Localized Hyperpigmentation

Melasma, Chloasma, Dyschromia

Hyperpigmentation is characterized by dark patches, typically on the cheeks and forehead.  It occurs more frequently in Asian and Hispanic women, but can be present in other populations.

What Causes Hyperpigmentation?

Researchers have shown that hormones and the skin’s response to exposure to ultraviolet light are the main factors involved in the cause of hyperpigmentation.  Pregnancy, along with taking oral contraceptive pills or hormone-replacement medications, can trigger and prolong the hyperpigmentation.  Although pregnancy-induced hyperpigmentation (the “mask of pregnancy”) tends to fade several months after delivery, pigmentation induced by oral contraceptive pills or hormone-replacement medications can linger long after the medications have been stopped.

How Can Hyperpigmentation be Treated?

  • First and foremost, use a broad-spectrum sunscreen and a wide-brimmed hat to protect against ultraviolet light.
  • Discontinue the use of oral contraceptive pills or hormone-replacement medications if possible.
  • Use bleaching creams, such as products with hydroquinone, to decrease unwanted pigmentation.  Products featuring a combination of tretinoin, topical steroid, and hydroquinone provide an even more powerful treatment for hyperpigmentation.
  • Application of a superficial chemical peel (Jessner’s or glycolic peels) by your physician will accelerate the fading of hyperpigmentation.  Note that we suggest discontinuing the use of bleaching creams with tretinoin two days prior to the first peel to avoid discomfort.
  • Treatment duration can vary, but typically lasts for at least six months and may require maintenance with the occasional application of tretinoin or bleaching compound.
  • Caution should be used with more aggressive treatments such as deeper chemical peels or abrasive lasers as these can often exacerbate the hyperpigmentation.

How to Use Prouvé Triple Bleaching Agent

  • Prouvé Triple Bleaching Agent is composed of Retin A® (.01%), Hydrocortisone (2.5%), and Hydroquinone (8%).  This unique combination offers the most optimal strength of lightening agent with a gentle soothing moisturizer so that it is more effective and tolerable than other products on the market.
  • Wash your face each evening with a gentle Buf Puf and mild soap (Dove) to remove the rough outer surface of the skin which inhibits penetration of the bleaching compound.
  • Apply the bleaching agent to your entire face unless otherwise instructed.  The forehead and nose (because of the larger oil glands) will require more agent to obtain the desired end point (pink & slightly flaky), the cheek and chin will require less.  This product may need to be adjusted by varying the amount applied and frequency of application.  It may be initially used every other day or twice a week until your skin builds a better tolerance.
  • If you get too dry, red, or irritated – stop for a night or so and use Prouvé Soothing HC Lotion or a similar moisturizer recommended by the doctor.
  • Bleaching compound increases your sensitivity to sun.  Always use a sunscreen in the morning.  NO EXCEPTIONS!  We recommend Solbar Avo 32 for normal skin, Neutrogena Ultra Sheer Dry-Touch 55, Prouvé Tinted Sun Shield SPF 30, Skinceuticals Physical UV Defense SPF 30, or Solbar Liquid 30 for oily skin (acne patients).

If you have any questions, please call the office.

Retin A® (Tretinoin) in the Treatment of Photodamage

Tretinoin (Retin A®), a compound derived from retinol (Vitamin A), is the only topical pharmaceutical agent to repair photodamaged skin.  Although the exact mechanisms of action are not fully understood, treatment of photodamaged skin with topical Retin A® is known to result in the regeneration of the dermal collagen matrix, epidermal thickening, compaction of the stratum corneum, and promotion of epidermal hyperplasia and angiogenesis.  Studies have demonstrated that retinoids are able the induce collagen synthesis in cultured human dermal fibroblasts, and that retinoic acid applied topically to the skin prevent UV induction of the matrix metalloproteinases (MMPs) that place a role in the destruction of the extracellular matrix.  The histological alterations induced by Retin A® treatment have been correlated with clinical improvements, including smoothing of the skin, lightening of hyperpigmented lesions, disappearance or significant improvement of fine wrinkles, and, to a lesser extent, coarser wrinkles.  Retin A® has also been shown to protect skin against photodamage induced by repeated UV exposure, making it an ideal agent for maintenance therapy.

Retin A® is available in several formulations and concentrations, the choice of which is usually determined by the patient’s tolerance.  Tolerance of topical retinoids by patients may vary with age, race, skin type, extent of photodamage, and local climate.  Treatment should be combined with photoprotection to prevent further photodamage.

Summary of the Cytological, Histological, and Vascular Effects of Topical Tretinoin (Retin A®):

  • Increase in epidermal thickness
  • Exfoliation
  • Increase of the stratum granulosum thickness
  • Decrease in melanin content and decrease in melanocytotic hypertrophy/hyperplasia
  • Reduced epidermal atrophy and increased thickness of the epidermis
  • Decrease in precancerous lesions, such as actinic keratoses
  • Increase in collagen synthesis, reducing fine lines and wrinkles
  • Increase in skin elasticity
  • New blood vessel formation and increase in blood flow

Precautions:

  • Do not use if you become pregnant or are breastfeeding
  • Discontinue use 3-5 days prior to waxing
  • Discontinue use 2-3 days prior to chemical peels

The Wrinkle Scale