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Skin Pigmentation

Author: Dr Naomi / 28 Oct 2015

Pigmentation means brown discolouration of the skin. It can take several main forms. I split it into these forms because each different form will be treated differently

  1. Freckles, brown sun damage, solar lentigos.
  2. Melasma /Chloasma
  3. Raised brown lesions
  4. PIH (Post inflammatory pigmentation)

There are multiple treatments for each type of pigmentation.

There are different types of skin pigmentation, having different causes and treatments. All are flat (not raised) and involve a darkening of the skin in an area.

  • Melasma
  • Chloasma: pigmentation related to hormones eg pregnancy or the contraceptive pill
  • Freckles
  • Solar lentigos: (senile freckles/ liver spots) dark lesions which are due to sun damage
  • PIH Post-Inflammatory Hyperpigmentation: which occurs after any treatment /injury to the skin which causes inflammation in skin that is predisposed (often in those with darker skin tones)

The type of pigmentation needs to be assessed and diagnosed by the doctor

There are multiple treatments for each type of pigmentation.

Freckles/brown sun damage /solar lentigos.

These are best treated with IPL or pigment laser.

Melasma /Chloasma

Before and after 3 months of topical lightening agents including hydroquinone

Before and after 3 months of topical lightening agents including hydroquinone

Pigmentation under eyes before and after lightening agent and treatment with BBL

Pigmentation under eyes before and after lightening agent and treatment with BBL

At Dr Naomi we have a specific regime for the treatment of  melasma

  1. Skin lightening agents: Including tretinoin/hydroquinone, kojic acid, vitamin C etc
  2. Regular exfoliation treatments:microdermabrasion and peels
  3. Skin needling with use of lightening agents
  4. Sonophoresis/iotophoresis with use of lightening agents
  5. Fractional laser and BBL

PIH (Post inflammatory pigmentation)

This can occur after any kind of inflammation of the skin in someone who is predisposed to it. Often those with darker skin tones, ie Fitzpatrick 3 and greater, will be more susceptible. causes of inflammation of the skin are vast eg waxing, laser, peels, IPL scratches, burns.

Prevention is better than cure, so patients with this predisposition to PIH should really be cautious with any beauty or cosmetic medical intervention, as PIH is always a risk,

Prevention of PIH

Those patients who have a history of, or are predisposed to PIH should have lightening agents prior to and after laser treatments. Also using a corticosteroid during the inflammatory phase of a procedure can be very helpful for prevention of this problem

Treatment of PIH

We use a program similar to our melasma protocol for treatment of PIH.

Raised Brown Lesions

To remove a raised lesion by laser, an ablative laser is required. We use an erbium laser.

Common raised brown lesions are  Seborrheoic Keratoses (old age/senile warts) and moles. If there is any sign that a pigmented lesion is dysplastic or a melanoma or skin cancer, then a sample of the lesion or the entire lesion needs to be examined. In this case we will send it for histology. Lesions which are suspicious are not suitable for laser.

Solar lentigos and freckles

Solar lentigos and freckles

Area of PIH (post inflammatory pigmentation after laser

Area of PIH (post inflammatory pigmentation after laser

freckles

freckles

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