Hyperpigmentation

• Age spots (sunspots, liver spots and solar lentigo)
• Melasma (chloasma)
• Freckles (ephelides)
• Acquired dermal melanocytosis (ADM)
• Senile warts (seborrheic keratosis)
• Postinflammatory hyperpigmentation (PIH)
• Nevus of Ota
• Nevus Spilus (Speckled Lentiginous Nevus)

These are small flat brown to dark brown spots with well-defined borders that appear on the face (cheeks and temples etc) and the hands, which are easily exposed to the sun.

Treatment

We use the Q-Switch Ruby Laser and the Ruby Fractional Laser to destroy melanin pigments. Darker spots are spot irradiated individually. While Ruby Fractional is a fractional irradiation of the Q-Switched Ruby Laser in the form of small dots. By reducing the total amount of heat applied to the skin, it is possible to irradiate the entire face of the patient with scattered spots and the occurrence of inflammatory hyperpigmentation can be reduced compared to spot irradiation. Additionally, heat diffusion by the laser is transmitted to the dermis and rejuvenates the entire skin. It is also important to continue the treatment to promote turnover of the superficial layers of the skin. This can be done with chemical peeling or microneedling such as Dermapen4.

To maintain and prevent the effects of treatment, it is most important to avoid sun exposure. Taking oral vitamin C and E is also effective. For patients with melasma, taking oral tranexamic acid (TXA) is also recommended.

Melasma is a light brown or brown patches with indistinct borders that appears symmetrically on both cheeks, usually starting in a person's thirties or forties. It is sometimes triggered by pregnancy or the use of oral contraceptives and is believed to be related to female hormones. Hormonal imbalance caused by emotional stress may also affect the appearance of these patches and physical stimulation such as excessive massaging may also aggravate them.

Treatment

Taking oral tranexamic acid (TXA) is effective in the treatment of melasma. By interrupting the melanin production in melanocytes, melasma and brown spots fade away. Hydroquinone cream is also effective as an ointment. Prevention is important such as avoiding exposure to sun and not to rub the skin too much.

For machine treatment in melasma, we use a needle RF (radiofrequency) device called a Thermoneedle to improve melasma. This is a procedure in which microneedles are inserted into the skin and radiofrequency energy is transmitted through the needles to the dermal layer. The melasma mode of the Thermoneedle, which delivers the appropriate energy to the melasma skin area, restructures the skin basement membrane and calms the activity of melanocytes.

Freckles often appear at the age of 5 to 6years old and are small light brown pigmented patches distributed over the nose and cheeks. They are often familial in origin and appear more intensely when exposed to sunlight. Freckles are prone to recurrence even after treatment, but the condition improves with sunlight protection and laser therapy. Freckles tend to disappear with Ruby Fractional irradiation. Prevention and recurrence are prevented with oral vitamins C and E and hydroquinone cream.

ADM usually develops after the age of 20 and appears symmetrically on the cheeks, nose, and forehead. It is difficult to distinguish it from melasma but the treatment is often successful. Q-Switch Ruby Laser and Ruby Fractional are effective treatments.

These are light brown or brown pigmented raised patches that occur frequently on the face. It is the same as age spots but in its advanced stages it may become an elevated pigmented spot. They may darken in the sun so shielding from the sun is important for prevention.

Treatment is covered by insurance. We recommend the Surgitron, a high-frequency scalpel that removes the lesions while scraping them off. There is also a malignant disease called actinic keratosis(keratosis solaris) which is similar to seborrheic keratosis so the excised tissue undergoes pathological examination. After the excision, we recommend the patient to shield the area from the sun by taping and oral intake of vitamin C to prevent hyperpigmentation and the appearance of new lesions.

Inflammation such as acne scars, insect bites, injury scars and after laser treatment of pigmentation spots can cause hyperpigmentation. Postinflammatory hyperpigmentation resolves spontaneously in six months to a year, but may be difficult to remove due to sunlight or friction. Treatment is to keep safe from sunlight and to avoid hard rubbing. Oral intake of vitamin C and hydroquinone cream may also be used. When acne is the cause, it is important to treat the acne and take measures to prevent sunburn.

Nerves of Ota are bluish bruises on the face, which are more common in women and appear from childhood to puberty. They appear on one side of the face, mainly around the eyes and cheeks. Q-Switch Ruby Laser is used for treatment. Insurance coverage is available but there are certain conditions for the coverage that will be discussed during consultation.

Nevus Spilus are brown pigmented patches that do not rise like moles. It is mostly present at birth but if it occurs at puberty, it often grows hair at the same time. Treatment is performed by Q-Switch Ruby Laser. However, it is not effective for all patients and a trial irradiation is recommended. It has been reported that good results are often observed when the laser treatment is performed during childhood thus early consultation is recommended.