Cosmetic Surgery Blog

As many of you who regularly read my blog may know, I have had a problem with hyperpigmentations (darker skin spots, or patches) for quite some time. While they aren’t flaring up as much as of late, I do know that melasma is an affliction I will always have to deal with. Some of you may relate these darker patches with getting older (you may have heard them called skin spots, age spots, liver spots, or sun spots), however hyperpigmentations such as melasma affects many younger people as well. However, what is defined as “age spots” is normally found on the hands and neck. Melasma, or Cholasma normally affects the face.

As you know UV exposure significantly hastens the aging progress. Excessive UV exposure causes free radicals which in turn break down and the cellular structures causing thin skin, wrinkles, and worse, skin cancer. You can easily tell the difference between a sun-damaged face and a face which has had little sun exposure. Just compare the inside of your arm to the outside.

Most hyperpigmentations that are caused by the sun alone are usually called freckles (although larger, darker skin spots can result) and can be found anywhere on the body. Miraculously I barely have any, but I do notice a few on my shoulders from sun exposure over the years.

Preventing hyperpigmentations and skin spots from actual sun damage isn’t always easy. Limiting sun exposure during peak UV times and using a good sunscreen every day (and reapplying!) can significantly decrease your chances in developing them, or worsening them. I am sure you have noticed the milky white skin of Marsha Cross, the redhead from Desperate Housewives. You will always find her toting an umbrella or donning a wide-brimmed hat, and surely plenty of sunscreen. Beautiful, untouched skin like that takes work.

The Hormone Factor

Melasma, or you may have heard it called Cholasma, caused by hormones is something which can be found in patients in their teens on up. It can also be a result of taking oral birth control pills (OBC), or other forms of birth control (implant, injection, ring, etc.) Natural imbalances in your own hormones can also trigger the onset of hyperpigmentations. Those of you who may be receiving hormone therapy may notice hyperpigmentations on the face as well. I personally feel that taking OBC pills triggered the onset of my own pigmentation problems.

At about 25 I started taking OBC pills again to control adult acne. Not that I know for sure if OBC was the definitive cause, but it seemed the post-inflammatory hyperpigmentations (PIH, red or darkened spots left over after an acne flare-up) were staying around longer so I started looking into a regimen to help get rid of the red spots. I was speaking to an aesthetician at a plastic surgeon’s office and she introduced me to Obagi (which I would personally no longer use). I was on tretinoin (Retin A Micro) and hydroquinone twice a day. It was getting rid of the PIH, but after ONE day of yard work, I had very dark brown patches on my cheeks, forehead and chin. They only went away temporarily as I chemically exfoliated my skin with Obagi program, but would always return even without sun exposure! So I stopped taking the OBC and it did get better.

The Medication Factor

Although I have been told you will either get it, or not, I personally feel that being on a tretinoin and hydroquinone regimen and being on oral birth control medications is what truly did me in. Granted tretinoin/hydroquinone causes sun sensitivity anyway, but I have taken OBC pills before, and never had any hyperpigmentations which were not PIH.

Last summer I went back on OBC pills and was not on any type of topical medication and had been out in the sun a lot. Even though I religiously applied Anthelios sunscreen, they were still getting darker and darker. This is when I started the Cosmelan peel (which I highly recommend), which helped tremendously. But still, they kept forming with any sun exposure. So off I went again with the OBC, and continued I did with the Cosmelan and high SPF sunscreen. They went away again. It’s almost as if I am afraid of getting back on OBC again. Even though I am breaking out like a 14 year old, I am not sure which is worse—darker patches or @&#$%! red pimples.

How to Get Rid of Hyperpigmentations and Dark Skin Spots

The regimen which may be best for you is largely dependent upon your skin type, how your skin reacts in general and what your doctor has to offer. There are many treatment types available, from tretinoin-based (Retin A) skin care programs and other chemical exfoliants, to light-based therapies (Intense Pulsed Light, or IPL, and LASERs), and others such as physical methods (microdermabrasion).

After using many regimens, I personally prefer Cosmelan. I feel I do not get the sun sensitivity from it as I do with tretinoin or hydroquinone but you do have to take care in sun avoidance and protection. It is imperative that you keep the newly uncovered skin out of the sun, whether direct or reflected UV. It is a program that requires perseverance, however. You will remain red and peely for quite some time and it is uncomfortable to apply the Cosmelan 2 maintenance cream over your already raw skin. But it’s worth it! I have a friend who just went on it for only one month and her skin looks like night and day.

Schedule a visit with your doctor and see what he/she has to say and what they recommend. Remember, just because someone doesn’t recommend a product that you have heard good thing about, doesn’t mean the product isn’t great—they just may not know about it or have any experience with it. I suggest visiting the Spectacular Skincare forum http://spectacularskin.com/forum/forum.php  and chatting with the other members about what they used to get rid of their own hyperpigmentations. It’s a good step in finding out the available methods, from home remedies to full-blown prescription-only regimens.

I know what it is like to be self-conscious about your skin and having to cover it up with highly pigmented foundation just to look even. I did it for a very long time. Although I am breaking out right now and am layering on the concealer, I have to say at least the darker patches are gone. If it’s not one thing, it’s another, right?