For all areas of the face and body and limbs including lips, under arms, privat area, elbows, knees, knuckles. There are ethnic predisposition and variability.
Common triggers of different kinds of pigmentation are:
Sun exposure: Ultraviolet (UV) light from the sun stimulates the melanocytes. In fact, just a small amount of sun exposure can make melasma return after fading. Sun exposure is why melasma often is worse in summer. It also is the main reason why many people with melasma get it again and again.
A change in hormones: Pregnant women often get melasma, Birth control pills, hormone replacement therapy, thyroid gland hormone disbalance, adrenal glands issues etc, other general internal disease and metabolic conditions.
Skin traumatisation (skin diseases and different medical and non-medical manipulation affecting and irritative skin products: very often after healing of active skin lesions and rushes the reaction of pigment cells is melanin production activation. Due to mechanical disorder of pigment distribution within different layers of skin and pathological stimulation melanocytes the post inflammatory hyperpigmentation occurs.
If a product irritates your skin, pigmentation can worsen.
At Dermacare we use professional dermatological approach to treat such a complex pigmentation disorders with more than 20 years of success. We consider every patient deserves proper medical assessment with identification of main trigger mechanism to target not just a skin hyperpigmentation.
Despite of permanent or temporal triggers presence at Dermacare the topical signature mixture of medical ingredients prescriptions along and in combination with latest proven laser technology allow us to say that success in pigmentation disorders treatment is very high.
As adjuvant therapy and maintenance is medical aesthetic procedures to help uniform the skin color and glow/brighten the tone.
Post Traumatic Hyperpigmentation
Under Eye Dark Circles
Dermatologists can diagnose most patients by looking at their skin. To see how deeply the melasma penetrates the skin, your dermatologist may look at your skin under a device called a Wood’s light.
Sometimes melasma can look like another skin condition. To rule out another skin condition, your dermatologist may need to remove a small bit of skin. This procedure is called a skin biopsy. A dermatologist can safely and quickly perform a skin biopsy during an office visit.
Melasma can fade on its own. This usually happens when a trigger, such as a pregnancy or birth control pills, causes the melasma. When a woman delivers her baby or stops taking the birth control pills, melasma can fade.
Some people, however, have melasma for years — or even a lifetime. If the melasma does not go away or a woman wants to keep taking birth control pills, melasma treatments are available. These include:
Hydroquinone: This medicine is a common first treatment for melasma. It is applied to the skin and works by lightening the skin. You will find hydroquinone in medicine that comes as a cream, lotion, gel, or liquid. You can get some of these without a prescription. These products contain less hydroquinone than a product that your dermatologist can prescribe.
Tretinoin and corticosteroids: To enhance skin lightening, your dermatologist may prescribe a second medicine. This medicine may be tretinoin or a corticosteroid. Sometimes a medicine contains 3 medicines (hydroquinone, tretinoin, and a corticosteroid) in 1 cream. This is often called a triple cream.
Other topical (applied to the skin) medicines: Your dermatologist may prescribe azelaic acid or kojic acid to help lighten melasma.
Procedures: If medicine you apply to your skin does not get rid of your melasma, a procedure may succeed. Procedures for melasma include a chemical peel, microdermabrasion, dermabrasion, laser treatment, or a light-based procedure. Only a dermatologist should perform these procedures.
New skin problems can occur when the person who gives the treatment does not tailor it to the patient’s skin type.
Ask your dermatologist about possible side effects (health problems that can result from the treatment).
If you notice any of the following after getting treatment for melasma, be sure to call your dermatologist:
Darkening of the skin
Dark Circles treatment
Have you tried treating dark spots on your own without getting the results you want? Do you constantly see new dark spots appear as others fade?
If you answered yes, you’re not alone. Darks spots and patches rank as one of the most common reasons that people with skin of color see a dermatologist.
Effective treatment begins with understanding why you get this discoloration. If you can eliminate the cause, many spots will clear on their own and you can prevent new ones from appearing.
Why dark spots and patches appear
People who have medium to darkly colored skin get dark spots and patches because something triggers their skin to make extra melanin, the substance that gives skin its color. Many everyday things can trigger extra melanin in people who have skin of color.
Dark spots and patches often appear when:
A pimple or patch of psoriasis clears
A wound caused by an insect bite, cut, burn, or other injury heals
You take (or apply) certain medications
A skin or hair care product irritates your skin
Changes due to hormones occur, such as during pregnancy
If you treat a skin condition like acne or psoriasis so that you stop the flare-ups or breakouts, you’ll eliminate what’s causing the discoloration. Most dark spots will then fade on their own.
Likewise, if you find that a skin care product is causing the discoloration, switching to a gentle product that doesn’t irritate your skin can stop new dark spots from forming and allow existing spots to clear.
Freckles, sometimes called ephelides (singular ephelis), are clusters of concentrated melaninized cells which are most easily visible on people with a fair complexion. Freckles do not have an increased number of the melanin-producing cells, or melanocytes, but instead have melanocytes that overproduce melanin granules (melanosomes) changing the coloration of the outer skin cells (keratinocytes). As such, freckles are different from lentigines and moles.
Ephelides describes a freckle which is flat and light brown or red and fades with reduction of sun exposure. Ephelides are more common in those with light complexions, although they are found on people with a variety of skin tones. The regular use of sunblock can inhibit their development.
Liver spots (also known as sun spots and lentigines) look like large freckles, but they form after years of exposure to the sun. Liver spots are more common in older people
The formation of freckles is triggered by exposure to sunlight. The exposure to UV-B radiation activates melanocytes to increase melanin production, which can cause freckles to become darker and more visible.
Freckles are predominantly found on the face, although they may appear on any skin exposed to the sun, such as arms or shoulders. Heavily distributed concentrations of melanin may cause freckles to multiply and cover an entire area of skin, such as the face. Freckles are rare on infants, and more commonly found on children before puberty. Upon exposure to the sun, freckles will reappear if they have been altered with creams or lasers and not protected from the sun, but do fade with age in some cases.
Freckles are not a skin disorder, but people with freckles generally have a lower concentration of photo-protective melanin, and are therefore more susceptible to the harmful effects of UV radiation. It is suggested that people whose skin tends to freckle should avoid overexposure to sun and use sunscreen.
The presence of freckles is related to rare alleles of the MC1R gene, though it does not differentiate whether an individual will have freckles if they have one or even two copies of this gene. Also, individuals with no copies of the MC1R do sometimes display freckles. Even so, individuals with a high number of freckling sites have one or more of variants of the MC1R gene. Of the variants of the MC1R gene Arg151Cys, Arg160Trp, and Asp294His are the most common in the freckled subjects. The MC1R gene is also associated with red hair more strongly than with freckles. Most red-haired individuals have two variants of the MC1R gene and almost all have one. The variants that cause red hair are the same that cause freckling. Freckling can also be found in areas, such as Japan, where red hair is not seen. These individuals have the variant Val92Met which is also found in Caucasians, although it has minimal effects on their pigmentation. The R162Q allele has a disputed involvement in freckling.
The variants of the MC1R gene that are linked with freckles started to emerge in the human genotype when humans started to leave Africa. The variant Val92Met arose somewhere between 250,000 - 100,000 years ago, long enough for this gene to be carried by humans into central Asia. Arg160Trp is estimated to have arisen around 80,000 years ago while Arg151Cys and Asp294His have been estimated to arise around 30,000 years ago. The wide variation of the MC1R gene exists in people of European descent because of the lack of strong environmental pressures on the gene. The original allele of MC1R coded for dark skin with a high melanin content in the cells. The high melanin content is protective in areas of high UV light exposure. The need was less as humans moved into higher latitudes where incoming sunlight has lower UV light content. The adaptation of lighter skin is needed so that individuals in higher latitudes can still absorb enough UV for the production of vitamin D. Freckled individuals tend to tan less and have very light skin, which would have helped the individuals that expressed these genes absorb vitamin D.
Under a dermatologist’s care, many people with melasma have a good outcome. Melasma can be stubborn, though. It may take a few months of treatment to see improvement. It is important to follow your dermatologist’s advice. This ensures that you get the most benefit from treatment. It also can help avoid skin irritation and other side effects.
After your melasma clears, you may need to keep treating your skin. Your dermatologist may call this maintenance therapy. Maintenance therapy can prevent melasma from returning.
You can help prevent your melasma from returning by wearing sunscreen and a wide-brimmed hat every day.
Post Acne Blemishes
What's the difference between acne marks and acne scars?
In order to treat acne marks and scars, it's helpful to learn how to distinguish between the two. Patients often mistake dark spots for acne scars but they're actually very different, the red, purple, or brown marks that linger after a pimple or blemish has disappeared are classified by derms as post-inflammatory hyperpigmentation. These marks can take between 3-6 months to go away on their own. You can expedite the process with a diligent treatment of topical retinoids, vitamin C serums, sunscreen, and over-the-counter brighteners." True acne scars, however, are permanent indentations from collagen damage and can come in many shapes and forms, and laser treatments and temporary dermal fillers are the only ways to treat the issue. Some scars are thick, raised hypertrophic scars that stick out above the skin; others are keloid, which are scars that have over-healed, and manifest as dense, rubbery skin tissue. Then, there are atrophic scars that appear as depressions in the skin — they're the most challenging to treat. The three main categories of atrophic scars are:
Ice pick scars: Deeper than they are wide, with jagged edges. Sometimes they resemble a large, scooped out pore.
Boxcar scars: Broad, rectangular depressions with steep, defined edges.
Rolling scars: Broad depressions that have rounded, sloping edges, hence the name.
What causes acne scars and dark marks?
The spots that linger after a pimple has healed are caused by inflammation that has disrupted the skin's natural healing process. "When your skin is opened up, like when you pop a pimple, and then closes back together, you can get abnormal pigmentation, texture, and tone that looks different from the rest of your skin. Sometimes the broken blood vessels that remain after an acne lesion fades can result in a mark," says Dr. Bowe. For a number of people who are able to refrain from picking, inflamed pimples or blemishes can still leave a dark brown or red mark — but these naturally fade over the course of a few months.
The tone of your skin makes a huge difference in the shade of the spot. "In lighter skin tones, red or purple marks are more common and fade over a few weeks. For darker skin tones, a pimple typically leaves a brown mark that takes on average four months to go away on its own," says Dr. Woolery-Lloyd, who founded Specific Beauty, a skincare line specifically designed to treat uneven skin tones, hyperpigmenation, and other issues that women of color tend to face.
Since it's pretty difficult to determine what causes one person to scar more than another, the best way to avoid scarring is to treat acne with a great skin care routine — and that means you need to resist picking, poking, or touching a pimple.
But, sometimes a particularly aggressive blemish is truly on a mission to leave its permanent mark. "Acne scars occur when normal tissue in the skin is destroyed and replaced with fibrous tissue. You can think of an acne lesion as a wound. When the damage caused by acne is severe, the body can respond by creating too much tissue or too little tissue. The production of too much tissue forms a keloid or a hypertrophic scar, and too little tissue leads to that depression in the skin, or atrophic scar. The deeper and more inflamed the acne lesion, or the more that it is picked or squeezed, the more likely it is to scar.
Some acne marks and scars are completely within your control while others are pre-determined. Aside from genetics, there are several lifestyle habits that can make dark marks and scars worse. "Sun exposure can supercharge melanocytes, or pigment-producing cells, causing marks and scars to darken." And, to reiterate one last time, picking or squeezing pimples creates further inflammation and can ultimately lead to more damage.
Here's the full run-down on how to get rid of acne marks and scars.
How to treat acne dark marks:
"The discoloration from dark marks will usually fade over time, but there are a number of treatment options to help speed up the process."
Post Burn Pigmentation
Post inflammatory pigmentation is temporary pigmentation that follows injury (e.g. thermal burn) or inflammatory disorder of the skin (e.g. dermatitis, infection). It is mostly observed in darker skin types. Post inflammatory pigmentation is also called acquired melanosis. More severe injury results in postinflammatory hypopigmentation, which is usually permanent.
Who gets post inflammatory pigmentation?
Post inflammatory hyper pigmentation can occur in anyone, but is more common in darker skinned individuals, in whom the colour tends to be more intense and persist for a longer period than in lighter skin colours. Pigmentation tends to more pronounced in sun-induced skin conditions such as phytophotodermatitis and lichenoid dermatoses(skin conditions with lichen planus-like inflammation, such as erythema dyschromicum perstans).
Some medications may also darken post inflammatory pigmentation. These include antimalarial drugs, clofazimine, tetracycline, anticancer drugs such as bleomycin (flagellate erythema), doxorubicin, 5-fluorouracil and busulfan.
What causes post inflammatory hyper pigmentation?
Post inflammatory hyper pigmentation follows damage to the epidermis and/or dermis with deposition of melaninwithin the keratinocytes (skin cells) and/or dermis.
Inflammation in the epidermis stimulates melanocytes to increase melanin synthesis and to transfer the pigment to surrounding keratinocytes (epidermal melanosis). If the basal layer is injured (e.g. lichen planus), melanin pigment is released and subsequently trapped by macrophages in the papillary dermis (dermal melanosis or pigment incontinence).
What are the clinical features of post inflammatory hyper pigmentation?
Post inflammatory hyper pigmented patches are located at the site of the original disease after it has healed. The lesions range from light brown to black in colour. The patches may become darker if exposed to sunlight (UV rays).
Post Traumatic Hyper pigmentation
The treatment of post inflammatory hyper pigmentation (PIH) tends to be a difficult and prolonged process that often takes 6-12 months to achieve the desired results of depigmentation. Each of these treatment options potentially improves epidermal hyper melanosis, but none is proven effective for dermal hyper melanosis. Daily use of a broad-spectrum sunscreen (sun protection factor [SPF] 15 or greater) is an essential part of any therapeutic regimen.
A variety of topical treatments have been used to treat epidermal post inflammatory hyper pigmentation, with varying degrees of success. These agents include hydroquinone, tretinoin cream, corticosteroids, glycolic acid (GA), and azelaic acid. Lightening of hyper pigmented areas may be achieved with one of the previously named topical agents; however, a combination of topical creams and gels, chemical peels, and sunscreens may be necessary for significant improvement.