Treating Pigmentation

Hyperpigmentation is the development of abnormal dark pigment in the skin. Treatment using various skin care products and procedures has given our patients excellent results.
Melanin gives the skin its pigment and is produced by a type of skin cell called a melanocyte. If you have overactive melanocytes they will produce darker pigmented areas called hyperpigmentation. There are several types of hyperpigmentation that can occur, the common causes being: sun-related (such as freckles), pregnancy and hormone related (such as melasma), and medical problems (such as hyperpituitarism and Addison’s disease).
The primary reason for hyperpigmentation is that the melanocyte is over-producing pigment. The pigment production it can be arrested or inhibited with topically applied “bleaching creams”, and abnormal pigment that has already been produced can be removed with FotoFacial IPL and exfoliating peels.

Hyperpigmentation Treatment Options 

Superficial hyperpigmentation is treated with exfoliating home care products containing glycolic acid, microdermabrasion, esthetician applied acid peels, and intense pulsed light (FotoFacial). Please see our section on FotoFacial for more information on this superb technique.
Deeper, dermal hyperpigmentation is usually treated with “bleaching” creams in addition to exfoliating treatments. The best known “bleaching” agent that reduces hyperpigmentation is Hydroquinone, which inhibits enzymes that the cells use to produce melanin. While Hydroquinone is the most common treatment agent, Kojic acid is a close second, and several others can be used successfully in combination.
Hydroquinone is generally used alone (usually at 4% strength), but it is also being successfully combined with other agents such as tretinoin (Retin-A) and topical corticosteroids. Tretinoin is effective in regulating the epidermis because it helps the Hydroquinone penetrate better. Steroid is an anti-inflammatory; sometimes if you have inflammation it can cause hyperpigmentation. So with a steroid we can lessen inflammation and use the hydroquinone as a bleaching agent.
A agent gaining popularity is Kojic acid. This is especially beneficial for people who develop irritation from Hydroquinone. Kojic acid seems to affect hyperpigmentation along a different chemical pathway than hydroquinone. We often recommend that patients use one product in the morning and an different one at night, then in a couple of months switch the treatments around. We just cannot be sure how any individual will respond.
There are a number of other modalities that are effective at reducing hyperpigmentation, so working out the best regime for each individual patient comes with experience. For instance, lactic acid may help by increasing the exfoliation of the pigmented cells. We may add glycolic acid peels, and TCA peels. Liver spots or sun spots (which are localized oval shaped brown spots) respond well to FotoFacial (IPL). We usually treat the patient for a couple of months and then reevaluate.

All doctors unequivocally agree that if the patient wants to get good results with any of these agents, using a good sunscreen is mandatory. If the patient is not going to use a broad-spectrum sunscreen religiously, the patient shouldn’t bother using these agents. The main problem with bleaching creams, whether prescription or over the counter, is that they work as long as you are avoiding sunlight. You can use these creams for six to eight weeks and get a wonderful result, but short time in the sunlight may put you back where you started. Therefore, we spend a great deal of time helping the patient to avoid problems so they obtain the best, longest lasting improvement.