Pigmentation + Discoloration
Uneven skin pigmentation and discoloration can be the result of many dermatologic conditions. Finding and addressing the root cause is the key to restoring even skin tone and correcting pigmentation in the long term.
Not every skin tone responds similarly to treatments designed to create a more even skin tone, and treatment options should be customized to an individual’s skin tone and skin type. Treatment of hyperpigmentation may include topical active ingredients, prescription medications, laser treatments, and/or chemical peels. Consistent broad spectrum photoprotection is essential when you’re looking to achieve a more even skin tone.
Where sun spots are present there is also sun damage, and Dr. Sherber’s approach centers around enhancing your skin’s reparative mechanisms through the implementation of advanced skincare actives into your skin regimen such as retinoids, glycolic acids and antioxidants, as well as the use of fractionated non-ablative lasers, and overall skin cancer assessment and prevention.
Melasma is a common cause of symmetric blotchy hyperpigmentation and uneven skin tone that can be triggered by hormonal shifts, sun exposure, and heat (even excess heat from laser treatments. Dr. Sherber often sees patients for a second opinion because their melasma worsened from previous mismanagement and helps them to navigate their way to healthy, even skin. Pregnancy and use of hormonal contraceptives are frequently associated with the development of melasma, and it can also occur in association with other hormonal changes such as perimenopause and thyroid dysfunction.
Other common concerns relating to pigmentation and discoloration include dark circles under the eyes, which can be improved with targeted treatments ranging from Lasers to Injectable Filler, and dark spots.
SUN DAMAGE
Sun damage can take many forms in the skin, from pre-cancers to dark spots to redness and visible veins, to enlarged pores. When skin is exposed to UV lights, free radicals are generated which damage collagen and DNA and, in turn, contribute to skin aging and skin cancer.
Sun damage can present as brown “sun spots” when clumps of uneven pigmentation develop from UV exposure, and Dr. Sherber’s approach is not only to treat these cosmetically but also to prioritize reducing the overall burden of photodamage in the skin. Whereas freckles (also known as ephelides) are genetically determined and will fade in the winter months or in the absence of sun exposure, sun spots (also known as lentigines) result from sun exposure and persist on the skin.
RECOMMENDED TREATMENTS
Dr. Sherber takes the time to assess each individual case of sun damage to determine the best method of treatment. To start off, she typically recommends that her patients incorporate skincare products that contain clinically active concentrations of retinoids, glycolic acids, and antioxidants to enhance skin’s reparative mechanisms.
There’s a growing body of scientific literature to support that gentle fractionated non-ablative laser treatments not only improve skin texture and skin tone but also reduce pre-cancerous damage in the skin.
Chemical peels such as antioxidant-enriched glycolic peels are another option that bring fresh skin to the surface and reduce sun damage. If Dr. Sherber diagnoses pre-cancerous damage, these area may need to be treated with prescription creams that selectively remove abnormal cells.
For those with clinically evident sun damage, Dr. Sherber recommends an annual total body skin examination for skin cancer surveillance and monthly self-administered skin exams at home to check for new or changing spots.
MELASMA
Melasma is characterized by symmetric blotchy areas of dark pigmentation that most commonly appear on areas of the face such as the forehead, upper lip, and cheeks. This skin condition can be triggered by hormonal changes of pregnancy (some call this “mask of pregnancy”) or menopause, or from exogenous hormones such as birth control pills or hormone replacement therapy. Certain topical treatments and laser treatments can worsen melasma, so consulting an expert is essential in successful management.
RECOMMENDED TREATMENTS
Dr. Sherber first focuses on getting to the root cause in an individual case of melasma in order to determine the best method of treatment. To start off, she typically recommends that her patients incorporate particular skincare products such as a daily tinted mineral broad spectrum sun protection to block against visible light which can worsen melasma discoloration. She also often emphasizes topical brighteners as a treatment to help fade unwanted pigmentation, while being intentional about gentle formulations as to not trigger any additional pigmentation caused by inflammation of the skin.
While most lasers will worsen melasma, the new Clear+Brilliant Perméa laser has a 1927nm wavelength that is very effective at targeting the darker areas of pigmentation without overly heating or inflaming the skin. Immediately post-laser, when absorption of topical treatments is increased 17x, Dr. Sherber applies a customized blend of brightening serums to each patient’s skin for added benefit. Such brightening ingredients might include forms of vitamin C or tranexamic acid. Depending on the depth and severity of melasma, Dr. Sherber may pre-treat the skin for several weeks prior to laser treatment using a tailored regimen of topical treatments. She does not recommend IPL or BBL in the treatment of melasma since for most skin types it can result in initial improvement and subsequent worsening of hyperpigmentation.
In more severe or stubborn cases, treatment with oral tranexamic acid may be indicated. Dr. Sherber will order blood tests before initiating treatment to ensure that this is suitable given that it may confer a small increase in the risk of developing a blood clot. Dr. Sherber may also recommend blood tests to check for hormonal irregularities ranging from estrogen levels to thyroid imbalances. If melasma is triggered by oral contraceptives, Dr. Sherber may recommend changes to your medication regimen.
DARK CIRCLES
Eyelids have the thinnest skin on the human body, and can show the first signs of aging. Individuals with a genetic predisposition for darkness or shadowing under the eyes may experience dark circles that are persistent and unrelated to age. The key distinction is whether the “dark circle” is due to brown discoloration of the skin, veins showing through the surface of the skin and causing a blue hue, or a true shadow from hollowing under the eyes.
RECOMMENDED TREATMENTS
Dr. Sherber will evaluate each individual case of dark circles to determine the best method of treatment. For brown discoloration under the eyes, Dr. Sherber will customize a regimen of topical brightening treatments, and may recommend Perméa laser treatments or chemical peels for more intensive brightening. For visible veins, a very gentle treatment with the Nd:YAG laser can be a safe and effective option to fade the bluish hue in certain anatomic regions under the eyes.
The incorporation of particular skincare products can make a significant difference in the appearance of “dark circles.” Supersaturating the under eye area with hydrating eye creams can produce notable plumping, whereas application of caffeine-containing products can depuff.
Hollowing under the eyes can be improved with injectable hyaluronic acid fillers to soften the shadows. Since the filler is placed deep, on the orbital bone, it is less prone to getting worn down by strong muscle contractions as it does in other sites and generally lasts for months to years. Not all undereye anatomy is amenable to treatment with fillers, and Dr. Sherber will not recommend this treatment if it won’t produce the desired result.
For those with significantly uneven undereye contour with pronounced undereye bags more dramatic hollowing, a lower blepharoplasty may be the best choice to produce the most natural-looking result as opposed to the addition of volume with fillers.
Crepey skin in the under eye area can be made more dense with fractionated non-ablative laser treatments such as Clear+Brilliant and a combination of skin boosters and targeted topical treatments.
DARK SPOTS
Uneven skin tone can develop from genetics, environmental damage, or a combination of both. Dark spots which darken significantly following sun exposure may be freckles, or ephelides, and those that are always present and appeared after childhood are generally sun spots, or solar lentigines.
Dr. Sherber examines all dark spots for signs of abnormality before proceeding with cosmetic treatment. She particularly looks for dark spots that are new or changing, or that don’t meet the ABCDE criteria and may be concerning for skin cancer.
RECOMMENDED TREATMENTS
Dr. Sherber will evaluate both the cosmetic and medical concerns relating to an individual’s dark spots to determine the best method of treatment. The implementation of topical treatments that contain brightening ingredients or glycolic acid can act to fade unwanted pigmentation when paired with daily use of a broad spectrum sun protection. Newer topical approaches that avoid bleaching agents like hydroquinone include transexamic acid and cysteamine.
Laser treatments are often the best way to break up uneven pigmentation and produce rapid and reliable results. The Perméa laser fades dark spots without any downtime, while the LimeLight spot-treats areas of stubborn pigmentation. Dr. Sherber typically recommends LimeLight treatments as a winter sport since skin should not be tanned pre- or post-treatment, whereas Perméa is safe even in the summer months with proper photoprotection.
Another beneficial treatment can be chemical peels which can be a valuable addition to a skincare regimen geared towards fading unwanted pigmentation. When dark spots are intermixed with red areas, called poikiloderma, Laser Genesis can help even out the skin’s complexion by fading both brown and red areas.