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DCCC Skin Notes Gavin R Powell, MD • Ryan J Harris, MD • Seth a Permann, PA-C • Thea N Heaton, PA-C

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DCCC Skin Notes Gavin R Powell, MD • Ryan J Harris, MD • Seth a Permann, PA-C • Thea N Heaton, PA-C May 2015 DCCC Skin Notes Gavin R Powell, MD • Ryan J Harris, MD • Seth A Permann, PA-C • Thea N Heaton, PA-C May Special Sun spots, blotches, liver spots, melasma: hyperpigmentation, or an in- crease of brown color in the skin, has 10% off IPL many names, but what can be done about ○○○○○○○○○○○○○ this common skin issue? 10% off Obagi, HydroQ and RetAdvanz Three of the most common causes of hyperpigmentation are an accumulation of sun exposure over time, hormone effects, or injury. There are multiple options for cosmetically treating these trouble areas. Your DCCC provider is able to diagnose the problem and work with you to find the best solution. Solar lentigo (sun spot, liver spot) is the most common benign, sun-induced lesion. A solar lentigo looks like a freckle and is more often seen in fair-skinned people. They appear most commonly on the face, arms, backs of the hands, chest, and shoulders as we age. The term “lentigo maligna”, refers to a lesion that may look similar to a solar lentigo, but is actually a superficial melanoma. If you notice a freckle that looks different than the others, including having a darker & irregular color or increased texture, these could be warning signs and should be evaluated by your dermatology provider. Yearly skin checks are recommended! For the most part, lentigines are a cosmetic concern which many people are interested in having re- moved. The procedures we offer at DCCC include: Excel V laser, Intense Pulsed Light (IPL), or cryo- therapy. -The Excel V laser is an excellent option for treating solar lentigines and may be used safely in people with all skin types. Laser light is absorbed by superficial melanin (pigment) in the lesion, causing a breakdown of the pigment cells. This treatment will cause darkening of the lesions initially, with sloughing away of the color completely over the course of a couple of weeks. There may be some swelling in re- sponse to the laser on the day of the procedure, but no “down time” is necessary. This may require multiple treatments. -IPL is a non-laser treatment, which uses light to treat each lentigo individually. This treatment also causes darkening of the lesion before it sloughs away over the course of a week. Sometimes more than one treatment is necessary. IPL is not effective in people with dark skin tones. -Cryotherapy is a quick and effective way to treat lentigines as well, but side effects may include hypopigmentation at the treatment site or slight scarring. (continued on Pg 2) Melasma is a common skin problem, seen often in people with darker skin tones. It causes brown to gray-brown patches on the face. Most people get it on their cheeks, bridge of their nose, forehead, chin, and above their upper lip. Women are far more likely than men to get melasma. Hormones, combined with sunlight, seem to trigger melasma and it is often seen in pregnancy (pregnancy mask) or with the intake of oral estrogens. The best treatment and prevention of melasma is consis- tent, daily sun protection, either with physical barriers (wide- brimmed hats) or sunscreen. When looking for a sunscreen, it is important to find one that has “broad-spectrum” UV protection and contains an SPF of 30 or above. Sunscreen should be reapplied every 2-4 hours when skin is exposed to the sun. Melasma is usually caused by superficial pigment deposits and therefore responds well to topical bleaching agents. The most commonly used cream for bleaching the skin is hydroquinone, which inter- feres with the pigment producing cells, decreasing their numbers. Retinoid gel is a vitamin A derivative that causes rapid turnover of skin cells, pulling pigment to the surface, where it is naturally shed. At DCCC, we have an outstanding product, called the Obagi Nuderm System, which utilizes the combina- tion of these products to provide maximal treatment for melasma. Nuderm combines hydroquinone bleaching cream and retinoid gel with glycolic wash and excellent skin care products. Pigmentary im- provement may be expected within 3 months of use. IPL, salicylic acid chemical peels, and microdermabrasion are also useful in treating melasma, espe- cially when used in conjunction with other treatment modalities. Post-inflammatory hyperpigmentation (PIH) is a condition in which an injury or inflammation to the skin causes increased pigment production. PIH occurs more often in darker-skinned individuals and can be difficult to treat as it often involves deeper skin layers. The most common cause of PIH is acne, but it also can result from psoriasis, a burn, or an injury. PIH will improve over time, however, this may take many months and the degree of improvement is variable. Treatment for PIH is individual and many pa- tients will benefit from the options that have already been discussed. The Excel V laser is a good choice for evening out skin tone and targeting specific trouble spots. Hydroquinone and retinoids may also be employed in the therapy. As is true with all pigmentary issues, sun protection is of supreme importance. There are simple, non-aggressive ways to reverse the effects of aging and sun damage in the skin. Speak with your DCCC provider if you believe you could ben- efit from these cosmetic treatments. Call for any questions or to make an appointment at (208) 467-3006 Check out our website at www.dermcentercc.com Like and share what’s going on with our facebook page.
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