24 Sep 2019 Peel it off
Now that all those beautiful long summer days spent outside are winding down, do you notice your skin isn’t holding that beautiful glow? Summer sun, saltwater, chlorine, sand and wind can all lead to dull, splotchy and discolored skin.
All that fun in the sun may be starting to show up on your skin now. These are the not-so-nice reminders of a long summer of sun called freckles, sunspots, overall discoloration and/or hyperpigmentation.
Hyperpigmentation is defined as excess pigmentation. These dark spots are very stubborn and become more pronounced with time instead of fading away naturally. The reason behind this is because the skin stops producing new healthy cells as a person ages. The old cells accumulate over time and give the skin a very dull appearance.
Although the definition is simple, the causes are multipart and immense. Treatment is dependent on cause and location (epidermal or dermal), and in many cases, early treatment can be effective.
Hyperpigmentation can be due to many causes.
The most single common form of hyperpigmentation is sun exposure. The degree and quickness with which it occurs does not show up until much later. This will vary according to the genetics of the individual and the amount of cumulative sun exposure. Over time, the sun makes the skin thicker and coarser, creating irregular pigmentation. Nonetheless, some people — even with careful use of sunscreen — will develop some new spots because with a lifetime of sun exposure, spots keep coming out over the years. If treated aggressively when younger and by practicing safe sun exposure, you will enjoy a clearer complexion longer in your lifetime.
Commonly referred to as “mask of pregnancy,” Melasma results from (1) excess estrogen (associated with pregnancy or oral contraceptives), (2) sun exposure or (3) genetics. When it comes to treating Melasma (large brown patches on the face), it can be very resistant to treatment. I usually start with a very mild chemical peel (Jessner or glycolic) and then increase the strength to a Retinoic peel as tolerated. Proper bleaching or fading creams are also recommended.
The treatments are virtually the same for hyperpigmentation. Some lasers in “lower” energy can be very effective in treating Melasma. I have had great success with the Clear + Brilliant laser, which uses low-energy fractionated technology to improve the skin’s texture. Multiple treatments will be needed on a monthly basis, and then every six months after that, to help maintain the results.
Treatment depends on the severity of the Melasma. Everyone’s experience will be unique, and no treatment plan will be 100 percent perfect or work the same way for someone else.
This hyperpigmentation is simply the darkening of the skin that results from any type of inflammation caused by acne, injury, over processed chemical peel, prolonged picking or scratching. The darker the skin type, the more easily post inflammatory hyperpigmentation can occur. In Hispanic or African American individuals, acne results in more blemishes (brown spots), and it takes longer for them to fade. The same amount of acne in a fair-skinned individual would have very little hyperpigmentation.
Unfortunately, pigmentation is much darker on the lower torso than on the face. In fact, post inflammatory hyperpigmentation (trauma) in the lower portion of the body can be permanent. The best option for treating this type of skin is micro-needling, which involves the use of a pen containing several tiny needles. The pen is used to inject these needles at different spots to create micro channels. Making small injuries to the skin
causes surface bleeding which compels the body to start its healing process. The old layer of skin starts becoming dry, and in a week or so, peels off. Over a period of 10 to 14 days, new collagen is formed to cover up the injuries. This new layer of skin is free from any kind of spots or marks. I often recommend growth factors for speedy recovery.
By middle age, some of the more common signs of hyperpigmentation begin to develop, such as seborrheic keratosis. They can be flat, rough or thickened; they can have texture to them; they can be very light; they can be very dark. These spots start to develop on the sun-exposed areas of the head, face, neck and forearms of the body. They usually do not respond to brightening creams or lotion, but rather respond to various laser modalities.
Once the brown spot(s) are lasered off, over time the spot may reoccur, because the person gets sun within the first two weeks after treatment and/or the spots were only treated partially, with the remaining portion re-forming. Of course, many other things happen to aging skin, such as loss of elasticity, wrinkles and roughness.
If you have isolated, very clearly seen middle, moderate to dark brown spots, you are going to do well with laser therapy, selectively treating those spots.
In some cases, brown spots have to be what I call “shaved” off, which means that a doctor basically puts a little anesthetic on the area and just literally takes the top layer off — and it heals up very rapidly.
Clients often ask, “What can I do about the dark circles around my eyes?” The answer is, “Not much.” These circles are the results of venous circulation, which is somewhat visible through the thin skin of the lower eyelids. Some true hyperpigmentation can happen around the eyes, and usually when adding a small amount of injectable fillers, it will camouflage the concavity.
If this article finds you calculating the years you have exposed your skin to direct sunlight, you may be wasting your time.
Studies have shown that 20 percent of the skin’s elasticity is altered under the age of 2 when exposed to direct sunlight. An individual who receives a sunburn under the age of 25 will have altered the skin’s matrix by 20 years, which affects the skin’s elasticity (protein fibers). That means your chronological age may be 25, but the stated age of your skin will be that of someone in their 50s. If you have never sustained a sunburn under the age of 25, then you can subtract 20 years from the stated age of your skin, meaning by the time you are in your 40s, you will have the elasticity of someone in their 20s.
In other words, by the time you are 25 years of age, 100 percent of your skin will have received irreversible damage from sun exposure. I know that’s a mouth full. I find myself repeating this over and over during consultations. In reality, who hasn’t had a sunburn at one time or another? Now is an important time to take a look at your skin.
IF IT LOOKS WEIRD, TAKE IT TO YOUR DERMATOLOGIST
If you have any concern about a new sunspot, talk to your dermatologist. Although the majority of sunspots that develop on the face are benign, malignant melanoma (the most deadly type of skin cancer) can also develop on the face. If a sunspot is very dark and looks different from the others, or is growing, bleeding, itchy or in general just doesn’t “seem right” to you, seek the opinion from a dermatologist immediately. Melanoma is almost 100 percent curable if caught early, so don’t delay in making an appointment.