treatment of pigmentation...

Discussion in 'Health Care' started by RedRose64, Dec 28, 2008.

  1. RedRose64

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    Co Admin

    Mar 15, 2007
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    Skin Pigmentation
    Patchy brown skin on the face and hands is a very common cause of concern as it has an aged appearance. There is a very strong desire in many to have their skin return to a smooth even toned complexion, unfortunately treatment often results in disappointment as the condition and the treatments are so poorly understood by the person affected.

    What causes pigmentation?

    There is often no single cause identified but a combination of causative factors can often be seen in someone that is genetically pre-disposed to pigment formation. Here is a list of some:

    Sun damage, acne, direct injuries, grazes, burns, anything that will cause inflamed skin, all these ‘injuries’ will heal but can leave the area suffering from a ‘post-inflammatory hyper-pigmentation’.

    Hormones and changes of hormone levels, eg. in pregnancy, hormones in medications, contraceptives, HRT.

    Certain medications such as tetracyline antibiotics, Valium, Dilantin, cosmetics with oxidised linoleic acid and salicylates, aging and free radicals from metabolism.

    Try and identify some of these causative factors in your own condition, not all are avoidable but if they are then prevention is the best medicine. The treatment of pigmentation can therefore be a tough problem because of the complicity of the factors listed.

    First and foremost you must remove provocative factors identified above. Then you must decide that you will not bake your face in the sun ever again. If you would like a tanned look, consider self-tanning lotions. Choose a cream, foundation or moisturiser with SPF 15+, which you must wear daily, even on overcast days. You must realise that there is no cure from your tendency to pigment but you can certainly treat the existing pigment and may remain free of it if you are committed to:

    Avoiding aggravating factors

    Hiding from the sun

    Wearing sunblock

    Next there are several ways to address the existing problem. Daily use of:

    Stimulant creams, eg. Glycolic acid, Tretinoic acid, Vitamin C, Azaelic acid


    Bleaching agents eg. tyroninase inhibitors Kojic acid, Hydroquinone

    can give excellent results. Combinations of these agents in the one compound cream work well, as long as they are prepared with adequate concentrations. The combination of Tretinoic acid and Hydroquinone appears to be very successful. However it can be irritating to the skin and it is more easily tolerated if combined with a small dose of hydrocortisone added in as in Kligmans’ formula. This formulation has a 3 month shelf life and is available only on a doctors’ prescription.

    Persistent compliance is required for optimal treatment, this is rarely achieved as results are not apparent for over six weeks and it is so easy to give up half way through. Beware of excessive and glossy advertising from large cosmetic houses in fashion magazines that promise results from creams with unproven tiny concentrations of active ingredients or worse still with unproven ingredients. Moving up the line some of our clinic procedures can often offer more definite improvement.

    Clinic procedures

    More invasive treatments done in the clinic can make for quicker results. The conservative approach of frequent mild treatments is often wiser than one strong treatment. The resulting inflammation from treatment may risk stimulation of more pigment production therefore best results are achieved when home care creams are used in combination with the clinic treatments.

    All over treatments to improve the whole tone of the skin affected include:
    Micro-dermabrasion, glycolic acid peels, TCA 10% peels, TCA 20 % peels, Jessners peels, or PCA peel (mixed Fruit acid, Citric acid, Lactic acid, Salicylic acid and Kojic acid).

    They can all be done as so-called ‘lunch-time peels’ on a 1-6 weekly basis. They have little recovery time and do not usually require any time off work.

    For the braver at heart or for those that have found the above frustratingly slow a TCA 35% peel is a medium peel and requires 7 –10 days down time.

    Treatment of pigment spots on the skin.
    TCA 35% applied with a cotton bud by an experienced practitioner can often produce excellent results. The spot will darken over a few days before gradually peeling leaving pinkness after 7 days. If looked after the pink area will gradually blend in with the surrounding skin tone over time. Often spots require 3 or more treatments before complete resolution.

    Laser treatments of pigmentation and age spots.

    Selective thermolysis of the unwanted pigment can be achieved by precisely applied beams of laser light of an appropriate wavelength and power. Our Medlite IV laser does an excellent job, ask for a further information leaflet about it. Similarly to the TCA burn it will look darker for the following week and may require repeat treatments.

    Fotofacialrf® is one of the very latest technologies. A little gentler than laser, it combines light energy and radio frequency energy to target brown pigmentation and red facial veins. Ask for more information on this procedure.

    Deeper peels or laser peels are not recommended for pigment problems on their own. It is not necessary to take the risk of deep peeling procedures when the methods described before will cure near 100% of problems.

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