Wide Range of Treatments for Hyperpigmentation
Hyperpigmentation is a change in skin color that may occur in spots, blotches or over a large area. It can be darkened skin, red blotches or any of the symptoms of sun damage following an active summer. Today’s dermatologists have a remarkable array of effective treatment options that range from specially formulated creams to the latest technology using lasers and other light-driven treatments.
A common instance of hyperpigmentation seen by dermatologists is known variously as melasma, chloasma or the dramatic term, “mask of pregnancy.” This last term is due to the fact that its onset is believed to be caused by female hormones, which can be present at increased levels due to pregnancy, oral contraceptives or hormone therapy used to treat menopause. The symptom is dark discoloration of a portion of the face due to repeated exposure to the sun.
Topical cream is one option; it is an important option for dark skinned patients who can suffer increased pigment damage from laser treatments. Creams such as Tri-Luma are a fraction of the cost of laser treatment and can be just as effective after several weeks of treatment. It is also worth noting that Tri-Luma is FDA approved for melasma treatment.
Patients who are reluctant to give up oral contraception or hormonal treatments may find their case of melasma to be resistant to topical treatment. One of the technologies applied in this instance or intense pulse light therapy (IPL). According to manufacturers IPL can correct a variety of skin conditions; as with most skin treatments the technology can be sometimes effective, sometimes not. For melasma patients whose skin remains discolored after the use of creams, there is also the option of a chemical peel. A ‘light peel’ is conducted with glycolic acid or with a low concentration of trichloroacetic acid (TCA).
Another common symptom of overexposure to the sun is the appearance of multiple lentigines, commonly known as liver spots. Patients with this condition may develop darkened hyperpigmentation over larger sun-exposed areas as well. For the treatment of a few scattered lentigines a common option is laser treatment on a spot basis. One treatment will produce brown crusty facial spots for about a week, but will produce 70% - 80% improvement in most patients.
The most common form of sun damage in fair skinned patients includes liver spots, a number of hyperpigmented patches, fine “telangiectasia” or spider veins - and varying degrees of wrinkles. For professionals with one or more of these conditions who cannot afford downtime, IPL can be applied in about five treatments separated by three week periods. The patient can return to work the day after treatment.
IPL is effective for hyperpigmentation but will not improve skin texture. For severe sun damage that has created pre-cancerous conditions, one dermatologist recommends IPL combined with photodynamic therapy (PDT) which utilizes a topical cream combined with blue light laser exposure. This treatment will result in a red, crusty facial area that lasts for a week or more; a successful result will be reduced hyperpigmentation and improved skin texture.
Fractional CO2-based lasers are the newest product for treating hyperpigmentation associated with sun damage. These systems utilize a series of microscopic laser spots closely interspaced, and leave undamaged skin untreated. The result is an improvement in hyperpigmentation and skin texture, along with a rapid recovery time, although swelling will persist for up to two weeks. The device can be set for depth of penetration and for percentage of coverage.
The number of options available to dermatologists for common hyperpigmentation cases make it possible for each treatment to be a customized combination of therapies. The deciding factors are the patient’s natural skin tone and the degree of sun damage.
