Sun Spots & Melasma- Let's Talk Pigment Issues

What are the best sun spot removal & melasma treatments?

Overview

Hyperpigmentation is the darkening of an area of the skin (or nails) caused by increased melanin. Causes of hyperpigmentation include:

• Sun damage

• Melasma

• Inflammation

• Skin injuries (including those related to acne)

• Diseases such as Addison's disease, Cushing's disease, acanthoses nigricans, etc

• Induced by dermatologic laser procedures

Melanin is produced by melanocytes (a type of cell) at the lower layer of the epidermis. Melanocytes produce color in the body in places such as the eyes, skin and hair and as we age, the melanocyte distribution becomes less diffuse and its regulation less controlled by the body. UV light stimulates melanocyte activity and where the concentration of cells are greater, hyperpigmentation occurs. My goal with this post is to touch on the two most common hyperpigmentation complaints seen in my clinic -which are sun spots and melasma. Lets dive in!

Sun Spots

Sun spots (also called liver spots, age spots or solar lentigines) are very common and are the result of contact with UV rays. Anyone can get them, but they are most common in people with fair skin and those older than 40 years. They often develop gradually over time as a result of repeated sun exposure.

Sun spots show up as flat, concentrated areas of brown pigment. In fact, sun exposure is the #1 cause of premature aging, and 80% of the skin’s visible signs of aging are caused by solar rays. The beach trips that once gave a glowing tan when we were younger are now responsible for giving us sun spots and fine wrinkles. 😣

True sun spots are harmless to your health and noncancerous- but they can be treated for cosmetic purposes. If you are ever unsure, it is always a great idea to be seen by a dermatologist for regular skin checks to make sure any new (or old) spots are not something else.

Melasma

Melasma is another type of hyperpigmentation that affects over 5 million Americans. Melasma differs from other types of hyperpigmentation issues as it is not just sun-related, but also caused in part by hormonal changes in the body. In pregnant women, it is nicknamed the 'mask of pregnancy' due to its high prevalence during pregnancy. Melasma is found more frequently in women in general- pregnant or not- partly because of the hormonal association. Melasma almost always targets a person's face- resulting in dark patches of skin on a person's chin, cheeks, nose and upper lip.

Melasma is not dangerous, but can lead to discomfort in public. Luckily we have come so far in the aesthetic and dermatologic world and have a variety of effective methods to combat pigment issues.

Removal Options

1. Intense Pulsed Light Therapy (IPL) - $800-$2000 per package

IPL also sometimes referred to as photo facial, IPL technology targets pigmented cells- working with a variety of different wavelengths of light to focus on dark spots. This is actually not a laser treatment, but rather light therapy! The treatment penetrates directly into the dermis to remove damaged skin cells and promote new growth and collagen with minimal side effects or downtime. There are a variety of different IPL machines on the market today with costs varying from $800-$2000 per package to include multiple sessions (3-6) spaced about every 4 weeks. IPL therapy is a very targeted approach that gets rid of sun spots effectively- the biggest (and really only) downside to this treatment is the high price tag associated. It may not completely get rid of spots either, but rather a noticeable lightening of them. If you still want an effective option, but not the price tag, a chemical peel or microneedling may be a great alternative!

2. Chemical Peels - $75-$300 per session

Chemical peels have been a mainstay option used for years to combat pigment disorders. Chemical peels are a procedure to remove the outermost layer of skin (epidermis) which leads to the formation of a new epidermis without the excess pigmentation from melasma. Peels come in many different chemical forms and varying strengths to combat particular skin issues. Common chemicals comprising the peel include:

• Trichloroacetic acid (TCA)

• Alpha Hydroxy Acids (citric acid, glycolic acid, lactic acid)

• Beta Hydroxy Acids (Salycilic acid)

• Tretinoin/Retinoic acid

• Jessner's Solution

The AHA acid peels for melasma are the most common chemical peel treatment options. Derived from sugar cane, AHAs are an organic compound with a proven application for treating melasma and sun spots. At Coastal Aesthetics, we offer two peels: The ZO® Ossential Stimulator Peel ("lunchtime peel") and the Skinmedica® Vitalize Peel.

The ZO® Ossential Peel is a perfect combination for someone interested in lightening pigmented areas without the downtime. It is comprised of both AHA and BHA components to help with the exfoliation and cell turnover; 10% Salicyclic Acid, 10% Lactic Acid, and 10% Citric Acid. The BHA, salicylic acid, helps to keep pores clear and is good for those who suffer with acne and oily skin. Lactic Acid and Citric Acid help to give the skin an even, healthy glow.

The SkinMedica® Vitalize Peel is a moderate peel and appropriate for all Fitzpatrick Skin Types. It contains a proprietary blend of ingredients (AHA/BHA and retinoid acid) to help rejuvenate the skin and offer dramatic improvement in texture and tone. The renewal process stimulates collagen production, improved pigmentation- including melasma and sun spots, and acne scars. Achieve visible improvement after one treatment with optimal results after a series of treatments. This is a more aggressive peel in comparison to our ZO® Stimulator peel and it is recommended to have a skin evaluation and consult prior to treatment.

The pros to peels in the treatment of hyperpigmentation are a more cost effective approach in comparison to IPL for hyperpigmentation. In addition, light peels offer milder results, but have no downtime! Medium peels- such as the Vitalize peel- can yield more dramatic results, but may require up to one week of downtime and expected peeling. The downside to peels in the treatment of hyperpigmentation is that it may not be as effective as IPL for resolution of sun spots and melasma. Moreso, aggressive peels with higher percentages of active ingredients and TCA peels can lead to increased pigment if the skin becomes damaged in the process. One thing to consider and remember is that treatment of difficult hyperpigmentation can include multiple approaches and peels can be a wonderful additive to IPL (as well as skin care!).

3. Microneedling - $250+ per treatment

Microneedling involves piercing the skin to create microchannels- small wounds- to initiate the skin healing and regeneration process. The regeneration of skin cells that microneedling causes can disperse clusters of melanin and in turn- lighten dark spots. Microneedling in the treatment of hyperpigmentation has not been widely studied in isolation as a treatment for dark spots. It has been reviewed in conjunction with skin care, peels and other modalities and has proven to be a strong addition to a patient's comprehensive treatment regimen.