Treatments For Hyperpigmentations
Clear, even-toned skin is the envy of us all -- if
you are fortunate to have it you may have received compliments
about your porcelain skin. However, since you rereading
this page, you probably do have skin tone unevenness or darkened
patches. Well, there is no reason to worry, there are treatments in
many hyperpigmentation cases.
Only a qualified Plastic Surgeon or
Dermatologist (and even an aesthetician in some cases) can determine your
needs and prescribe treatment plan which best fits your face. In
this section, we will cover the causes and treatment options for treating
What Is Hyperpigmentation
treatments are used to eradicate darkened areas of the skin which may result
from hormones, sun damage, injuries, skin-type characteristics, medications
and more. Hyperpigmentation lesions can be anything from
melasma/cholasma often attributed to pregnancy or hormonal imbalances to
The treatments vary from
melanin blocking agents combined with topical medications such as Retin
A which causes the body to exfoliate the skin to rid the body of the
hyperpigmentation while prohibiting new melanin production to laser
treatments. The treatments wholly depend upon your needs and skin
type. Some treatments can actually cause hypo- (lack of)
and hyperpigmentation problems in some individuals. Care must be
taken in proper diagnosis for a successful result.
Are You a
Candidate for Hyperpigmentation Removal?
entirely depends upon the cause of hyperpigmentation and the treatment
which is suited to your needs and skin type. Some you very well
may be able to handle, some you may not be a candidate for. The
first step is consulting with a qualified surgeon or dermatologist to
determine the cause and then go over your options for a solution.
For instance, you may be a candidate for hydroquinone use in
hyperpigmentations but not laser resurfacing. Some may only need
medication cessation or substitution.
This is really important
as not all skin types and individuals will be a candidate for every
technique or treatment. This largely depends upon your skin type,
wound type response and the presence of ethnicity in your family history
(keloids and hypo- or hyperpigmentations can form in darker skinned
especially for surgical applications -- an individual must be in good
health, not have any active diseases or pre-existing medical conditions
and must have realistic expectations of the outcome of your treatment.
Communication is crucial in reaching one's goals. You must be able to
voice your desires to your physician if he/she is to understand what
your desired results are. Discuss you goals with your physician so
that you may reach an understanding with what can realistically be
You must be
mentally and emotionally stable to undergo an cosmetic procedure or
treatment. Some of these treatments will require patience and stability
in dealing with the healing period. There is sometimes a lull or
depression after surgery or during prolonged treatments and if there is
already a pre-existing emotional problem, this low period can develop
into a more serious issue. Please consider this before committing to a
procedure. If the above describes you
and you have the desire
to rid yourself of hyperpigmentations, you may be a good candidate for
Your Options for
the cause there are several options. Some consist only of creams
or changes of your skin care routine or sunbathing habits -- some even
substituting or changing brands of hormonal supplements or birth control
For standard non-hormone induced hyperpigmentations Hydroquinone
usually reduces or removes hyperpigmentations very effectively.
For the person who do not wish to have expensive or invasive procedures
or only has slight hyperpigmentations - hydroquinone can be a good
option. However, these products may not be suitable for your needs
and they will also take longer than some treatment options.
Hydroquinone is a melanin blocker. You may have heard it call d skin bleach but in actuality it prohibits new melanin
production as your body goes through natural or chemical-assisted
exfoliation. These products can be obtained over the counter in
weak strengths or by prescription for your plastic surgeon or
dermatologist. Some formulations are even available on the Internet.
Formulations of 4% used
to be thought to be the best as irritation would erupt in higher
strengths. This has been proven although strengths up to 10% are
routinely formulated for patients. However it must be noted that higher strengths
of Hydroquinone have caused hydroquinone-induced ochronosis
(black speckling in the dermis) in patients with darker skins. And
have even been banned in parts of Europe and all throughout Asia due to
the belief that higher concentrations are carcinogenic.
Hydroquinone is used by
itself, it can be mixed with others such as...
- azelaic acid
- kojic acid
- licorice extract
Lustra Bleach (brand
name, BLEACHING agent): (Medicus) 4% Hydroquinone, 4% Glycolic and
emollient. It is richer and is less reactive and drying. It is used as
Kojic Acid is
available over the counter in weaker strengths, from your aesthetician
or through your physician - it is a natural agent capable of
blocking melanin production without the stigma of Hydroquinone use.
They are either made from one or two sources (or a combination of both):
ester of kojic acid from certain Japanese mushrooms or
asafetida extract [also known as Asafoetida, Devil's dung,
giant fennel and gum asafetida, (Ferula assa-foetida syn
F. foetida)] which is native to Afghanistan.
The peels one can get at an
esthetician/aesthetician/facialist ofice can be considered rather mild to
slightly invasive. Alternatively, you may visit a dermatologist and they have access to strengths that are much more
penetrating - we will cover these as well. These aren't exactly peels per se, but cause a reaction in your skin that makes you peel
a few days later on your own. They increase cell turnover rate and thicken the
dermis as well as correct hyperpigmentation or t exture problems. Of course the
amount of improvement depends on the strength or number of treatments you have.
The ones that you can get in a spa by a facialist are
that strong. However, some aestheticians are offering strengths which should
only be offered by a Dermatologist or physician.
- Alpha Hydroxy Acids (AHA):
Water soluble, these products such as 8% Glycolic acid cream can help remove
hyperpigmentations and help with photo damage, thickening of the dermal collagen
and increase cellular turnover. It shows the same type of improvements in other
treatments but offer no neoangiogenesis (blood vessel formation) so that
telangiectasias are not increased or inflamed. Includes Lactic Acids.
concentrations work better, of course. Low PH causes irritation, irritation
represents stimulus BUT one needs to change strengths. You must determine if
your physician knows the difference about high concentration, high free acid
concentration and low ph - irritation is symptomatic of it working. Although
extreme irritation should be avoided.
- BetaHydroxy Acids (BHA):
(Salicylic Acids are most common); lipid soluble. It is an exfoliant, an anti-inflammatory
(acetylsalicylic acid - aspirin family), a comedolytic (de-clogging agent
for pores). It is in many products. There are BHAs in Oil of Olay's Age Defying
Series, Pond's Prevent/Correct Neutrogena has products with BHA's and are
recommend by Dermatologists. They are not particularly known for removing
hyperpigmentations but does increase the rate of exfoliation which
increases the chance of removal as long as a melanin blocking agent
is used in persons who are prone to re-pigmentation of the treatment
- Topical Vitamin A:
(Retinyl Palmitate) Such as Retinol Products but specifically Vitamin A in OTC
(over the counter) creams/lotions such as the popular "night
creams" may contain.
These are more expensive but more effective. Some can be found on the Internet,
others you simply must get from your surgeon or dermatologist.
- Kinerase (N6-Furfuryladenine 0.1%)
or KINN-er-ace): "Scientifically Proven Results: In clinical studies conducted by a dermatology department at the University of California, Irvine, Kinerase™ was shown to help improve the signs of
photoaging. After 24 weeks of treatment, physicians saw improvement in 100% of Kinerase™ patients. Improvement was seen in roughness, blotchiness, and fine wrinkles.
Kinerase™ is not an Acid and Won’t Burn Like One: Unlike many other skin care products, Kinerase™ is non-acidic and won't burn or irritate your skin. In fact, patients using Kinerase™ in clinical studies experienced virtually no side effects."
Click Here to visit the Kinerase Site - ICN Pharmaceuticals, Inc.
Above information was taken from The ICN Pharmaceuticals, Inc. site and all restrictions of the use of this information, in any form, applies.
This product can remove freckles and other hyperpigmentations but only
- Retinol: (aka baby Retin A) Medicus:
Affirm is one brand, in 3 strengths,
1X 2X and 3X. This are less irritating but still stronger than OTC Retinol formulas.
These products cause exfoliation (peeling)
- Retin A: also
known as Tretinoin. It is the only FDA approved photo damage treatment lotion/cream.
Retin A is a very strong brand, Retin A Micro time released, whereas the Renova is the emollient based and can
be too heavy for some and cause break outs.
- Renova: Vitamin A
Aldehyde. This product is Tretinoin 0.05% in an emollient based cream and
not as harsh as the Retin A. Hence, less effective than Retin A, more effective
than Retinol. The product gets converted into a small amount of Retin A.
- Retin A Micro: 0.1% Tretinoin in microsphere form. It is a strong drug BUT in time release
formula so less irritation is seen than in the standard Retin A. Many patients
use Tretinoin with the Obagi NuDerm system.
- Avita: (brand)
Tretinoin in a less irritating formula.
- Refinity Peel:
15% lactic acid (AHA) product with cosmederm- 7 and a
70% glycolic peel with .06 pH and cosmederm-7. This product
increases the cellular turnover rate, helps with hyperpigmentation
and corrects skin mottling. Irritation can be moderate -
individualistic. (by Collagen Corp)
- Beta-Lift by
B-Lift X (salicylic acid peel). May cause exfoliation , peeling
skin, slight pinkness for a few days. Medicus markets a peel per
pack kit, that includes enough product for 1 peel with complete
instructions for both patient and physician.
Light: For increased effectiveness, these products are frequently
used before and after Laser surgery or dermabrasion or Intense Pulsed
Light (IPL) treatments. Especially in ethnic patients or persons with
darker skin tones (significant melanin presence). Usually,
standard hyperpigmentations (even freckles) and sun damage can be
removed with Intense Pulsed Light without the use of hydroquinone or peels. You may have heard of PhotoDerm or
FotoFacial/PhotoFacial; these machines produce intense of flashes of
light capable or removing pigmented areas effectively. Please see
our Intense Pulse Light Section
for more information.
Sometimes actual removal is needed via laser peels. These
treatments evaporate the first few layers (or even deeper) of damaged or
pigmented skin to reveal fresh, even toned skin. Many patients are
required to use hydroquinone or Kojic acid before these treatments to prohibit
excessive hyperpigmentations post-treatment. Please
see our Laser Resurfacing &
Treatment Section for more information.
Physician Strength Chemical
Hyperpigmentations can be removed with in-office chemical peels, or with a
series of peels. Please
see our Chemical Peel Section for more information.
Microdermabrasion is a mini
procedure that involves the skin being sandblasted by aluminum oxide
crystals, vitamin C crystals and other types of mild abrasives to remove the horny
(top) layer of the skin; dead skin cells.
process promotes the production of new cells in the basal (deepest) layer of the
dermis. A series
of microdermabrasion treatments
lessen the look hyperpigmentations in some patients.
see our Microdermabrasion Section for more information.
What to Expect
at Your Consultation
checking a few surgeons' backgrounds and credentials, you will make an
appointment for a consultation. You will meet with these surgeons/dermatologists/aestheticians
discuss your goals and you will disclose all information regarding your
health; if you smoke, what medications or vitamins you presently take,
etc, this is very important. You really should consider
smoking cessation as this can significantly decrease healing for more invasive
the Medication & Supplements List
for more information.
You will discuss your
complaints and concerns and discuss the various techniques,
the amount that can be corrected, etc. He or she should discuss
the risks associated with hyperpigmentation removal procedures with
you, as well.
If you would
like more information on Consultations or a list of questions to ask
your surgeon please visit the Consultation
Help Page. If you should choose to book or reserve a surgery
date for a more invasive treatment you will usually give a deposit to hold your surgery date.
times if you cancel a few days beforehand, this amount is
non-refundable. After paying your deposit and scheduling a surgery date,
you will also schedule a pre-operative appointment...
appointment addresses more questions you may not have thought to ask at
the initial consultation, such as more surgical details, concerns and
even ascertaining that your surgeon is aware of what you desire from
your procedure. Just as your surgeon will make certain that you
know what it realistically possible from this procedure.
also discuss your pre-treatment instructions and speak about the
recovery period instructions and what to expect in the months ahead.
For less invasive means you may be briefed at your initial consultation.
For surgical procedures, you
may be given prescriptions for antibiotics, pain relievers, perhaps
blood pressure medicines, prescription anti-inflammatory drugs and
perhaps a box or directions for gaining a box of Arnica montana.
to know more on the benefits of Arnica
montana? Perhaps you will be instructed to obtain Bromelain
or other types of remedies, although many surgeons would rather have you
not take ANYTHING other than your prescription medications, please do
not go against your surgeon's wishes. Remember, always ask your doctor
before taking any of these products.
not hesitate to address any concerns that you may have during this time
and even after your pre-operative appointment. If you remember something
when you get home or the next day or even the day of surgery - don't be
afraid to ask.
for Your Treatment
You should be
given a pre-operative information packet that explains everything you
should do and know before your treatment date. If you are
having Laser please see our section on Laser
Resurfacing & Treatment Preparation. If you are having Intense
Pulsed Light treatments, please see that section for preparation
information. For Chemical Peels,
please see its respective section. For Microdermabrasion,
Depending upon the procedure the pigmentation
irregularity may be removed either all at once or gradually by either, manual or
chemical-induced exfoliation, laser or Intense pulsed Light treatment or other means.
Please discuss this with your physician and see the appropriate pages in this
website for procedure-specific details.
The Road to
The recovery period varies significantly and is
highly dependent upon the treatment chosen. Please see the appropriate
procedure section for detailed information regarding its recovery period as well
as discuss this with your physician.
experience a lull or down period where they become depressed
or feel unattractive. This is very normal. Please print out our Emotional
Preparation Sheet so that you will be able to remind yourself
that you will get through your low period.
& Complications of Hyperpigmentation
The risks, complications & contraindications
vary significantly and is highly dependent upon the treatment
For Chemical Peels:
have oral herpes. You MUST gain the approval of your primary physician and
seek a prescription for oral acyclovir -- one brand name is Zovirax®.
This is very important! Zovirax® can significantly decrease your chances
of a break out. If you have a break out during your healing period, it can
spread to your entire face and result in severe and permanent scarring.
Be careful of crusting or
excessive weeping. In AHA peels you may think this is normal but there is
a borderline appearances that you must watch out for. Ask your skin care
specialist for specifics regarding what to look for. If for a typical AHA
peel, you should feel and look normal within 3 to 4 days. For deeper peels
your downtime may take weeks and then months for complete recovery.
If you experience painful areas of the face, contact your surgeon or skin care
specialist immediately. ESPECIALLY if you are prone to cold sores.
Blisters that form will need to be reported immediately!
coloration) and hypopigmentation (lack of pigmentation) can be problematic of
misdiagnosed skin types, failure to reveal any skin problems or ethnicity and
improper post-peel care. Infection is uncommon but possible so keep an eye
out for redness and pain.
Scarring is a problem if the
above is experienced so please adhere to your post-peel instructions to decrease
your chances of long term or permanent, visible signs of damage.
For Laser Resurfacing:
There are minor risks and
complications involved with Laser Skin Resurfacing which include but are not
limited to prolonged hyperpigmentation. In 5 to 10% of patients, darkening or brown
discoloration will occur requiring bleaching creams. This will generally
resolved the discoloration in 2 to 3 months. Prolonged redness occurs in 3 to 5% of
patients and this delays the fading to normal color by about 2 months.
There may be more
intense burns associated with laser resurfacing. Take care in choosing your
surgeon wisely. A specialist should be sought as the surgeon who is not
experienced with the technique and light touch could very well burn
you rather deeply, making matters worse.
If you have oral
herpes. You MUST gain the approval of your primary physician and seek a
prescription for oral acyclovir - one brand name is Zovirax®. This
is very important! Zovirax® can significantly decrease your chances of a
break out. If you have a break out during your healing period, it can
spread to your entire face and result in severe and permanent scarring.
Patients with olive
skin, brown skin or black skin (ethnic skin tones) may be at risk for
pigmentation changes (hypo-/hyper- pigmentation) no matter what type of
resurfacing method is recommended. Your surgeon should evaluate your skin
characteristics and family history before making any diagnosis for treatment.
*Warning: Patients having used Accutane in the past 12 to 18 months, those who are
prone to abnormal scarring or Keloids and those with frequent skin
eruptions such as psoriasis, eczema and herpes may not be good candidates for
Laser Skin Resurfacing. Consult with your doctor for more on this subject.
Intense Pulsed Light:
Although rare, blistering
or slight bleeding is possible as is hypo- or hyper-pigmentation
(lightened or darkened areas of skin). If pigmentation problems occur, it may be
anywhere from 3 to 12 months before normal skin tome returns. This is especially so
with hypo-pigmentation (lack of color). Be aware that some patients may
experience permanent skin pigmentation changes. Scarring is possible although it
too is a rare occurrence.
There are not many risks
associated with microdermabrasion if you are a healthy adult, but
enough to mention for those of you with skin or medical conditions.
medical grade machines are used at high power it carries potential risks of
hyperpigmentation, perforation, bleeding, and infection. Infection can also be a
risk if the machines are not sterile.
Many components of these machines are
meant to be sterilized, autoclaved or changed out with a new disposable piece.
Any and all pieces that come into contact with your skin should be able to be
sterilized or changed out.
Furthermore, it was brought up by a doctor in an
article on Medscape, that there could be possible harm from the inhalation of
the aluminum in the Al2O3 crystals, also known as Corundum.
*Also, you should
NOT have a microdermabrasion treatment on the affected area if you have the
- Undiagnosed lesions
- Recent herpes outbreaks
- Active, weeping acne (stages
- Active Rosacea
- Unstable diabetes
- Auto-immune system disorders
- Some patients hyperpigment
post-op. Lower pressures are used on follow-up treatments for these
*source for the
immediate above, Medscape Medical Journal (1999)
For Melanin Blocking-type
Risks can be irritation, permanent hypopigmentation, increased
hyperpigmentations if you do not use sun block during this time. Ochronosis (black speckles or discolorations) if high strengths are used for
long periods of time - especially in patients with
ethnic backgrounds, or naturally darker skin.
Tri-Luma For Melasma
Obagi For Better Skin
Retin A Micro
Intense Pulsed Light Therapy (PhotoDerm,
PhotoFacial, FotoFacial, EpiLight)
Chemical Peel Information (Phenol, Jessner, Blue Peel, Retin A)
Our YTF! Beauty Report Discussion Forum!
model: Treisha Hagensieker
Burns & Their
treatment - Yale Medical University Core
Merriam-Webster Medical Dictionary
Melanin Blocking Agents & their Chemical Structures - lecture, K. Alpert et
and/or treatment by: