Blotching, Spots and Pigment Removal

Almost everybody on close examination will see some skin pigment changes especially in the face. This ranges from mild increased freckling to severe dark blotches. A wide range is present in between these two extremes such as darkening of normal moles and blotches, increasing number and darkening of spots, and numerous blotches that have varying degrees or darkening. Many causes have been identified. Sun damage is the most often seen and recognized culprit either by itself or as an added insult on top of other causative factors. Numerous drugs have been implicated in leading to skin discoloration disorders. Medications especially hormones sensitize the skin to the sun or may produce pigmentation. The exact mechanism of increased skin discoloration is not known. It can occur with increased frequency in certain patients because of the complex relationship between hormones, medications, sun and genetic factors. The final effect is on the hormone producing glands and on the melanin producing cells themselves. Interference with a relatively new hormone called MSH (Melanocyte Stimulating Hormone) is the most often implicated somewhere in this process. Hormonal therapy, childbirth, or birth control pills can also have a direct impact on this process. Add to this patients that already have some natural increased color or freckles and the risk increases. Freckles are genetically programmed into the skin and many times are not even visible to the eye until some process makes them turn darker. I have seen this in my patients that work under fluorescent lights on a daily basis and require a UVA sunscreen to prevent their dark discoloration. Any of these factors are dramatically intensified with even mild sun exposure. In the specialized cells in the dermis called melanocytes, the chemical tyrosine is converted to DOPA, which is then coupled with proteins to produce melanin, the pigment responsible for skin color. This melanin is stored in granules called melanosomes, then released into the basal cells of the epidermis. Differences in color are attributable to the varying amounts and distribution of pigment within these cells. Hydroquinone, a very effective bleaching agent, works by blocking the enzyme tyrosinase and prevents formation of any more new melanin. Simultaneous Retin-A usage actually potentiates the action of hydroquinone. However, the overall bleaching effect of hydroquinone is not immediately visible because the agent acts only on the formation of new melanin. Glycolic acids are fruit acid derivatives that remove some of the loose upper dead cell layers, allowing for better penetration of the more active products during the bleaching program. These fruit acids, found to be safe in low concentrations, are frequently added to many cosmetic products and bleaches. Our office has special interest and expertise in the treatment of skin pigmentation problems especially utilizing skin bleaching programs.

We use several excellent medical grade product lines available only to doctors and doctor's offices. The Obagi system is one of these. These very predictably provide for evening skin pigmentation and removing spots and blotches, depending on their depth. It secondarily and very predictably smoothes the skin and evens the texture and softens the pore size and small wrinkles. The strength and success of this program lies in the specialized and customized use of Retin-A, hydroquinone, and glycolic acid. The products are used twice a day until success is achieved, and then only twice a week. The program is designed and customized to address exactly your anatomy and wishes. We will review typical before and after pictures at the time of your consultation. This program and these products do not interfere with other products you are using and do not interfere with the services of your personal skin care specialist if you have one. If you obtain success with the creams and desire more or deeper results, then we can move onto a more aggressive plastic surgery treatment such as a peel or even lasering at a later date. If you choose to do that, then your skin will be wonderfully prepared by the cream treatment for faster and better healing. All this means that this is one way or another a win-win situation for you. Visit our section on bleaching and peels and laser for more information.