Understanding Pigment Problems

If I could wave just one “magic wand” for a skin issues, I would do it for pigment problems.  This one skin issue accounts for so much of the psychological pain, self-consciousness and frustration that I hear daily.  It is understandable…all over the world women are supposed to have blemish-free, even-colored, glowing skin, and it can be very difficult to attain.   And who does have perfect skin anyway?  Very few of us over a whole lifetime.

Why are brown spots, melasma and other pigment problems so hard to treat?

Pigment (melanin) in the most superficial layer (the epidermis) is the easiest to treat because as the skin renews itself, the pigment will slough/shed (example –brown spots after acne). But when the pigment drops deeper down into the dermis, the renewal process is much slower and treatment cream/lotions don’t reach it.  The hardest of all is when there is also in increase in the number of pigment- making cells (melanocytes) and the pigment is deep (example – melasma).  You will need your doctor to help you with an accurate diagnosis.  Treatment can be effective if the diagnosis is right.
Possible causes of brown spots, melasma and other pigment problems:

  • Too much sun.   This can be at any point in your life including childhood
  • Pregnancy, oral contraceptives and hormone replacement
  • Acne
  • Various facial rashes and any skin irritation
  • Your genes
  • Rarer causes like overuse of hydroquinone creams, adrenal gland problems, etc.

General Information On How Different Pigment Problems Are Treated

It’s important to get an accurate diagnosis from your doctor first.  Here are some examples of treatment options though.

Moles – These generally need to be surgically removed.  Lasers may not be safe and are usually not effective.  Stitches may not be needed in some cases.

Lentigoes/freckles/sun spots with no texture – These are often improved with lasers or peels, and certain skincare products are helpful.

Raised benign growths  – These are often removed by using liquid nitrogen or hyfrecator; rarely a laser is needed

Melasma – Sunscreens, hydroquinones, antioxidants, and other topicals are still the mainstay of treatments, often combined with light peels or microdermabrasion.  Lasers often make melasma worse.

Pigment after acne – This is referred to as post-inflammatory, and is usually treated with topical, light peels, or microdermabrasion.  Controlling the acne is key.

Here Are The Dos And Don’ts:

  • Don’t scrub or exfoliate too much.  This can be irritating and make the pigment worse.
  • Stop any skincare product that is irritating you or making the pigment worse.
  • Use your doctor’s medications as directed – more is not better. If it’s getting worse, then stop the product and call the doctor.  Medications may take several months to work.
  • Be very wary of any product sold on the internet.  Many of these companies prey on the frustration and desperation of women and men with pigment problems.
  • Don’t overuse hydroquinones.  With too much, they may make pigment worse not to mention that they may cause mutations in DNA if overused.
  • Use a good sunscreen every morning that blocks Ultraviolet‑A (UVA) and UVB radiation with at least zinc oxide 10% or a zinc/titanium combination that is at least 10%.  Double sunscreen by using a cream or lotion sunscreen as a base and put a mineral powder foundation or the ColoreScience powder sunscreen over that.
  • Wear a wide brimmed hat whenever outside.
  • Stay out of the sun especially midday, and if you are on vacation, sunscreen again every time you get out of the water.

To Discuss With Your Doctor:

  • Discuss getting off any oral contraceptives or any estrogen containing medication with your doctor.  These can make pigment problems worse.
  • Using lasers to treat brown spots, especially in darker skin types, should only be done in dermatologists’ offices where experts are experienced treating darker skin. Particularly with melasma, lasers can make the problem worse.
  • Discuss biopsy and use of a “Wood’s” lamp to aid in diagnosis
  • Talk to your doctor about any suspicious spots on your face.  Malignant melanoma, which is a potentially fatal type of skin cancer, can occur on the face and begin in a spot that looks like a freckle.

For more information on melasma, see Dr. Irwin’s article on Melasma – In Depth.
For more information on brown spots, see Pigment and Texture Issues.
For more information on acne, see Dr. Irwin’s article on Acne.