Hyperpigmentation – Brown Spots

By Tom Haas, MD, FACS, MBA

            One of the most distressing skin problems facing women today is skin discoloration or uneven skin tone.  These brown splotches or spots are most frequently a result of sun exposure or hormones and can affect women of all ages and race.

Skin gets its color from melanin, a pigment your body produces naturally.  An over-production of melanin in certain areas shows up as brown patches or spots most likely on the face, neck, upper chest, hands, arms and legs.

Causes 

            There are 3 main reasons your skin becomes overly-pigmented the most common being sun-exposure.  Your skin will produce melanin to protect from the sun’s harmful UV rays, the result is a tan.  When over-exposure occurs, sun-damage is the result often appearing as brown spots medically referred to as lentigos but sometimes called “age spots” or “liver spots.”  This exposure is cumulative and not directly related to a sunburn on a particular day.  Once this over-production of melanin has started it is difficult to stop without medical intervention.

The second most common form of hyperpigmentation is due to hormones often referred to as melasma or chloasma.  Hormone shifts or changes contribute to the production of the melanin.  This is the result of pregnancy, oral contraceptives, or various stages of menopause.  Pregnancy for example can trigger an over-production of melanin resulting in the “mask of pregnancy” on the face.  It is important not to directly expose yourself to the sun while taking hormones, as this could make it worse.

The third most common form of hyperpigmentation is from injury (termed Post-Inflammatory Hyperpigmentation) to the skin including surgeries, cuts or abrasions.  Skin diseases such as acne may leave dark spots once the condition is cleared.  Hair waxing and improperly performed laser treatments can also contribute.

Prevention

            It is sometimes hard to prevent hyperpigmentation problems, hormonal shifts are unpredictable and accidental injuries are out of your control.  But, the most important preventative measure is sun-protection. By using a broad-spectrum sunscreen like SkinCeuticals Ultimate UV Defense SPF 30 you can help prevent further UVA/UVB damage.  In addition, carefully select medical advisors and staff when pursuing treatments involving lasers, lights, chemical peels, or manual exfoliations.

Treatments 

            Intense Pulsed Light (IPL) has become very popular in the past several years.  IPL, often referred to as Photofacial or Photo laser, uses a medically-selected light in specific wavelengths to rejuvenate the look of your skin.  It can actually repair a great deal of sun-damage with no downtime and minimal pain.  It is approved by the FDA in theUSAto treat age and sun damage, birth marks, pigmentation and blemishes, fine lines and wrinkles, acne, scars, open pores, and rosacea.  The controlled flashes of light are absorbed by the brown spots creating a heat that eventually breaks up the accumulated melanin.  The brown spots will then slough off after a couple days.  Three to five treatments are typical spaced four weeks apart.  It is important to understand not all hyper-pigmentation can be completely removed.  Sometimes the best result is a “blending” of the affected area which appears as an overall improvement.

Topical cosmeceuticals can also contribute to an even skin tone and diminish discoloration considerably.  Natural active ingredients such as Kojic Acid and Arbutin work synergistically to help break up hyperpigmentation as found in SkinCeuticals Phyto+.  Another popular topical agent is hydroquinone, a skin lightener, which decreases the production of melanin in the skin.

Lastly, chemical peels with Hydroxy acids and manual exfoliations such as microdermabrasion help exfoliate of the top layer of the skin contributing to more even texture, tone and youthful glow.

It is important to remember, sunscreen should be worn daily under make-up and especially during any ongoing medical treatments or programs for hyperpigmentation.

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Tom Haas, MD, FACS, MBA,  has been in practice for 14 years specializing in cosmetic plastic surgery. IMAAGE, a state-of-the-art plastic surgery and medical-spa facility opened in late summer. For more information: www.myimaage.com

 

 

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