Thursday, April 16, 2015

How to get rid of the brown spots!

Sun damage and melasma are the #1 causes of hyperpigmenttion (brown spots) on the face, hands and other parts of the body. It is most bothersome however on the face and hands. So what exactly causes these dark areas?

Let's talk about melasma first. Melasma  is a common skin problem. It causes brown to gray-brown patches on the face. Most people get it on their cheeks, bridge of their nose, forehead, chin, and above their upper lip. It also can appear on other parts of the body. Women are far more likely than men to get melasma. It is so common during pregnancy that some people call it the mask of pregnancy. Hormones seem to trigger melasma, whether it is due to pregnancy, birth control pills or hormone replacement therapy in menopause.

Sun Damage

Sun Damage
The term sun damage is self explanatory, but what is the pathology behind the spots appearing in the first place? Repeated sun exposure with the all too common sunburn will go away, but the damage does not. To protect itself from the damaging effects of the sun, your skin increases its production of the dark brown pigment called melanin. The extra melanin makes your skin look darker or sun-tanned. In some cases, the sun causes an uneven increase in melanin production, which produces irregular coloring or pigmentation of the skin. The sun can also cause a permanent stretching (dilation) of small blood vessels, giving your skin a mottled, reddish appearance.

Makeup does a decent job of covering the brown spots/patches, but it's there when you go to the gym to work out, or go to the lake, and most importantly when you look in the mirror. Unfortunately, melasma and sun damage can be an ongoing battle and it takes more than one type of treatment to reduce or remove it, and conscious maintenance to keep it away.

The three things  I recommend most often are IPL, followed by a medical grade chemical peel, and maintenance with a 4% hydroquinone product plus tretinoin .05%.

Our Accelawave IPL (intense pulsed light) machine produces a bright beam of light which breaks up pigmented brown spots causing them to gently flake off over the course of treatment. The device also gently coagulates and removes blood vessels below the skin surface, without the bruising associated with other laser treatments. Photons stimulate new production of collagen from fibroblast cells for improvement in fine lines and skin tone. Depending on the severity of the melasma or sun damage you may need 3-6 treatments.

We frequently use the Perfect Derma medical grade facial peel following a series of IPL treatments. The Perfect Derma Peel is the only peel that contains Glutathione as an essential anti-aging component. The Perfect  Derma Peel works by repairing and nourishing the skin on a more superficial level than IPL. The Perfect Derma peel also contains trichloracetic acid (TCA), phenol, salicylic acids, vitamin C and retinol. This peel gives skin a radiant glow, refines pores, and lifts more superficial skin hyperpigmentations.

I have used Obagi C-clarifying serum for years. I put it on once a day, everyday without fail. The active ingredient is 4% hydroquinone. Hydroquinone works by decreasing the production and increasing the breakdown of melanosomes (melanin pigment granules) in the skin's pigment cells (melanocytes). It does this by inhibiting the activity of tyrosinase, the enzyme needed to make melanin. In most cases you'll see lightning of any residual brown spots within 4 weeks. I personally use it as maintenance. If you need a moisturizer, Obagi has a C-therapy night cream which I really like that also contains 4% hydroquinone . 

My favorite tretinoin product is Refissa. It comes in an emollient form, so you don't have all the flaking like you do with other tretinoin preparations. Tretinoin is derived from retinoic acid, which is the acid form of vitamin A. Refissa works by blocking production of melanin, the skin pigment. Tretinoin is quite potent so you may find you want to just spot treat the brown areas or use it on your whole face only 2-3 times per week. You must apply it at night, because it will make your skin sun sensitive.

Of course as the old saying goes, "an ounce of prevention is worth a pound of cure!" Broad spectrum sunscreen everyday that is reapplied when you are out in the sun for an extended period of time is an absolute must. It is important to prevent further damage and to help maintain a beautiful complexion. 

Call us today and we will get you started on the road to a more even, beautiful complexion and skin tone. You can avoid the downtime and expense of an aggressive laser treatment. 

Anne R Trussell MD

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