Pigmentation problems are common in NZ because of our very high UV exposure.
The most common pigmentation problems are brown sun spots, melasma, age spots, seborrhoiec keratosis and pigmented birth marks. Pigmentation issues very depending on the natural colour of the skin. Treatments include fade creams, IPL, Elos Aurora, laser treatments like Fraxel Dual and in some cases biopsy or skin excision is required to exclude skin cancer such as melanoma.
Brown Sun Spots
Many people have mottled brown spots, freckles and patches on their skin due to excess pigmentation.
These are easily treated with medical grade Elos IPL or Fraxel Dual laser.. There are a range of different causes of pigmentation. Treatments differ depending on what type of pigmentation is affecting your skin. The brown pigmentation is called melanin and is made by special cells in the skin called melanocytes. The main categories of pigmentation problem are freckles, age spots, (also called liver spots or sun spots) melasma and postinflammatory hyperpigmentation. A doctor at Palm Clinic can tell you what type of pigmentation you have. You may have a combination of pigment problems.
Post Inflammatory Hyperpigmentation
Post inflammatory hyperpigmentation (PIH) occurs after injury to the skin from whatever cause and is far more prevalent in darker skin types such as Maori, Indian, Asian and Pacific Islanders. PIH appears as a dark brown area over the area of previous injury and is due to excess melanin being produced by melanocytes as a result of the inflammation. Typically PIH resolves over several months but can persist for 1-2 years and in some cases can be permanent. Treatment is generally patience as it will resolve and treatments risk further inflammation and therefore further PIH. However hydroxyquinone can be useful in some patients and others benefit from mild treatments of Elos Aurora, IPL or Fraxel Dual laser.
Freckles are small flat brown marks on sun exposed areas.
The medical term is ‘ephilide’ and they are an accumulation of melanin in the surface skin cells (keratinocytes). The tendency to form freckles is inherited and is often seen in red heads and younger people. Freckles usually fade in winter and reappear in summer. They need no treatment except sun protection. They can also be faded by Elos IPL, but will reappear with sun exposure. No treatment can transform a skin which freckles, into one which tans evenly. Of course, further sun exposure can bring the freckles out again so it is very important to apply a good sunscreen following treatment to maximise results.
Before and After Photos of Freckle Treatment with Elos IPL
Other Types of Pigmentation
Age spots are larger flat skin spots on the face and hands that appear in middle age after years of sun exposure. The medical term is ‘solar lentigo’ (plural: lentigines). They are caused by an accumulation of the cells that make pigment and fade but don’t disappear in winter.
If the brown marks are scaly, they may be solar keratoses (pre-cancerous sun damage) or seborrheic keratoses (senile warts). It is also important to distinguish them from early malignant melanoma (lentigo maligna). If the spot has appeared recently, has an irregular border, has more than one colour or you have any doubts see your dermatologist for a check.
Sun spots should always be protected from the sun. They can be faded with creams containing hydroquinone, alpha-hydroxy acids, retinoids and vitamin C. Stronger, quicker options to fade or remove spots are liquid nitrogen, chemical peels, dermal rolling and many lasers.
Freckles on the decolletage area of the chest are easily removed with Elos IPL.
Palm Clinic’s best option for treating age spots or freckles is Elos IPL which reduces the top layers of pigment, fading the brown spot without reducing the number of melanocytes. Good sun protection is essential after treatment to prevent brown spots darkening again. These lasers also reduce red veins and promote natural collagen formation.
Alternatively the revolutionary new Fraxel Dual laser which partially resurfaces the skin can also be used to remove brown spots. The melanocyte population is reduced making the brown spots less likely to recur. Fine lines and skin texture are significantly smoothed at the same time improving the overall appearance of the skin.
Melasma is blotchy areas of brown skin pigmentation on the face.
Melasma, (also known as chloasma), appears as blotchy pale brownish pigmentation on the face, especially forehead, cheek and upper lip. It is more common on darker skin types. It is especially common in women aged 20-40 and is associated with pregnancy or taking the contraceptive pill or injection. It also happens in healthy, non pregnant woman taking no medications and men using aftershave.
Sun exposure following some cosmetics can cause a phototoxic reaction where the chemical substance absorbs UV light. The resulting pigmentation extends where sun and cosmetic use have coincided, for example down the neck, often more on the right side in countries that drive on the left.
Melasma is more stubborn and unpredictable to treat than freckles or age spots because the melanocytes have become sensitized and continue to produce extra pigment with even the slightest hint of sun. Sun protection is an essential part of treatment.
Consider stopping hormonal medications although it may be many months before any benefit from this becomes apparent. Fading creams containing hydroquinone, alpha-hydroxy acids, retinoids or Vitamin C inhibit new pigment formation. Cosmetic camouflage using special make up is another approach. It is important that you see an experienced doctor bfore embarking on any treatment as melasma is a particularly difficult condition to treat and is often misdiagnosed by beauty therapists who sometimes treat melasma with skin treatments or IPL that may make the condition worse.
Fraxel laser has been touted as the best available laser for treating melasma. This is a laser which improves melasma by fractional resurfacing of the skin. This decreases the melanocyte population so less melanin is produced. Fraxel is the first laser to be approved by the American FDA for melasma and is cleared for use on Asian, Polynesian, Maori and European skin. It is Palm Clinics experience however, after many years of treating melasma with Fraxel, that the results are unpredictable and in some situations can make melasma worse. For that reason we no longer use our Fraxel laser for melasma. We now treat melasma more conservatively with home care products including fade creams and Vitamin C and Vitamin A peels.
Frequently Asked Questions About Melasma
What Causes Melasma?
There is a genetic predisposition to melasma but triggers may include:
- Hormonal contraceptive including the oral contraceptive pill and injected progesterone.
- Sun exposure
- Antibiotics and many other medications wich are photosensitising (including those commonly prescribed for acne).
- A phototoxic reaction to scented or deodorant soaps, toiletries and cosmetics.
- Pregnancy from hormonal change - often fades a year later but can persist.
- Unknown factors
Melasma usually affects women; only 1 in 20 affected are male. It generally starts from the age of 30. Melasma is more common in people that tan easily or have naturally darker skin.
What Areas are affected by Melasma?
What is the best treatment for Melasma?
We recommend an initial consultation with one of the doctors at Palm Clinic who will diagnose your condition and exclude the possibility of a skin cancer or suspicious mole within the area to be treated. We will try and determine the cause although this is often not possible. Once exacerbating factors are eliminated we will recommend complete sun avoidance, home products, vitamin A peels and possibly dermastamping.
Melasma is an extremely difficult condition to treat and we cannot guarantee a specific outcome. We have many patients with excellent results but there have been a few in which the melasma has worsened after treatment due to post inflammatory hyperpigmentation (PIH). If this occurs the PIH typically resolves over a few months.
Is IPL used for Melasma?
Seborrhoeic keratosis is often referred to as a senile wart. These skin growths can appear anywhere on the body but are most common on the trunk and in areas where there is skin friction such as under the breasts and in the armpits.
Seborrhoeic keratosis is easy to treat as although they are generally raised above the skin surface they do not penetrate deep into the skin. At Palm Clinic we use a procedure called Surgitron which uses radiofrequency to shave the growth off the skin leaving a grazed area the size of the growth which typically heals without a scar. An alternative treatment is liquid nitrogen but this is more likely to leave a white scar.
Seborrhoeic keratosis is always benign and never turns into skin cancer but we would perform a biopsy if there was any doubt about the diagnosis.