Freckles and Lentigines
Freckles are clusters of concentrated melanin which are most often visible on people with a fair complexion. A freckle is also called an "ephelides".
Lentigines are blemishes on the skin associated with ageing and exposure to ultraviolet radiation from the sun. They range in colour from light brown to red or black and are located in areas most often exposed to the sun, particularly the hands, face, shoulders, arms and forehead, and the head if bald.
- Bleaching Creams
- The use of hydroquinone and kojic acid are one of the beneficial treatment for freckles and lentigines. They may help in lightening if they are applied consistently over a period of months.
- Tretinoin (vitamin A acid, Retin-A) also helps to make freckles and lentigines lighter when applied over a period of time.
- A light freeze with liquid nitrogen can be used to treat freckles and lentigines.
- Chemical Peels
- Chemical peels are used to remove age spots, superficial pigmentation, discoloration, wrinkles and fine lines. They generally help to make the skin smooth and firm and also help in curing freckles and lentigines gradually.
- Intense Pulsed Light Therapy (IPL)
- IPL delivers energy to melanin that effectively reduces pigmentation. Post procedure, the freckles and lentigines will darken and eventually fall off or fade away in a few days to a week. You will need to protect your eyes from the light by wearing goggles .The number of sessions varies from each individual.
- Laser Removal
- The most effective freckle and lentigine removal method is laser removal using a Q Switch Nd:Yag Laser. A laser projects a focused and collimiated ray on the area that is affected, causing the ray to be absorbed by the melanin so that the darker cells are destroyed and the healthy cells are left intact. You will need to protect your eyes from the laser by wearing goggles. The number of sessions varies from each individual.
Melasma (also known as "Chloasma faciei"or the mask of pregnancy when present in pregnant women) is a tan or dark skin discoloration. Although it can affect anyone, melasma is particularly common in women, especially pregnant women and those who are taking oral or patch contraceptives or hormone replacement therapy (HRT) medications. Melasma is not related to any medical disorder and by itself is a harmless skin condition despite the cosmetic concern associated with its appearance on facial skin.
The cause of melasma remains unknown but is believed to be due to an increase in the production of cells which release the pigment melanin, which is responsible for the dark colour of the skin.
- What causes the increased production of melanin is not known but some triggers include:
- Heredity factors and hormone fluctuation/production: the rash is most common in pregnant females
- Prolonged sun exposure
- Use of birth control pills
- Certain medications like tetracycline and anti-malarial drugs (derived from quinine)
Over the years, various treatments developed to treat melasma including:
- Bleaching Creams
- There are many skin lightening agents on the market and the most commonly used is hydroquinone. Numerous other agents sold in herbal and nutrition stores may work as skin lightening agents as well, however each patient has a unique skin type and reactions to skin lightening agents vary.
- Chemical peels
- The most commonly used acid compounds to remove melasma include trichloroacetic acid, azelaic acid, glycolic acid, lactic acid and various fruit extracts. Stronger peeling agents tend to have a higher effectiveness rate than lighter strength peeling agents. Stronger peeling agents may also carry the risk of side effects such as burning, skin peeling, scarring and even worsening the skin discoloration.
- Laser Treatment
- using a 1064/532mn Q Switch Nd:Yag laser system.
- Sunscreen is of paramount importance.
- Without daily use of opaque sunscreen, treatment will fail (a broad-spectrum formulation with an SPF over 30 plus cover up is adequate).
These treatments do not necessarily cure the cause of melasma and the effectiveness of each will vary from patient to patient. Even after treatment, skin discoloration may not always disappear completely and each patient may have to try various different treatment options to see a satisfactory result. Some treatments may have to be continually performed to sustain results, such as applying a skin lightening agent on a regular basis, combined with effective sunscreen usage and sun exposure avoidance.
Acquired bilateral anevus of Ota-like macules (ABNOM), or Hori's macules, are a pigmentary disorder that is clinically characterized by speckled or confluent brownish-blue or slate gray pigmentation over the face, and histologically characterized by diffuse upper dermal melanocytosis. Unlike naevus of Ota, the pigmentation occurs in a symmetrical bilateral fashion, has a late onset in adulthood, and does not involve the mucosa.
The cause is unknown, but proposed mechanisms include the dropping off of epidermal melanocytes, the migration of hair bulb melanocytes, the reactivation of preexisting dermal melanocytes, and the manifestation of latent dermal melanocytosis, which is triggered by dermal inflammation, atrophy, or aging-related degeneration of the epidermis and dermis.
Lasers are the most common treatment for this condition. Twenty-six percent of patients treated with the Q-switched Nd:Yag laser for one to two treatments, and 50 percent of patients who underwent more than two treatments had good-to-excellent clearing.
Café au lait spots (CALM)
Café au lait spots or Café au lait macules are pigmented birthmarks. The name café au lait is French for "coffee with milk" and refers to their light-brown color. They are also called "giraffe spots."
There is no effective cosmeceutical product to remove CALM. Only laser treatment has been shown to reduce the apperance of CALM but it’s effect varies from each individual.
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