Kenneth Beer, M.D. is a board-certified dermatologist and dermatopathologist in Palm Beach, Fla., and the director of scientificskin.com, an online skincare company. He is also the director of The Cosmetic Bootcamp, which trains physicians in best practices for cosmetic medicine. Dr. Beer is an instructor in dermatology at the University of Miami, and he is an A.B. Duke Scholar at Duke University. He obtained his medical degree from the University of Pennsylvania School of Medicine, and received his dermatology and dermatophathology training at the University of Chicago. Visit Dr. Beer's office at palmbeachcosmetic.com.
 
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Shedding Light on Dark Skin Splotches

Monday, 19 Jul 2010 10:40 AM


The causes of skin discoloration – areas that are either too dark or too light – are varied and treatments may prove frustrating. However, understanding some of the most common disorders may help to find appropriate treatments and avoid making the problem worse.

Hyperpigmentation (too much) is more frequent than hypopigmentation (too little) but both can have profound psychological and emotional consequences.


Let’s focus on hyperpigmentation, which tends to be of particular concern for women. This is partially due to their ongoing exposure to estrogens. The estrogen may be from their own bodies, from oral contraceptives or from pregnancy. Pigmentation that covers the cheeks, known as melasma, is associated with estrogen.

Injuries and Irritants

Pigment may also be the result of injuries such as those from a rash, burn, or scar. Chronic physical irritation, such as rubbing, may cause the pigment from the skin to tattoo an area. Chemical irritants, including fragrances and preservatives, may also result in increased pigment. Sunburns may cause lasting pigment changes if they are severe or frequent.

One particular type of hyperpigmentation deserves special mention. It can occur when skin is exposed to sunlight after contact with lime peel – perhaps as a result of squeezing the lime into a drink. So this reaction, which is commonly seen on the hands, is also known as “Margaritaville dermatitis.”


Lasers, Peels, Topicals

Treating hyperpigmentation usually involves lasers, chemical peels, and topical products. Many dermatologists will begin to treat facial hyperpigmentation with topical hydroquinones. When hydroquinones are combined with other medications such as hydrocortisone and tretinoin, they become even more effective. One prescription combination is Tri-Luma. Another frequent prescription is Retin-A, which has been used for decades.

For those who do not want to use prescription-strength products, a variety of over-the-counter brighteners are available (mine is at www.scientificskin.com). These may combine botanical extracts such as licorice to inhibit production of pigment.

Lasers and intense pulsed lights (IPL) may also treat the condition. Each is a light-based device that can produce energy delivered to the pigmented cells. Once the pigment absorbs the energy, it can be degraded. Although higher energy levels can help to clear the pigment faster, they are associated with increased complications such as burns and worsening the discoloration.

Before being treated with a light-based device, inquire about the device as well as the person using it. The person should have experience and supervision by someone trained to use lasers. In my practice, we use two different IPL devices and a laser designed to target pigment.

Chemical peels have been used since ancient times to lighten the skin and recently they’ve enjoyed a resurgence; they may be made from various ingredients and come in different concentrations. My favorite peel for hyperpigmentation is made with salicylic acid. Used in strengths from 20 to 30 percent, these peels are applied monthly in a doctor’s office and may be combined with a home regimen. Expect some mild flaking after a salicylic acid peel but no significant peeling.

No matter how you treat your hyperpigmentation, you should use good sun protection to ensure that you do not make it worse. Before embarking on a treatment course, speak with your dermatologist to be sure that the proposed remedy makes sense in terms of the risks, costs and time involved.

To learn more about Dr. Beer, please visit www.palmbeachcosmetic.com.




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