Askanesthetician's Blog

An esthetician explores skincare issues and concerns

Why Is Hyperpigmentation So Hard To Get Rid Of? June 23, 2016



One of the more difficult skincare problems to solve is hyperpigmentation or dark spots on your skin.  This is also a very prevalent skincare issue that affects people of all skin tones.   Just where do these frustrating spots come from and how can you get rid of them for good? In this post I want to give you some insight into what causes hyperpigmentation in the first place and how to combat it effectively.

How Does Hyperpigmentation Form?

There are a few different types of hyperpigmentation or dark (brown) spots that can form on the skin.  You can get hyperpigmentation from the sun, from hormones, or as a result of an injury to the skin.  This last type of hyperpigmentation includes the marks that show up on the skin after a pimple heals.  (Please keep in mind that while many people call the red or brown marks that are left on the skin after a breakout heals “acne scars” they are definitely not scars but rather hyperpigmentation)   Certain ethnicities are more prone to hyperpigmentation than others.  Interestingly enough the treatment for hyperpigmentation is the same no matter its source.

I’ve been having an internal debate how technical I should be in explaining how hyperpigmentation forms because it is easy to get very lost among the scientific terms and processes that occur in the skin.  I also feel that such an explanation can be a bit overwhelming for non-science people (I include myself in that category).

I decided to take a middle of the road approach in my explanation.  Here it goes.  Your epidermis (the top layer of your skin) contains melanocytes which produce melanin. Melanin determines your skin color and tone. Everyone has the same number of melanocyctes in their skin; your skin color is determined by the amount of melanin activated in the skin.  Melanin is also the pigment that protects your skin from UV rays.  So when your skin experiences excessive sun exposure or prolonged sun exposure year after year, day after day more melanin is produced in order to protect your skin from the sun’s damaging rays.  A tan is actually a sign of your skin’s “self defense” mechanism kicking into gear.  Sorry to say but with every tan you get you’ve done damage to your skin. Dark spots from the sun can show up in a cluster on one area of your face, perhaps on the side of your face that is exposed to a window in your office or while driving, and can take years to appear after the initial damage has been done to your skin.  Many times as an esthetician I find it hard to convince people to use sunscreen on a daily basis simply because the damage daily sun exposure is doing to their skin is not evident at first.  It can be hard to for people to realize that they need sunscreen everyday when the damage they will see from the sun will only show up 10, 20 years later.  So please remember to apply sunscreen daily in order to prevent hyperpigmentation in the future.

Melasma is the hormonal hyperpigmentation.  Many women develop this type of hyperpigmentation during and after a pregnancy or from using birth control pills.  The hormonal changes that are going on in your body due to pregnancy or the use of birth control pills cause this type of hyperpigmentation to form though exactly what doctors are still not entirely sure.  Sun exposure can make melasma worse. Some lucky women may find that their dark spots fade a bit after giving birth, but for many women this type of hyperpigmentation is an unhappy side effect from a happy life event.

Post inflammatory hyperpigmentation is the red, brown, or even yellow marks that are left on the skin after an injury to the skin or after a breakout has healed. Once again as a defense mechanism, in this case a defense against skin inflammation, the body produces extra melanin.  If there is one positive from this type of hyperpigmentation it is usually the easiest kind to get rid of.


First of all it is important to keep something in mind when treating hyperpigmentation – there are no quick fixes for this skin care problem.  You need time, patience, and the daily use of skin care products in order to get rid of hyperpigmentation.  If you have had a dark spot on your face for 6 years you cannot expect it to disappear in just a month.  When I say patience I really mean it.  You need to religiously use the right skin care products at home in order to eventually see results months down the road.  Once hyperpigmentation occurs, with the exception of red marks (and some types of brown marks) left on the skin after breakouts heal, your dark spots have no real desire to go anywhere.  If anyone promises you a miracle cure for hyperpigmentation run in the opposite direction.  Also please don’t put lemon juice all over your face and go out in the sun expecting to fade dark spots.  No matter how many times this skincare hack appears in your Pinterest feed you need to ignore it.  You’ll just end up making your skin more sensitive or even causing burns instead of helping your skin if you follow this “tip”.

One of the reasons hyperpigmentation is so hard to get rid of is because you actually have to treat your skin in two different ways at the same time in order to lighten dark spots.  Though the skincare industry is constantly changing and innovating at the moment the accepted way to treat hyperpigmentation is to shutdown or suppress the production of new melanin, prevent the transfer of new melanin to the melanocyctes, and remove the existing dark spots.  This requires a combination of products to achieve; there is currently no one product on the market that can do all three of these things.  Usually hyperpigmentation is treated with one product that supresses melanin production and another product that brings excess melanin to the surface of the skin and then helps it flake off.

In the United States one of the more prevalent skincare ingredients used to treat hyperpigmentation effectively is hydroquinone.  Hydroquinone is controversial for a few different reasons and has been replaced by a host of other ingredients to brighten dark spots because of the controversy surrounding it.  In order to better understand the controversy about hydroquinone I suggest reading Dr. Leslie Baumann’s article that I have listed below in “sources and further reading”.  There is a lot of misinformation circulating about hydroquinone so be sure to educate yourself on this topic before buying into the anti-hydroquinone hype.

Other skincare ingredients that can help treat hyperpigmentation are:  Vitamin C, kojic acid, licorice, arbutin, and azelaic acid.   A product with one or more of these ingredients is best paired with a retinol (or prescription Retin-A) for best results.  You can also use a product that brightens dark spots in conjunction with an AHA exfoliator though keep in mind a strong exfoliator can actually make hyperpigmentation worse or even cause hyperpigmentation for people with sensitive.  When in doubt see a professional in order to create the perfect skincare regime for your skin.  And above all, apply a generous amount of sunscreen each and everyday!  Use at least SPF 30 and make sure your sunscreen protects from both UVA and UVB rays.  Don’t think that your make-up with SPF is giving you enough sun protection because you’ll never apply enough make-up in order to reach the amount of SPF listed on the product.  So be sure to always apply a sunscreen first and then your moisturizer and make-up.

Other Treatment Options

If you have the money for more expensive in-office treatments getting laser treatments from a dermatologist should produce faster results than using just home care products to treat your hyperpigmentation.  Of course you’ll get the best results from a laser treatment if you take proper care of your skin both before and after the treatment.  Follow the advice the doctor or their esthetician gives you; if they don’t give you any before and after advice go to another office.

You can also see an esthetician or dermatologist for a series of chemical peels that coupled with the correct home care regime can help get rid of hyperpigmentation once again faster than if you were just using products at home.  Just as you need a good home care skincare regime before and after a laser treatment in order to get the best results you need to do the same with a chemical peel.

Sources and Further Reading:

My Related Posts:



Chemical Peels for Darker Skin Tones October 16, 2012

Recently a blog reader who was African-American asked if it was safe for her to get a chemical peel.  My answer was resounding “yes, but” and by that I meant – yes, but make sure you are careful.  The reason for my warning?  The darker your skin tone the more prone you are to hyperpigmentation which means you can receive a chemical peel you just can’t have a very deep one.

First let me just refresh your memory, in case you need it, to the benefits of chemical peels.  The WebMD article Chemical Peels and Your Skin explains what peels can do for your skin:

Chemical peels can be done on the face, neck, or hands. They can be used to:

  • Reduce fine lines under the eyes and around the mouth
  • Treat wrinkles caused by sun damage and aging
  • Improve the appearance of mild scars
  • Treat certain types of acne
  • Reduce age spots, freckles, and dark patches (melasma) due to pregnancy or taking birth control pills
  • Improve the look and feel of skin

Areas of sun damage may improve after chemical peeling.

After a chemical peel, skin is temporarily more sensitive to the sun, so wear sunscreen every day.

According to the Skin Inc. article Understanding Darker Skin Tones does a good job of explaining the unique issues facing darker skin tones:

Despite prevailing misconceptions, if you’ve got darker skin, you’re not immune to the effects of sun damage and premature aging. While the rules of cleanse, moisturize and SPF apply to everyone, darker tones do need unique care. Mona Gohara, MD, assistant clinical professor at the Yale University School of Medicine department of dermatology in New Haven, CT, a key promoter of skin care awareness and sun safety in non-Caucasian populations, explains the chemistry and concerns of darker skin.

1. What is the basic skin biology of people of color?

There are three layers that comprise the human skin: the epidermis, the dermis and fat. Within the epidermis there are pigment-producing cells called melanocytes. Melanocytes produce melanin, which is the substance that confers skin color. People all have the same number of melanocytes, regardless of complexion–the browner you are, the more melanin you are producing. In short, melanin determines skin color. Melanin has many different functions in human skin. Most importantly, it provides inherent protection against the sun and is a natural antioxidant.

2. What are some of the common skin issues affecting people with darker skin tones? Are these issues different than people with lighter skin tones and if so, why?

Post-inflammatory hyperpigmentation (PIH) is a condition that occurs more frequently in individuals with darker skin. It is localized skin darkening that occurs after trauma or inflammation. For example, when people of color get a pimple, for some reason melanocytes rev up and produce more melanin. As a result, when the lesion fades, the skin gets darker. The same phenomenon applies for cuts, bruises and resolving rashes. To treat PIH, you need to use an SPF of 30 or higher every day, and give it time. Other remedies such as hydroquinones, retinol, glycolic acid and chemical peels can also help speed up the process.

So how can you make sure that you are helping your skin instead of hurting it when you get a chemical peel?  According to the article Peels and Hyperpigmentation by Pamela Springer from the July/August 2012 issue of Skin Deep you need to keep the following things in mind:

Generally, peels and other exfoliating agents are used to resolve photodamage, fine lines and wrinkles, and dyschromias (the brown spots associated with aging).  These conditions are most often seen in individuals with lighter skin coloring, Fitzpatrick I-III.  Those with pigmented skin, Fitzpatrick IV-VI, are more likely to have conditions such as dark postacne lesions, hyperkeratosis, pigmentary reactions, pseudofolliculitis barbae, or textural changes.  But despite the disparities, dark skin is not as complex as one would image, and it will respond well to superficial chemical peeling as long as certain protocols are followed.  …

The outcome of a chemical peel is determined by how well the skin has been prepared.  For darker skin, the concern is avoiding PIH [post inflammatory hyperpigmentation].  Peels that penetrate too deeply can generate heat or erythema (redness) while on the skin, potentially altering melanin synthesis and/or causing abnormal melanin distribution.  Deep penetration can also destroy the melanocyte, leaving an area of the skin void of color.

To decrease this risk, the client should be placed on a pretreatment home-care regimen for four to eight weeks (depending on how dark the skin is) prior to a scheduled light- or medium-depth peel.  During this time, the goal is either repair the acid mantle or to perform other treatments that will enhance the outcome of the peel.  If the acid mantle is intact, the home-care regime should consist of a skin-lightening agent, 2-5 percent glycolic products, and a full-spectrum sunscreen.

There should be visible reduction of dyschromias after two to three weeks of the home-care regimen.  Priming the skin in this manner will go a long way toward eliminating post-peel complications.

The article further points out that manufacturer instructions for peels can be modified in order to work for darker skin tones.  For instance a peel that is supposed to be left on the skin for 5 minutes should be left on for 1 or 2 minutes on darker skin tones.  There are numerous peeling agents that can be used successfully on darker skin tones such as:  lactic acid, mandelic acid, salicylic acid, and jessner’s solution.

Tips for Before and After A Peel

If you are considering a peel and have a darker skin tone do some of research before getting a peel.  If you have a spa or doctor’s office in mind for where you want to do the peel ask to come in for either a facial or at the very least for a discussion with the esthetician who will performing the peel.  This way the esthetician can understand your skincare concerns and see your skin before the peel.  This is also the right time to assess what sort of pre-peel regime you need to be on at home in order to both enhance the peel results and to prevent any complications for arising.  This pre-peel consultation and/or facial is essential for the receiving the best result with your peel.  The esthetician should be able to clearly explain what type of peel she would choose to do on your skin and why and how she might modify the peel because of your skin color/tone.  You should also discuss post-peel treatments in order to calm the skin and prevent any PIH.  If you have any allergies, have had an adverse reaction to a skincare product or ingredient in the past, are on any medications and/or prescription skincare products, or spend a lot of time in the sun all of these issues need to be discussed in length with your esthetician before having a peel.  Also keep in mind that sometimes the best results from peels come after a series not just from one peel.

Bottom Line:  Anyone with a darker skin tone can benefit from a chemical peel as long as they properly prepare their skin before hand, receive the peel from someone who knows the risks in involved with peeling darker skin tones, and practices proper post-peel care.  Chemicals peels remain a viable and great option for a host of skin issues for all skin colors and ethnicities.

My Related Posts:

General Reading About Chemical Peels:

Articles About Ethnic Skincare:

Image – Three Friends by William H. Johnson from


Why You Should Never Pick or Pop Your Pimples March 21, 2011

Filed under: Acne — askanesthetician @ 6:48 am
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I have a confession to make – I pop my pimples.  Yes, I tell my clients all the time that they shouldn’t ever pop their pimples or pick at their skin, and though I truly know how bad it is for my skin to pop my pimples I still do it.  Anyone who has ever popped a pimple knows how addictive that act can be.  Once you do it is hard to stop.  But here’s why you should avoid popping pimples and why you should never pick at your skin.

This is the thing – if you pop or pick at your pimples they will take longer to heal and could get worse, you risk damaging your skin by pressing and pushing on it aggressively, you could push the bacteria from the pimple deeper into your skin instead of expelling it, and you really run the risk of having the pimple leave a mark or even a scar.  Believe me I’ve been there – every time I pop a pimple I am left with a post inflammatory red mark in the area of the pimple that sticks around for about six months.  Concealer is one of my best make-up friends.

Having said all that I know how hard it can be to keep your hands off of pimples, particularly the red ones with pus.  Believe me I know – I still have trouble keeping my hands off the ones with pus.  So is there a safe way to pop pimples?  Truthfully – not really.  BUT if you insist on squeezing your pimples you can look for some suggestions on how to do this in the book Breaking Out by Lydia Preston on page 151. 

The bottom line is this – hands off your pimples!  Be patient, apply topical anti-acne products to your breakout, and wait it out.  Your skin will thank you later.


13 Reasons You Should Get A Chemical Peel From An Esthetician April 11, 2010

I think chemical peels are great and not just because they are part of my repertoire as an esthetician.  I like to think of chemical peels as a “reboot” for your skin allowing healthy skin appear.  A series of chemical peels can help treat a myriad of skin issues.  There really is no reason not to try one.

This post addresses the issue of chemical peels performed by estheticians.  There are plenty of “peels” that are available for home use.  Peels that you use at home provide very superficial peeling, simply exfoliation, and can help you maintain even toned, healthy skin.  Chemical peels performed by estheticians have a lower pH than home use products so that they can penetrate much deeper into the skin, will normally cause you to turn red, a lot of time your skin will peel following a peel, and these peels, when performed in a series, can treatment skin conditions such as hyperpigmentation and acne.  Simply put – a chemical peel performed by an esthetician will do a lot more for your skin than a home use product called a peel.

What Are Chemical Peels?

There are many different types of chemical peels, and each company that sells peels has its own series of formulations.  Having said that the chemical peels used by estheticians are generally a solution that has a combination or sometimes just one alpha hydroxy acid (AHA) or beta hydroxy acid (BHA).   The solution is applied to the skin, normally in layers though some peels are simply one layer, like a treatment mask.  The peel is either removed at the end of the treatment or left on to self-neutralize.  The acids in the peel work to dissolve the top layers of the skin creating a controlled wound and thus allowing the skin to regenerate itself.

Reasons to get a Chemical Peel

A chemical peel will:

  1. Improve the texture of your skin
  2. Increase the cell turnover rate of your skin
  3. Improve your skin’s ability to hold moisture
  4. Help your skin produce more collagen
  5. Reduce fine lines
  6. Decrease hyperpigmentation
  7. Unclog pores and help clear up acne
  8. Leave your skin smooth
  9. Make your skin softer
  10. Make your skin look more even-toned
  11. Give you a “glow”
  12. Make your skin look dewy
  13. Improve minor scarring

A chemical peel cannot make dramatic improvements to deep wrinkles or very sagging skin.  Conditions like that need to be treated with lasers or cosmetic surgery.

Who Can Get a Chemical Peel?

Truthfully pretty much anyone can get a peel as long as they don’t have any of the contraindictions listed below for peels.  Generally people with darker skin need to take more precautions before getting a peel and must make sure that the peel they are receiving is formulated for their skin type.  The reason for this is that very strong chemical peels can actually cause more hyperpigmentation on darker skin.

Contraindications:  It is generally recommended that pregnant and nursing women not receive peels since there are no studies, as of yet, about the effects of peels on fetuses or nursing babies.  You cannot get a peel if you have been off Accutane for less than 6 months.  If you are prone to cold sores a peel can actually bring on an outbreak so you need to take anti-viral medication before, the day of, and the day after your treatment.  Also if you have a tendency to scar, are taking antibiotics, have cancer or an autoimmune disease, or have an open sore you cannot get a chemical peel.

Everyone’s skin will be more sensitive to sunlight following a peel so make sure that you have plenty of sunscreen on hand after your peel, and be sure to vigilantly apply and reapply your sunscreen after a peel.  Hopefully the esthetician who performed the peel will either include post-peel products in the price of the peel or have them available for purchase at a reasonable price.

Make sure that the esthetician who is performing the peel has asked you an extensive list of questions before going ahead with your peel.  An esthetician must keep many factors in mind before performing a peel so that the client gets the best possible result with the fewest possible side effects.  You will be asked questions about medical conditions, allergies, the products you are currently using, and the results you want to achieve.  You may also want to go with a lighter peel the first time you get a chemical peel and build up the strength of your peels from there.  All of these issues should be discussed with your esthetician before you receive your first peel.

How Are Peels Performed?

Before you get a peel you should exfoliate at home or have a professional microdermabrasion treatment so that your skin in properly prepped for the peel.  Your skin will be cleansed and “degreased” before the peel is actually applied.  This means that all surface oils and debris are removed so that the peel can penetrate properly.

How Does It Feel?

Generally you will feel a warmth over the area being peeled during the procedure.  The esthetician performing the peel will either fan the area being peeled or provide you with a small electric fan to hold over the area.  You may feel stinging, burning, and even itching while the peel in performed.  Those sensations will stop once the peel is over.  Your esthetician will check in with you throughout the peel so if you ever feel any great discomfort she or he will know to stop the peel immediately.

What to Expect After a Peel

As I already mentioned first and foremost your skin will be quite sensitive to the sun following a peel so be extra vigilant about sunscreen use following your peel.   Because of this it usually isn’t a good idea to get peels in the summer or right before going on a vacation to a warm climate.

Following a peel your skin will feel tight and then a little dry.  You may remain red for an hour or so following the peel.  If you peel after the chemical peel treatment peeling will begin approximately 3 to 5 days following your peel.  The extent of peeling varies according to the person and the depth of the peel.  Not everyone peels following a chemical peel actually.  Some people have some mild itching following their peels.

Keep In Mind

Because chemical peels are stimulating you actually need to modify your lifestyle behavior slightly following a peel so that you don’t cause any unneeded irritation or hyperpigmentation to your skin.  So following a peel avoid excessive exercise with sweating for a few days.  Don’t scrub or pick at your face.  You cannot use retinol products or AHA products for at least 10 days following your peel.  And avoid any sort of excessive heat source like a sauna or hot tub.

How Often Can You Get a Chemical Peel?

Generally it is best to get a peel every four to six weeks.  But if you suffer from acne there are some peels that you can do every two weeks until you get the results you want.  Generally it is a great idea to buy a series of four or five peels up front so that you can achieve the treatment results that you want.  Also when you buy a series of peels upfront you will probably receive a discount.  Consider buying a deal that allows you to get chemical peels interspersed with microdermabrasion treatments or facials.  The microdermabrasions and the facials will enhance the results of the peel by helping to exfoliate the flaky skin you have on your face.  These treatments will also help prep your skin for your next peel.

When Will You See Results?

Truthfully chemical peels can be a bit unpredictable.  Some people see results as little as 10 days after their peels.  Other people won’t see results until about three weeks following their peel.  And for people who receive many facial treatments a chemical peel may just enhance the normal way their skin always looks.

Sources and Further Reading


Acne Marks and Scars: Treatment Options April 7, 2010

Once your acne has cleared you may be left with unsightly marks and scars on your skin which can remain for months, years, or even permanently.  For this reason acne marks and scars can be just as upsetting to the acne sufferer as the acne itself.  But before you despair there are lots of treatment options available to get rid of both acne marks and scars.

Post-Inflammatory Hyperpigmentation

The mark left on the skin from an inflamed acne lesion is a macule or a “pseudo scar” which is a flat, reddish spot on white skin, and brown, black, gray, blue, or even blue-black on skin of color.  This form of hyperpigmentation it is not raised or sunken.  This mark indicates that the inflamed acne lesion is in its final stage.  A mark like this can remain on the skin anywhere from a few weeks to six months or longer depending on how deep the damage extends into the layers of the skin.  For more information about post-inflammatory hyperpigmentation and how to treat it please see my previous post Help for Hyperpigmentation.

Acne Scars

Though post-inflammatory hyperpigmentation is unsightly and may take many months to heal, acne scars are a more troubling reminder of past acne lesions since they simply do not fade or heal with the passing of time.  Scars are reminders of injury to tissue and the body’s attempt to repair that injury. There are two main types of acne scars:  hypertrophic and atrophic.  Both are formed in the same way – inflamed lesions destroy a portion of the dermis and along with the collagen in that area.  There is no way to predict who will scar, how deep the scars will be, and if they will improve over time.  Most frequently scars result from severe inflammatory cystic, nodular acne.  Though by no means a perfect solution, one way to prevent scars or to ensure that they aren’t very severe is to treat acne as early as possible and for as long as necessary.  The faster you respond to the inflammation in the skin the more likely you are to prevent scars.  Though this, of course, is no guarantee that scars will not develop it is a way to perhaps help ensure they will not be deep scars.

Hypertrophic scars are created when the skin responds to injury by overproducing new collagen.  This type of scar is also called a keloid scar.  The excess amount of collagen that forms gets piled up in fibrous masses thus resulting in protruding, firm, and smooth scars.  Typically these scars are 1 to 2 millimeters in diameter, but some may be much larger – 1 centimeter or more.  Keloids can be red or purplish in color and most significantly, keloids extend above the skin’s surface.  This type of scar can hurt, be itchy, and even become infected.  There is a genetic connection when it comes to the formation of keloids with such a condition running in families, and the cause of this type of scar is not completely understood.  Unfortunately, once keloids develop they can grow both uncontrollably and unpredictably and even recur after treatment.  Keloids can be treated with localized injections of corticosteroid or interferon.  Laser treatments can be combined with steroid treatment in order to avoid a recurrence of scars.  Cryotherapy, the freezing of keloidal scars, can also be combined with steroid injections as a removal option.  There are also a few unproven therapies that might help keloids like using silicone sheets applied directly to the scar or applying creams such as Mederma and Aldara.  Sadly keloids remain difficult to treat and, as already mentioned, may even return after treatment.

Atrophic scars are caused when the damaged collagen only partially, or not at all, grows back.  This leaves a depressed area in the skin.  The website lists five different types of atrophic scars that can occur because of acne:

  • Ice pick scars that usually occur on the cheeks.  They are usually small and can be either shallow or deep, dark or soft to the touch.
  • Depressed fibrotic scars that are usually quite large and have sharp edges and steep sides.
  • Soft scars which are usually small and circular in shape.  They can be either superficial or deep  and are soft to the touch.
  • Atrophic macules are soft and often have a slightly wrinkled base.  They are small when they are on the face but can be a centimeter or larger on the body.
  • Follicular macular atrophy usually occurs on the chest or back.  These scars are small, soft, and white.

Atrophic acne scars cannot really be completely eliminated but with both resurfacing treatment and fillers they can be improved about 80%.  By seeing how a scar reacts to gentle stretching you can get a rough idea of what type of treatment would be best for you.  Shallow or soft-sided scars will almost or totally disappear when the skin is pulled taut; these types of scars can be corrected with resurfacing and fillers.  Scars that cannot be stretched out when you pull the skin generally require surgical excision to correct.

Numerous treatments exist for atrophic scars.  They include: excision, dermabrasion, chemical peels, laser treatments, skin fillers, and implants.  Very briefly I will describe each of these procedures:

  • Excision is used for ice pick scars and is done with a small surgical instrument whose size matches that of the scar being treated.  The entire scar area is punched out with the instrument.  There are variations on this technique, and it is combined with dermabrasion and laser treatment for the best result.
  • Dermabrasion is performed by doctor who uses a motorized tool with a metal head or a wire brush to remove the epidermis and the papillary layer of the skin.  Though tissue damage occurs it initiates a healing process by which new collagen is formed.  Though this is a very effective treatment for scars problems though pigmentation problems can develop even when the procedure is done properly.
  • Light chemical peels work by removing dead skin cells and promoting the production of collagen.  You need between four to eight light peels in order to see results.  Doctors can perform deep chemical peels that usually remove part of the epidermis.  This leads to collagen remodeling and renewal of the epidermis.  Trichloroacetic acid (TCA) is usually used for the deep peels, in concentrations of 20 to 70%.
  • Two types of laser treatments exist: ablative and nonablative.  Ablative lasers destroy tissue while nonablative target only a specific area and not do destroy tissue.  In both cases the regeneration of the epidermis occurs.
  • Skin fillers plump or elevate the area of the skin that is sunken.  Fillers fall into two main categories: biodegradable or permanent.  Biodegradable fillers are made from either human or animal tissues.  The body metabolizes these substances eventually and then most, if not all, of the benefits are lost.  The rate at which this metabolism occurs depends on the substance used and the individual’s unique characteristics.  There are both cow and human collagen fillers as well as hyaluronic acid fillers available.    Also fat from another area in the patient’s body can be injected into the face.  Permanent fillers are usually made from silicone and are supposed to stay in place pretty much permanently (as their name indicates), but silicone fillers are surrounded by controversy because of their link to autoimmune diseases and allergic reactions that can occur from their use.
  • Implants are the least commonly used technique to correct acne scars.  These are skin grafts that use skin from another area of the patient’s body.  This graft is implanted in the dermis beneath the acne scar.  Additionally, Synthetic implants made from polymers can be implanted beneath acne scars.

There are numerous treatments available that can significantly improve the look of acne marks and scars so there is no need to be unhappy with your appearance if you have post-inflammatory hyperpigmentation or acne scars (or both).  In order to find out what your best treatment option is it is important to talk to a qualified medical specialist.



Sources and Further Reading


Help for Hyperpigmentation February 11, 2010

Hyperpigmentation, dark spots, blotches, or areas on the skin, occurs when the body over produces pigment.  There are three main kinds of hyperpigmentation caused by three different factors .  No matter what type of hyperpigmentation you have there are many solutions to this skincare problem.

The three main types of hyperpigmentation are melasma, sun (sometimes called age) spots, and post inflammatory hyperpigmentation.  Melasma is caused by hormonal changes in the body; pregnancy and birth control pills can cause melasma.  Sun spots or sun damage is, obviously, caused by sun exposure.  The last type of hyperpigmentation is post-inflammatory hyperpigmentation.  This discoloration of the skin occurs after injury or irritation to the skin or after an acne lesion (pimple) has healed.

As already mentioned there are a number of treatments for hyperpigmentation.  First and foremost you must use a sunscreen, spf 30 or higher, daily and be sure to reapply throughout the day.  Sun exposure will only make your hyperpigmentation worse (i.e. darker) so it is important to protect the skin on a daily basis.  Daily use of sunscreen will also prevent new sun spots from forming.

There is only one FDA approved agent to reduce hyperpigmentation and this is hydroquinone.  Only products with hydroquinone in them can be legally labeled “lightening” products.  All other products that claim to help lighten hyperpigmentation without hydroquinone are usually labeled “brightening”, “bleaching”, and even “illuminating”.  Please remember that there is no legal definition of or oversight over the words “brightening”, “bleaching”, or “illuminating” found on product labels.  Be sure to turn the product you are looking at around and read the ingredients list. 

 Hydroquinone is a chemical lightening agent that comes in strengths of 1 to 2% in OTC products and 3 to 4% in prescription products like TriLuma.  To use a hydroquinone product you apply the cream, gel, or solution just to your dark marks twice a day for no longer than six months.  Hydroquinone works by inhibiting the tyrosinase enzyme which forms pigment in the skin as well as disrupting the synthesis of the melanin protein in the skin.  Because of its impact on the melanocyte it is thought that hydroquinone disrupts basic cellular processes including DNA and RNA synthesis.  Though hydroquinone has shown to be effective in treating hyperpigmentation it is far from a perfect ingredient and is surrounded by controversy.  For example, its use has been banned in the European Union and in Japan, and as recently as 2006 the FDA reported its intention to ban the use of hydroquinone in non-prescription products.  As of April 9, 2009 the Cosmetic Ingredient Review Board has listed hydroquinone under “ingredients found safe with qualifications” on its website and writes:  “≤1% in aqueous formulations; but only for brief discontinuous use followed by rinsing from skin and hair; and should not be used in any type of leave-on, non-drug cosmetic product”, but as of yet no ban on hydroquinone has gone into effect in the US.  The reason for all this concern about hydroquinone is that the ingredient has both potential mutagenic and cancer causing properties.  In addition to these upsetting issues some people are allergic to hydroquinone or develop contact dermatitis from using this ingredient.  All of these concerns and issues render hydroquinone an effective but unsatisfactory ingredient for some for treating hyperpigmentation.  Personally I feel that when hydroquinone is used for short periods of time, 3 to 6 months, there is no reason to be concerned over its use.  OTC products contain such a small percentage of hydroquinone, 1 to 2%, that I feel there is no need for alarm when you choose to use such a product.  (I have a list of links at the end of this post if you want to read more in-depth about hydroquinone.)

If you do not want to use hydroquinone, many alternatives exist.  Ingredients that are skin brighteners include: kojic acid, arbutin, licorice root, bearberry, soy, mulberry, vitamin C, niacinamide, and azaleic acid.  The current trend in products to treat hyperpigmentation is to combine several of the above mentioned ingredients in one product for better results.

Non-prescription products containing hydroquinone take a long time to work, as do the non-hydroquinone alternatives.  Prescription products usually work much faster.  The more superficial your hyperpigmentation is the easier it will be to remove.  Please also note that people with darker skin tones are more prone to hyperpigmentation, particularly post-inflammatory hyperpigmentation.  If you have darker skin you need to be more gentle when treating your hyperpigmentation so that you do not cause more irritation and/or hyperpigmentation to your skin.

There are other ways to treat hyperpigmentation; regular exfoliation can help get rid of hyperpigmentation.  For example you could use products containing glycolic acid, an alpha hydroxy acid, which works by exfoliating the uppermost layers of the skin.  More superficial dark marks can be removed with this type of  exfoliation.  Glycolic acid can be found in face washes, creams, gels, lotions, and chemical peels.  The form and concentration of the glycolic acid you should use will be determined by the severity of your dark marks and your skin’s reaction to the acid since glycolic acid can cause irritation to some people. 

Another treatment for hyperpigmentation is a series of chemical peels that include ingredients such as glycolic acid, lactic acid, hydroquinone, kojic acid, licorice root, mulberry extract, bearberry extract, azelaic acid, and ascorbic acid (Vitamin C).  The peels will use one or more of the above mentioned ingredients.  A series of chemicals peels can make quite a difference in the appearance of the skin and can definitely improve hyperpigmentation.  Side effects from chemical peels include redness and peeling for a few days after the peel.   To get the best results from your chemical peels it is a good idea to combine the esthetician or doctor administered peels with home products that treat hyperpigmentation.

Another great treatment option for hyperpigmentation are laser treatments.  Lasers such as the Ruby and Q-switched ND:YAG reach the dark spots deep in the skin, converting light to heat, and literally blow up dark spots which then flake off the skin.  Though the procedure only takes a few minutes redness and scabbing can occur; recovery time is about a week.  Intense Pulsed Light (IPL) treatments can also help hyperpigmentation with no downtime.

Just as there are a number of causes and types of hyperpigmentation there are also many different treatments.  Do a little research and give some thought to how your skin reacts to different ingredients before deciding what treatment option is best for you.  Eventually you should have no problem finding the right solution for your hyperpigmentation.


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