Hyperpigmentation Part III: 3 Dermatology Procedures That Eliminate Dark Spots
Jennifer Stieber Our last post (Hyperpigmentation Part II) focused on prescription creams that reduce dark spots. Although these creams are extremely effective, they do take months to see final results. To accelerate dark spot removal, we can turn to elective in-office procedures. Book Now 1.IPL IPL stands for Intense Pulsed Light. It is often referred to as a laser, which is a misnomer, since IPL uses bright flash lamps, rather than isolated beams of laser light. IPL is very effective at removing brown spots like freckles and sun spots, however it is not safe for anyone with tan skin because the device cannot differentiate between the melanin in a dark spot and the baseline melanin that makes up someone’s skin color. Due to this limitation, many offices have shied away from using IPL in recent years, or sold off their devices. 2. PEELS: Whereas topical therapies such as retinoid creams can be very slow-acting, chemical peels rapidly lift all types of hyperpigmentation in a matter of days, including freckles, sun spots, melasma, and post-inflammatory hyperpigmentation from acne scars. Chemical peels can also be tailored to be safe on all skin colors, and they can be used all over the body- including the chest, arms, legs, and back. Unlike IPL which is better for “spot treatments” and cannot evenly treat large areas of skin, chemical peels can be spread evenly over large stretches of skin. It is important to recognize, however, that the results of peels completely depend on the frequency and quality of topical skincare (See our past posts for more on this) used before and after treatment. If your provider does not have a thorough discussion with you about pre-care and after-care, this is probably a red-flag that they do not have a deep knowledge of how the peeling process works. Peels also have the added benefit of inducing the repair mechanisms of the epidermis and dermis, resulting in brighter, thicker, more overall glowing skin. Our favorite Peel is Revepeel because it is the safest for all skin colors. ViPeel is another effective, commonly used peel. 3. MICRONEEDLING. Although chemical peels and IPL have been in use for decades, only recently has microneedling been studied as a way to remove pigmentation. About 6 clinical studies since 2011 have shown the benefits of microneedling, and that these benefits are augmented when used in conjunction with excellent pre-care and after-care, or when alternated with chemical peels. In particular, microneedling is a very safe technique for dark skin types, where risk of side effects is very high with techniques that are light or laser-based. Some of the most commonly used microneedling devices include: MDPen, Skin Stylus, and Skin Pen. Book Now
Hyperpigmentation Part II: 3 Of The Best Prescription-Strength Treatment Creams According To A Nurse
1. HYDROQUINONE Hydroquinone is the gold standard for treating hyperpigmentation in dermatology. Its effectiveness and safety is so well-documented in clinical studies that almost all dermatology providers will recommend 4% hydroquinone as a first step for anyone with significant pigment concerns. This ingredient works by interrupting the same step of melanin synthesis that kojic acid and licorice extract do (2 ingredients mentioned in our previous blog post: Hyperpigmentation Part 1) however on a much more significant, medical-grade scale. It is important that anyone using hydroquinone consult regularly with a nurse practitioner or physician, because very rare cases of overuse or misuse have resulted in unsightly side effects. Oftentimes, your nurse practitioner will schedule you for a “hydroquinone vacation” during which you take time-off from using the drug. Book Now 2. RETINOIDS Retinoids like tretinoin, tazarotene, and adapalene, are powerful synthetic versions of retinol which is a naturally-occurring vitamin that plays a role in maintaining many organs in the human body, including the skin. Numerous clinical studies have shown that when applied to the skin, retinoids are very successful at reducing freckles and sun spots. The effectiveness of retinoids results from their ability to interrupt multiple steps of melanin production. Furthermore, retinoids are an excellent choice for treating hyperpigmentation because they increase skin cell turnover and shedding, allowing for greater penetration of other active melanin-suppressing ingredients like hydroquinone. Although there are a handful of FDA-approved retinoids on the market, the most studied and well-vetted of all is tretinoin, which is why it is the prescription retinoid cream of choice for many dermatology providers. Topical over-the-counter retinol is also effective, however these formulations are not as stable and have a short shelf-life. 3. TRI-LUMA Now that we’ve discussed retinoids and hydroquinone, this brings us to another favorite tool amongst dermatology providers, Tri-Luma, a combination cream of hydroquinone, tretinoin, plus a small dose of fluocinolone which is a steroid anti-inflammatory. As we mentioned above, retinoids like tretinoin have the ability to act as a penetration-enhancer, augmenting the effectiveness of hydroquinone. Although this combo is quite powerful, both tretinoin and hydroquinone have the undesirable side effects of redness, irritation, and dryness. This is why the added anti-inflammatory is important – it counters these unwanted side effects, increasing patient comfort and convenience. Even with the use of prescription-strength creams, improvements in pigmentation can take months, and not all pigmentation will always resolve. For more rapid improvement, in-office elective dermatology procedures are a wonderful supplement to any topical therapy. In fact, when high quality topicals are used in conjunction with procedures like chemical peels or microneedling (discussed in our next blog post Hyperpigmentation Part III), dramatic improvements in pigmentation can successfully be achieved. Book Now DISCLAIMER : THIS CONTENT IS FOR INFORMATIONAL PURPOSES ONLY AND IS SOLELY THE OPINION OF JENNIFER STIEBER, NP WHICH MAY DIFFER FROM THE OPINION OF OTHER HEALTHCARE PROFESSIONALS. IT SHOULD NOT BE USED AS A SUBSTITUTE FOR PROFSSIONAL DIAGNOSIS OR TREATMENT.
