How to treat PIGMENTATION

Hey guys welcome to the skincare blog today's topic is a really broad topic and that's how to treat pigmentation.

It's a really broad topic because pigmentation can be due to many different causes in different locations so today we're just concentrating on facial pigmentation that causes facial pigmentation and how to treat this lecture in itself will take normally about an hour at least an hour and a half to do but it's going to be a ten minute lecture and it's going to be a broad-based topic okay.

So the most important the aspect of treating facial pigmentation is identifying the cause if you want some home remedies I've done that article already today is basically how specialists like my self and a fellow dermatologist treat facial pigmentation and this is our might and how we actually think in regards to the facial pigmentation the first and foremost it's a diagnosis what is the cause if you don't have to cause the facial pigmentation you will not find a solution so for us.

It's always about finding the diagnosis in the most common like the most common cause of facial pigmentation which I see in the day-to-day basis realistically no kidding probably about six cases a day is melisma so melisma basically is due to several factors including hormones UV exposure and most importantly genetics and it presents in a certain way it presents as patchy areas of pigmentation involving most commonly the upper lip it also involves the area of the forehead and around the eye area but most importantly usually sparing just below the eye about a centimeter so you've got the space which melisma does not affect it affects women much more commonly than men but certainly, men do get it. But women is because hormones the other hallmark of an Elizabeth is that it usually worsens in pregnancy

So that's a number one thing which I asked women secondly for mates for example being when the pill can actually make it worse and is often the fluctuation which means it gets worse in summer and usually proves in winter it's because of the UV index in Brisbane where I live it's super common like seriously it's super calm it's probably one in probably ten women have this condition it is one of the harder conditions to treat but certainly it is treatable now how I approach this is that the first and foremost is sun protection you've got to actually have some protection and by sun protection.

I mean hats yeah hat really broad brim hats not caps hats together with sunscreen sunscreen twice a day once in the morning and once at noon and I prefer a broad spectrum sunscreen preferably a physical base so something like zinc oxide or titanium dioxide but certainly stuff like milk on Excel from LA roche-posay one of my favorite sunscreens now sun protections are first and foremost secondly. 

I use something called a Taurus and less inhibitor and there may be something like mela derm or hydroquinone and that's gotta be applied as tolerated start three nights ago upto six nights a week follow that you're going to improve some of the pigmentation but the trick is to actually use lasers in the laser which I use preferably is what's known as aq-switch laser it serves q-switch laser is a low-dose laser so there's no chance that your melisma will flare up unlike using the fractionated lasers so yes.

I realize clearly brilliant Fraxel they're great lasers but all of these lasers fractionated lasers can actually flipmelisma but if you use what's known as rescue switching you can actually improve melisma but also, firm up your skin so I use lasers in conjunction with creams at all times it's nip about the laser it's never about the cream it's about the combination occasionally I use something called trans exam occasion which is basically a what we call the VG f1 orvascular endothelial growth factor one modulator and that can help with melisma so look at a couple of cases here.

we'll study them carefully chemical peels can be a useful way to treat melisma however this is of historical value only these cases are done well over a decade ago and you can see the effectiveness of TCA peel or medium depth pills together with creams they're excellent way to treat Sun damaged that's TCA peels nowadays we've replaced it with lasers to using what's known as cue switching which is low fluent or low dose lasers and this is the before and afters together with using Taurus and those inhibitors. 

they're a predictable safe effective method for the treatment of malaise MA and it can also be used to treat certain forms of sun damage together with melasma so this is the before and this the afters it's about ten weeks between the intervals now using newer technologies such as picosecond lasers we can get these amazing result especially ethnic skin types to study carefully the wrinkles, as well as pigmentation, will get an amazing improvement using picosecond lasers once again. they've got to be in context with the skin type with the patient and this is all off-label use so picosecond lasers nanosecond lasers combined with creams will get a good improvement with malaise but in 95% of cases and the great thing about it is there's no chance of worsening the pigmentation and once again for treating even rebound pigmentation or post-inflammatory hyperpigmentation these lasers are excellent now living in Queensland the second most common cause of facial pigmentation is due to that's it sun damage to sun damage often this conflict because it's not straightforward sun damage in the majority of cases.

What was a majority from death 40% of cases will have an element of melasma especially in the younger population, you have an element of melisma that can easily be confused with sun damage if you use older technology such as IP l on sun damage can work really well but if you use that with in the patient who's got a tiny bit of melisma you'll treat the sun damage but you will flare up melisma this is one of the common flareup factors which I see it's called iatrogenic in other words induce melisma and that's due to I peel so let's talk about sun damage sundown it usually presents differently it usually hasn't the characteristic pattern which hazard melisma it hasn't got the seasonal fluxyeah compared to Melissa no it's often worse in summer and the sun damage is more discreet in other words you can actually draw around it rather than a model appearance which you have in my Elizabeth some damage is super easy to treat.

I use everything from q-switch laser all the way to Fraxel in face Fraxel is probably one of my favorite lasers for treating sun that bench you only need one treatment and the downtime is about six days or so so depending on the amount of pigmentation you have due to sun the damage I use things like for example Pico lasers q-switch laser fractionator lasers all the way to fully ablative laser resurfacing now fully ablative laser resurfacing has got a downtime of about 10 days and you're ready for about three months but that's that's a big gun and then they only hold that for you know really bad sundamage so why use fully ablative erbium and also co2 lasers for treating sun damage such as this because it gives are markable result both in pigmentation together with the reduction in wrinkling. 

So we'll see another case shortly of marked pigmentation couple with wrinkling and this is one treatment in one treatment only but it is serious downtime with this third most common cause of facial pigmentation is postinflammatory hyperpigmentation or PIH as you guys know PIH is one of the hardest conditions to treat the reason being is that you can't hurry up any laser aimed at treating PIH has got to below and it's got to be slow you can't actually use for example an ablative laser to blow up the pigment because all your skin's going to do is go.

It's going to actually rebound back that's gonna send more pigment up to your epidermis in your dermis and you're going to get a longer prolonged PIH so you're gonna get a PPP IH to prolong postinflammatory hyperpigmentation so PIH due to acne chicken poxdermat it is eczema any one of those conditions yeah it's gonna take you at least six months and in some cases especially ethnic skin types Asian skin types Mediterranean skin types and certainly in a South India Central India it is going to take anywhere up to 12 to 18 months before resolving time in sunscreen is going to be your biggest friend fatigue treating PIH lasers can certainly help it out and in this situation.

I use Pico lasers or nanolasers so PIH is number three guys I'm using Pico so piggish a focus for acne scarring this is my favorite the setting for treating certain scars and ethnic skin types it doesn't work well on a fairer skin types before for ethnic skin types with this particular type of scarring with post-inflammatory pigmentation it works really well here is the pic oh sure it's firing at ten Hertz I'm using 0.71 I'm listening to the lasers as full of photoacoustic laser you hear that ping as soon as you hear that ping will release the melanin also gives a shock wave effect to actually do what's known as a spring effect in other words it remodels collagen because of the sheer energy of this laser so it works by li o beads it stands for laser-induced optical bodies which is basically the melanin being shattered which releases the growth factors but also just a shear strength of this laser at this wavelength will also stimulate collagen so excellent for ethnic skin types in the context of PIH secondary to acne certainly lasers can help.

But I have to use many other procedures including subcision dermal fillers and many others to achieve this result PIH due to IPL burns can also be treated with lasers this is the before and after after five sessions ten weeks later now acne scarring should not be confused with piee of post-inflammatory erythematic is redness and this has to be treated with vascular lasers so understanding which type of pigmentation is vital to getting results the fourth case of pigmentation which I see frequently is due to genetics and that's due to either freckling freckles are pretty easy I mean man you've gone that's a kid so you know what freck lesare yeah we can remove them but guess what they'll always come back it's a hundred percent chance that freckles will come back so we can use everything from IPL all the way to Fraxel laser or you can use.

I peel with racks or something like or pulse Fraxel generally speaking with pulse per axle you need one treatment in 80% of freckles we go if you maintain that with things like aah a creams and vitamin A trip knowing you're going to get about a year or two out of it that's providing it could be episode okay so that's number four number five birthmarks I see are realistically probably four or five per week at least one a day okay so the most common Brown birthmark of hyperpigmentation call it come see ALM for those of you who don't know what the comments it's called a cafe or like Mac you're the great thing that comes isthat if it is diagnosed correctly youhave got an 80% chance that laser canactually help and the laser of choice is just realistic way in the old-fashioned q-switch laser will do it so you don't need to go for those fancy Pico lasers which yes.

We do use and I it is one of my favorite lasers for actually treating pigmentation especially in ethnic skin types but for cards or capello macules you only need the old-fashioned nanolasers so things like c6 red lights they all work fine so that is super common will at least in my books anyway but that is another form of pigmentation so guys I hope you found that useful I do one article every Saturday morning skincare blog and that's why it's growing so hello guys please by all means like by all means charm your thoughts below in the section if you liked this please like it share I'll see you sametime same place next week bye