Treatments of Brown Spots and Irregular Pigmentation
Increased irregular skin pigmentation (referred to as “Hyperpigmentation”) can be due to a number of problems, including solar lentigos (also called ‘sun spots’ or ‘liver spots’), freckles, solar keratoses (scaly, precancerous areas of sun damage), seborrhoeic keratoses (harmless areas of thickened skin which are usually raised and slightly waxy in texture), birthmarks, post-inflammatory or melasma. Melasma is a frequent cause of acquired pigment concerns and tends to cause diffuse patches of pigmentation on the face which are made worse with sun exposure, irritation of the skin and oestrogens (for example the contraceptive pill or pregnancy).
It is always important to have an accurate diagnosis of an area of changing pigmentation by a dermatologist before any treatment, to make sure an area of potential skin cancer is not missed.
At your consultation your dermatologist will assess and correctly diagnose your pigmentation problem and develop an individual treatment program to deal with your specific problem.
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What treatment options are available for brown spots and irregular pigmentation?
A variety of treatment options are available according to the individual pigment problem, including sun blocks, specialised skin care products, prescription vitamin A creams (retinoids), prescription lightening creams, glycolic acid products, chemical peels, microdermabrasion, hydrafacials, cryotherapy/ freezing (using liquid nitrogen), microneedling and lasers. The most dramatic and rapid improvement is achieved with the PicoWay® laser, Intense Pulsed Light or Fraxel® lasers, in particular the Fraxel® Restore laser with Dual wavelengths (1550nm and 1927nm).
Fraxel® Restore Laser with Dual Wavelengths (1550nm and 1927nm)
Fraxel® laser technology was patented at Harvard University in 2003. Fraxel lasers use microscopically small beams of laser energy to precisely treat 15-50% of the skin at a time. The islands of treated skin stimulate the body’s own natural healing to produce new fresh skin and push the unwanted pigment and old collagen out, replacing it with younger-looking, clear skin.
The Fraxel® Re:store with Dual Wavelength has both 1550nm and 1927nm wavelengths and is non-ablative i.e. it does not break the surface of the skin and therefore has a short recovery time. It removes both pigment and old collagen so it also helps rejuvenate the skin texture, reduce wrinkles, tighten pores and soften scars as well as removing unwanted pigment. Both the 1550nm and 1927nm wavelength are good for pigment and texture, but the 1927nm is particularly good for pigment. After the treatment the skin may be red and slightly swollen and there is usually slight flaking of the skin 5 -10 days later. As the skin is not broken, patients are usually able to return to work that day and are able to wash and apply make-up as usual (although they would not choose to go to a big event that day). The treatment is performed using local anaesthetic cream. Patients see an improvement after one session but most choose to have 3-6 sessions for maximum results. Because the Fraxel® treatment does not break the skin it is safe and effective on delicate parts of the body such as the neck, chest, hands and arms as well as the face. It can also be used on skin of all colour (from very fair to very dark).
A particularly popular treatment is to have the Thulium wavelength treatment first to remove the unwanted pigment, then follow it up 2-4 weeks later with the 1550nm wavelength to help reduce wrinkles and improve skin texture. Another popular choice to do both the 1550nm and1927nm treatment on the same day.
For melasma, a very effective treatment is to combine the Picoway Laser with the a couple of gentle passes with the Fraxel 1927nm a treatment we refer to as “Clear and Lighten”.
Intense Pulsed Light (Lumecca)
Intense Pulsed Light (Lumecca) is also effective for treating large areas of sun-damage by improving both redness and sunspots at the same time. Following treatment the brown spots develop a dark crust which scabs away over a few days and the redness looks less prominent. There is no swelling. However, Intense Pulsed Light Treatment should not be performed id there is a tan.
PicoWay® Laser
The PicoWay® lasers are excellent at removing unwanted pigmentation, including sunspots, birthmarks and post-inflammatory hyper-pigmentation. In fact, the PicoWay® is able to remove pigmentation in such a gentle way that it has also been FDA-approved to improve melasma/chloasma. It is one of only a handful of laser devices (of which Fraxel® Restore is another) which is FDA-approved for improving melasma.
When the PicoWay® is used for pigmented skin lesions, it feels like a very short, warm (but not painful) spark on the treated skin and the brown marks go slightly darker. There may be some very slight swelling of the brown mark, which settles within a day or two. The slight darkening of the brown marks lasts 10-20 days while the body’s own clearance system clears the pigment away. Some brown skin lesions clear in one session, but most need 2-3 sessions to clear. Individual brown spots can be treated by using 2-4 mm diameter beams to trace over the surface of the individual brown spot or, for larger areas, a 6mm fractionated spot can be used to pass over the large area. It does not usually require local anaesthetic cream.
As mentioned above, for melasma, a very effective treatment is to combine the Picoway Laser with the a couple of gentle passes with the Fraxel 1927nm a treatment we refer to as “Clear and Lighten”.
All of these treatments for skin pigmentation should be done alongside good sun protection and good skin care, including sometimes prescription products which our consultant dermatologists can advise you about.
