PPP- Pigments, Pesky skin issues Plus more … PART 1

I hope the trinity series on ACNE was useful. 
Over these next 2 weeks, I will be sharing about PPP, Pigments, pores plus more… 
skin diagram
Today, I will discuss the biggest topic in Cosmetic Dermatology. And that would be pigments.
Under Pigments, I will discuss the common pigmentary woes affecting Asian skin.
Freckles
Melasma
Sunspots
Hori’s Nevus
PIH (Post inflammatory hyperpigmentation)
Pigments in the Asian Skin:
Dark spots, red spots, brown spots, blue spots, gray spots, what are they? I have had many patients asking me about those spots on their faces. So to help you learn more about your skin, and understand those spots you see when you look into the mirror, I have decided to walk you through some of the common pigmentary conditions.
Essentially, treatment consists of protection from the sun, lightening creams and a careful combination of medical peels, and lasers. 
LASERS
Pigment lasers- 2 main categories 
ND YAG 1064
Alexandrite laser
Your Laser specialist would be best able to explain the choice of lasers.
MEDICAL PEELS
A class of its own. In experienced hands, it can make a world of a difference. 
AHA – Glycolic. Lactic, Mandelic
BHA – Salicylic for those of you with acne prone skin
TCA – A stronger, deeper peel
Jessner – A nice peel that neutralises on its own
Cosmelan – Effective for certain subtypes of melasma
To learn more about medical peels visually, please click on the following youtube link. DRDANIELCHANG/MEDICALPEEL
Common myths:
I have thin skin so I cannot do lasers or medical peels. -> NOT TRUE
My facial therapist says lasers and peels can thin my skin. -> NOT TRUE
Lasers and peels can cause my dry skin to worsen. -> CASE BY CASE BASIS
Allow me to first start with freckles, those brown spots that you get for working out in the sun since your schooldays.
Freckles: 
What are they?
– Freckles are spots which commonly appear with sun exposure and are found on the cheeks and nose. They increase with age and darken with sun exposure. They lighten with sun protection.
How can we treat it? 
– In my opinion, treatment includes strictly avoiding the sun, using sun protection, using skin lightening cream and laser
therapy.Here is an example of freckles.
freckles  images2 
FRECKLES
=======================================================================
Melasma. 
So what causes Melasma?
-Melasma is very common with the Asian skin. It is multifactorial, with a strong genetic and hormonal component. It is worsened with sun exposure, OCPs and pregnancy. It tends to be distributed either over the cheeks or a central distribution from the forehead down to the chin.
How can we treat it? 
-There are many treatment regimens for melasma. Personally, I would suggest an advanced treatment which consists of priming the skin with lightening agents for a month, +/- oral medication followed by careful chemical peels and lasers.
melasmaBefore-After-Photos-Melasma-with-Laser-IPL-Damage
MELASMA
============================================================================
Solar Lentigines/ Age spots
What are they? – These are discrete lesions which progress with age. Prevention is the key with sun protection and sun avoidance.
How can we treat it? – They may be lightened with bleaching creams and pigment lasers. (sunspots, solar lentigo)
solar lentigofreckles
Solar lentigo 
=============================================================================
Hori’s Nevus
What are they?This is a pigmentary condition characterized by multiple dark blue gray spots, commonly found bilaterally in the cheeks. They darken with sun exposure and childbirth.
How can we treat it? IMHO, they can be lightened with a careful combination of sun avoidance, skincare and lasers.
abnomFig3a
HORI’S NEVUS
=================================================================
Cafe Au lait spots
These are light brown macules that can be found over jawline, neck, face. 
Effectively treated with pigment lasers, but they can recur.
download (1)
Post inflammatory Hyperpigmentation
As the name suggests, these are pigmentation that form after an injury, be it picking a pimple, derma-roller performed on a skin, injury to the face etc… It can happen anywhere. Treatment entails careful use of laser toning with lightening agents and strict sun protection. They take 3 months to improve. 

skin-perfect-brothers-walnut-acne

(courtesy of skinperfectbrothers.com)

PIH – This can happen anywhere on the body

download (2)images

PIH – What is it?

It is an area of localised hyperpigmentation, as a result of damage to the skin. It can range from light brown to black. It is temporary.

How can we treat it?

  1. Sun block
  2. Exfoliation
  3. Antioxidant

What are the causes?

  1. Sun
  2. Injury. This can be as a result of over zealous chemical peel, laser, or other energy based devices.
  3. Heat

So I hope this issue on pigments has been useful. Remember, stay skin smart. Avoid the sun. And saw goodbye to ugly brown spots.

DR DANIEL CHANG

 

 

 

img_20160730_194250.jpg

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Categories Skincare and Aesthetic Medicine

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