weeks. Safe for all skin types, this treatment has a high success rate and minimal side effects, which can include redness for the first few days and light flaking. Most patients see significant improvement just one week after beginning treatment. Starting at about $750.

Peels

Chemical exfoliation can also help improve the appearance of excess pigment by exfoliating the upper layers of the skin where some pigment resides. (As an added plus, you'll also see improvement in texture as well as fine lines!) Your dermatologist or plastic surgeon can recommend the best course of treatment based on your skin tone and specific pigment problem, but some dermatologists find that a series of two to six 30 percent to 70 percent glycolic acid peels coupled with Jessner's solution is especially beneficial for minimizing melasma. For optimal results, your dermatologist or plastic surgeon may also prescribe a retinoid or another peeling agent for at-home use between peels. Anyone with a darker skin tone may have a higher complication rate with these peels. If you have darker pigmented skin, make sure your doctor is experienced treating skin tones similar to yours. Starting at about $150 per treatment.

Light-based treatment

Freckles, sunspots and melasma all result from changes within the dermis of the skin -- melanocytes inject cells with pigment as the skin's own defense mechanism against sun and other aggressors. A series of fractional resurfacing, IPL, diode and even photomodulation treatments like GentleWaves can improve pigmentation disorders and, in some cases, clear them completely. With IPL or diode treatments, you feel a snap and some heat, and then you'll notice the pigment get much darker in the minutes or hours following treatment. That darkened pigment will flake away over the next week or more. It is important that you don't exfoliate aggressively or try to remove the flaking skin. It may take three or more treatments to clear the pigment. With photo modulation, improvement in pigmentation is gradual over the course of treatment and in the following weeks. Generally a twice-per-week, four-week course is recommended with bimonthly follow-up treatments to maintain your results. Fractional resurfacing will slowly break up the pigment and resurface your skin -- you may notice a fine flaking in the days following each treatment. Starting at about $200 per treatment, depending on the technology used and the size of the area treated

Sun protection is essential

While using any treatment for pigmentation disorders, diligent sun protection with an SPF of at least 30 every day is necessary for two reasons. First, sun exposure can trigger production of the pigment you are trying to eliminate, and second, chemical peels, topicals such as retinoids and light based treatments can all increase sun sensitivity.

Paige Herman and Marie Kuechel are editors of New Beauty, a semi-annual magazine about cosmetic enhancement. Reach them at editors (at)newbeauty.com. For more columns visit www.scrippsnews.com