09
Aug
Help I don’t like my darkened skin patches on my face: What can be done for melasma?
In times past, hydroquinone agents that were applied topically were the mainstay of treatment for melasma hyperpigmentation patches on the face. However, you have to be careful with hydroquinone use long term because of potential complications to include acute and chronic issues. Acute complications include irritant or allergic contact dermatitis and postinflammatory hyper- and hypopigmentation. Chronic issues include ochronosis, nail discoloration, conjunctival melanosis, and corneal degeneration. Ochronosis is the most common chronic complication related to long-term use of hydroquinone, and is comprised of asymptomatic hyperpigmentation, erythema, papules, papulonodules, and grey-blue colloid milia on sun-exposed areas of the skin. There are some carcinogenicity concerns as well. Short-term hydroquinone use for a few months is fine up to 4% and often can get better results mixing with Kojic acid, retinoids, and steroids. Some countries have banned hydroquinone because of the concerns of people over using them.
I do prescribe these at times to “jump start” improvement of hyperpigmenation, but just for a few months. However, will then stop it. Then start SkinCeuticals “Advanced Pigment Corrector because it has a tyrosinase inhibitor and is safe for daily use pretty much indefinitely. It can improve both discoloration and even the skin tone evenness.
We have had tremendous success using this product and like it because it has been clinically proven and tested on all ethnicities to improve the appearance of stubborn skin discoloration and uneven skin tone as it boosts the appearance of radiance. Skin discoloration is often caused by accumulated sun exposure, hormonal shifts, and the natural aging process, Advanced Pigment Corrector is a multi-action comprehensive technology working to exfoliate skin to reduce the appearance of discoloration. Fades the appearance of discoloration, promotes even skin tone, improves visible skin luminosity for renewed radiance, ideal for nearly all skin types, except very sensitive, paraben-free, and non-comedogenic. In summary, the best thing is it doesn’t carry the potentially very serious risks hydroquinone can and it can be used daily indefinitely.
Certain types of pigment unevenness, though not melasma, on the face is very amenable to Intense Pulsed Light (IPL, e.g., Lumecca) photofacial treatments. SkinCeuticals also has a very safe to have applied “advanced pigment corrector” peel with lactic and salicylic acid. We also carry DermalInfusion, which combines microdermabrasion with helpful serums for acne-prone skin as well as hyperpigmentation. Lastly a “physical” type sunblock with zinc or titanium vs a chemical sunblock is key to keeping the pigment from flaring up again when exposed to outdoor sunlight.
John Burroughs, M.D.
Dr. John Burroughs specializes in eyelids, orbits, and faces and has performed over 20,000 related procedures. His role in oculofacial plastic surgeries has been highly appreciated.
He is an alumnus of the Air Academy High School, University of Texas, and Uniformed Services University of the Health Sciences (F. Edward Hebert School of Medicine), Maryland. He later followed a transitional internship and ophthalmology residency in San Antonio, TX, and has decades of aesthetic treatment experience.
Dr. Burroughs is American Board of Ophthalmology-certified and is a Fellow of the American Society of Ophthalmic Plastic Reconstructive Surgeons, the Oculofacial Society and the American Academy of Ophthalmology and a member of many other associations. He is a lifelong learner and teacher.