How to Treat Hyperpigmentation Flares

After summertime, it is common to see a sudden appearance or worsening of facial hyperpigmentation. There are several causes of skin hyperpigmentation, but often, it is due to prior inflammation in the skin or melasma. Melasma is a skin condition that causes brown patches, most commonly on the cheeks, nose, forehead, and upper lip, although it can appear in other areas. Melasma is usually symmetric (i.e., appears on both sides of the face) and can be exacerbated by sun exposure, heat and visible light, which makes it particularly noticeable in the summer months. It can also appear due to hormonal triggers like oral contraceptive pills, IUDs, hormone therapy and pregnancy. If you experience hyperpigmentation, it is important to be evaluated by your board-certified dermatologist to have it properly diagnosed, prior to pursuing any treatments. Every case of melasma presents differently, so while these are helpful guidelines, you should consult with your dermatologist first for a customized treatment plan.

What are some ingredients to help with hyper pigmentation?
Sunscreens are essential to prevent melasma from darkening due to sun exposure. The best sunscreen for patients with melasma is physical sunblock that contains zinc oxide as the active ingredient and is SPF 30 or higher. In addition to sun protection, it is important to regularly apply topical treatments to lighten hyperpigmentation. The most effective ones are hydroquinone, kojiic acid, azelaic acid, ascorbic acid, glycolic acid (AHA or alpha hydroxy acids), and retinoids. Most of these ingredients work by inhibiting pigment synthesis. AHAs and retinoids also increase cell turnover which effects skin permeability. This may allow for better penetration of other lightening agents when used in combination. In-office, we often formulate Re-Brightalyze pads for each patient’s specific needs. SkinMedica Lytera 2.0 can also be beneficial. These products combine antioxidants and lightening ingredients that produce the most consistent results without overly irritating the skin.

What treatments can help?
For best results, we recommend a combination approach of chemical peels, with or without microdermabrasion, and laser treatments. The Clear+Brillant Permea, Fraxel Restore Dual, Q-Switched lasers, Pico lasers, and Intense pulsed lasers have been used to successfully treat hyperpigmentation.

Chemical peeling agents resurface the skin by inducing a controlled wound and thus removing superficial layers of the skin. As a result, chemical peels promote the growth of a new healthy top skin layer and improve skin problems like hyperpigmentation, fine lines and wrinkles, uneven texture and skin impurities.  Read our chemical peel FAQ here for what to expect during your treatment with one of our medical aestheticians.

Our dermatologists will often recommend our Permea treatment in the summer time, which combines the Clear and Brilliant laser with a topical antioxidant treatment. The special Permea handpiece is optimized for brighter more even skin tone and enhanced skin permeability. It combines the laser treatment with a synergistic Skinceuticals CE Ferulic antioxidant treatment, which takes advantage of the increased skin permeability to achieve maximum patient benefits.

Clear+Brilliant: Six Treatments // With Patient Permission

What if I don’t respond to lasers or topical?
Most patients will see improvement with these courses of treatment. Another option is tranexamic acid, a prescription pill that has recently been shown to improve the appearance of melasma. The largest study on the use of oral tranexamic acid for treatment of melasma was a retrospective review of 561 melasma patients treated with tranexamic acid. More than 90% of patients received prior treatment of their melasma, including bleaching creams and energy-based laser treatment. Among patients who received oral tranexamic acid over a 4-month period, 90% of patients demonstrated improvement in their melasma severity.

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