What can I do about my Dark spots? Help for hyperpigmentation.

I know I have shared with you all about the fact that I am a Skin Care specialist for an amazing local dermatologist.  I have been in the medical field for over 25 years.  I have talked to you all about moisturizers, and acne, and today I want to talk some about another issues that are very problematic.  DARK SPOTS!!!!!

Dark spots, or hyperpigmentation (the correct medical term) is a skin problem that can affect men and women of all ages, and can be very embarrassing and make people self conscious. It affects how we feel about the way we look.  Acne is troublesome also, but that can usually be cleared up rather quickly with the correct medication.  Dark spots do not clear up as quickly, and sometimes it can take a combination of preventative measures, corrective products and procedures to keep our skin looking the way we want it to look.  I am going to talk today about Melasma, sun damage, and acne induced dark spots.
I understand the difficulties of uneven skin tone and dark areas on your skin very well.  Not only do 95% of my patients come see me to correct uneven skin tone, but I also suffer from an uneven skin tone problem.  I am an olive complected caucasian, and I have a skin condition called Melasma.  That is where I want to start today.

Melasma is a skin condition that affects women more than men, and is caused by our hormones, (great, one more thing to blame our hormones on).  It affects all skin tones (caucasian, african american, asian and latin) people.  It can sometimes be easier to see on women with a lighter skin tone (skin tone 1-2) because of the contrast between their regular skin tone and the melasma.  The skin is usually “splotchy”.  The dark areas do not have even borders, and can even appear like “spatters” of dark spots on the face.  As if someone took a paintbrush and dipped in a darker skin tone and then spattered your face with the darker color.

Melasma on my forehead
Melasma on my forehead

Those are a few ways it can look on different skin tones.  The skin can look as if you have a mustache on the upper lip.  It is also referred to as the “mask of pregnancy”.  That is because often when women are pregnant and their hormones are all over the place, melasma shows up.  I can tell you though that you DO NOT have to be pregnant to get melasma.

Sun damaged skin can look very similar to Melasma, however, it usually shows up looking more like dark brown circles on the face that have very clear borders, unlike melasma. Sun damage spots are more visible in skin tones that are lighter such as caucasian, asian and latin.  African American and Arabic skin, while it can also get sun damage will have less than lighter skin tones because of the darker skin tones, which offer more protection from sun damage than lighter skin tones.

Then there are the dreaded spots from acne.  Patients will call me and say they have “acne scarring”, or “Blemishes” or simply “dark spots” from acne.  These discolorations can occur on the face, neck, chest, shoulders and back.  Anywhere there has been an acne bump.  Acne causes redness and inflammation many times, and in skin of color inflammation or redness commonly leads to a dark spot.  The dark spots will be worse if you “pick” or “squeeze” your acne bumps.

Dark spots caused by acne.
Dark spots caused by acne.

Okay, so I have told you about a few different kinds of hyperpigmentation.  So now you want to know what you can do to make it GO AWAY!!  Right?  okay, I will talk about that now.

So what can you do to clear up your skin???  Well, the first step is to prevention.  For melasma and sun damage that means 1) SPF 30 (at least) sunscreen on your face EVERY day that you are outside.  2) Try not to be in direct sunlight without covering your face with a hat, visor, umbrella, etc.  I wear a visor ALL summer long.  We went to the beach for our weekly vacation and my body was protected with sunscreen.  My face was protected with a big floppy hat.  If my arms and legs are brown and my face is not I am totally okay with that.  I battle melasma all the time, so I protect my face from the sun as much as possible.  HATS are your best friend.

For acne the best prevention is an appointment with a good dermatologist to get medication that will prevent you form continuing to get bumps.  I talk more about acne and treatments here.  Truly the key with acne is the proper medication to keep the bumps from coming in the first place.  Second, if you do get bumps, DO NOT PICK, SQUEEZE or otherwise mess with them.  That will help tremendously to avoid dark spots!

The next step is products.  There are even prescriptions you can use to help with lightening dark spots.  Specifically the medication is “Hydroquinone”.  It has 4% hydroquinone which is a skin lightener in it, however it can be VERY expensive (most of the time at least $60.00 to sometimes over $100.00).  For comparison, a very nice over the counter product you can use to lighten dark spots is Ambi, or Porcelana fading cream.  They have 2% hydroquinone, so they are less potent than a prescription, but are more affordable.

However, my FAVORITE product that I have had LOTS of success with (I use it myself and LOVE it),  is Genius Ultra Pads by Arbonne. I have sold this product to many patients, and every single one of them has seen improvement using it. (I use it and it works for me also) As a matter of fact, most of them say it works better than the prescription Hydroquinone.  It is used in the evening and is botanically based which is why I love it so much.  It has ingredients in there that are botanical: phytinol (plant retinol), mandelic acid, grain alcohol, and other botanical ingredients.  Those botanics are natural lighteners and it works beautifully, and smells great!!

genius-before-nd-after

genius

Step three is procedures that are done in the doctor’s office or a spa.  Procedures administered in a doctor’s office are generally stronger than the ones at a spa, but not always.  In our office we administer Theraplex and Vitalize peels as well as microdermabrasions (which are for people who cannot tolerate a peel).  While a peel will usually work more quickly on dark spots, not everyone can tolerate a peel, and if a peel is used on a sensitive person the skin can be burned and permanently damaged.  Lower strength Glycolic peels can be purchased online as well, and used at home, but I would caution anyone who is considering doing that to make sure your skin can tolerate a peel.  Truly the best way to know is to make an appointment with a skin care specialist, dermatologist, etc who has been trained to know what questions to ask, and understands the complexities of skin.  Everyone is different and because there is the potential for long term or even permanent damage to ones skin, proceeding with care is important!  The peels we administer are: Theraplex 20% and 30% salicylic acid peels  and Vitalize peels which are Salicylic acid, lactic acid, resorcinol, and retinoic acid.  Obviously the Vitalize peels are stronger, however I have used them on people of all skin tones.

We also administer microdermabrasions for dark spots on people who cannot tolerate chemical peels.  They sometimes take a bit longer to see results, but over time they work well also.  We use the smart peel microdermabrasion system, but there are others that work well also.

Some physicians have also touted laser as the best way to remove dark spots from acne, sun damage and melasma.  I have to admit I have never used a laser on a patient but I can tell you while I have heard very good things about them, please do your research. Lasers can be costly, and it can take many treatments.  In addition laser is not as effective on darker skin tones.  It is best suited for lighter Caucasian skin.  I as a darker toned Caucasian would need to be cautious also.

There are many other treatments, products and peel systems out there.  The best thing I can say is if you have questions do your research, find a good Dermatologist and make an appointment. If they don’t answer your questions to your satisfaction, find another one.  Doctors are vying for business and are affected by the recession just as we all are.  Therefore they WANT your business and should work to keep your business.  And if you live in the Hampton Roads area and have questions, let me know, I give FREE consultations and work on Mon – Sat.   If you don’t live near me, come visit!!!  🙂

Real Food: Why my family is now eating organic!

I have struggled with my weight for many many years! I have written blogs about it, complained about it, and had finally given in and decided to accept it when something amazing happened to me.

Karol and I went to see Jillian Michaels.  Going was kind of a fluke.  We love Jillian Michaels, and to be honest I had no idea she was doing a speaking tour.  I happened to stumble upon the information on Facebook, and checked out the price of tickets.  I went to the web page, squinted my eyes, took a deep breath, and hit the button to see the prices.

I was quite surprised to see how affordable the tickets were.  So I texted Karol and asked her if she wanted to go see JM.  To say she was excited would be an understatement!! So tickets were purchased, and we waited with bated breath. The night came and we went to see the amazing Jillian Michaels.  The first hour she talked about food and the second hour she talked about living a full life without “shoulds” and guilt, etc.  I have spent years in therapy, that stuff I knew. But the food stuff that I should have known, had eluded me somehow.

I have written about my huge grocery bills. Switching to an organic diet was daunting to say the least.  I was worried about the cost, and how I was going to afford to feed my family of 5 and not break the bank.  But Karol and I were committed to eating better.  No more pesticides, hormones, antibiotics and other nastiness in our food. However, the cost of switching really concerned me.

So we entered the Real Food genre slowly.  Just purchasing the food we were making for ourselves.  The interesting thing was the first week we purchased all organic for ourselves we reduced our grocery bill by almost $100.00!!!

Photo courtesy of Blue Planet Green living
Photo courtesy of Blue Planet Green Living

So we ventured out farther into the organic realm and purchased organic meats and dairy.  I have to say that the milk was the hardest for me.  Spending $6.00 a gallon almost gave me a heart attack, but I figured it was the right thing for my family, so I just took a deep breath and put it in the cart.  Two of them…..  The most interesting thing is, my boys like the organic foods.  They say they taste better!!!

We bought organic peanut butter, organic crackers, cereal, creamer, etc.  It has been an interesting transition.  Last week the grocery bill was a bit higher than the first week, but we had cat litter, cat food, and some cleaning supplies, so it was not all food.

I have even found “healthy” alternatives to candy and soda.  I no longer indulge in candy made by any of the huge chocolate companies that immediately come to mind.  Instead I have switched to Unreal Candy.    Their products have NO high fructose corn syrup, artificial colors or flavors.  No chemicals!!!!  Just wonderful natural ingredients!  Currently you can find these products at CVS and Target stores!  The price is the same as the other ones in the candy aisle, so why not spend the same and get a MUCH MUCH better product?  Seriously! CANDY!  lower in sugar and healthier?  This stuff is amazing, you have to try it!  (not paid by the company for my endorsement). I used to avoid candy like the plague, never thinking I could fit it into my daily calorie “budget”.  Now I can, and so can you.  Why feed you and your kids crap when you can feel them foods without chemicals?

Photo courtesy of getunreal.com
Photo courtesy of getunreal.com

I used to be a Diet Pepsi junkie.  As a matter of fact I drank 2-3 cans of caffeine free diet pepsi every day.  After seeing Jillian, we decided to no longer use artificial sweeteners.  Then one day while shopping we found Zevia.  Stevia sweetened soda.  They have a wonderful assortment of flavors.  Root Beer, Dr Zevia, Cream soda, orange, grape, cherry, cola, caffeine free cola, among others.  It was a bit more expensive than other sodas, but at only one can per day it was completely affordable. The next week my local Harris Teeter had it on sale buy one get one free, so mama stocked up!! You can buy this product at Jewel, Acme, Whole Foods, Harris Teeter, Kroger, Safeway, Target, Walgreens and more.  You can also find them on Facebook and Twitter.

Photo courtesy of Zevia.com
Photo courtesy of Zevia.com

So we are on a new trend. Eating REAL food, drinking naturally sweetened sodas, and guilt free candy!

It is working!!  Two and a half weeks in I am down 5 pounds, and have lost inches in my stomach, hips and thighs!!  Karol is taller and has a faster metabolism than me.  She is down 7 pounds!!

I am excited to keep going and see how healthy we can get!! No more chemicals, hormones, or antibiotics for my family!!

An inoperable brain tumor?? What??

You can never be sure exactly what is going on inside your body.  Well, there are the obvious things, like hunger pains and gas….   But beyond that, it is impossible to really have a clear picture of how healthy our organs are, or how our blood looks, or exactly how things are functioning.  Of course we know when they STOP functioning, but what about when things are “okay”, but may not be perfect.

For example, what if your lungs had some spots that were unhealthy because when you were younger you decided to cave to peer pressure and a smoked cigarettes for 15+years……(I am talking about a friend here….duh), or if you decided to smoke Marijuana a couple of times just to “check it out”….ummmm duh,…..a friend again……. or maybe you even might have tried something harder once…..(FRIEND……….OKAY????…..sheesh).  We can’t look into our bodies and see what kind of damage these choices may have caused.

What about the people who have illnesses due to no fault of their own, but just because it is that way for them?  What about time bombs that are just ticking away like Cancer, or heart disease, or high cholesterol, or a stroke.  Just waiting until your guard is down to strike and cause havoc in your life and loved ones.  Too bad we can’t have some sort of see through window that doctors can use to see what might happen to us and our bodies so we can prepare.

My point is  that we never know what is going on inside us.  Maybe that is a good thing, maybe not.

About 4 years ago Bluebell began having headaches.  Every day.  All day.  They were worse if she coughed, or sneezed, or bent over to tie her shoes.  I made her go to the Primary Care doctor.  They sent her to a neurologist.  He ordered an MRI.  We were called back to the Primary Care doctor.  She brought us in, and told us she did not know what was causing Bluebell’s headaches, but they had found a “Tumor” in her brain while they were doing the MRI, and Bluebell would be sent to a Neurosurgeon for evaluation.

Then the Neurosurgery appointments began.  MRI’s, Cat Scans, discussions.  This was in December of 2009.  Bluebell was diagnosed with a Meningioma (benign tumor of the meninges), which was sitting right next to her brainstem in a very bad (inoperable) spot.  She had an amazing Neurosurgeon at the Portsmouth Naval Hospital: Dr. Piccarilli.  Dr. P. is a super smart lady, and told Bluebell that it was a very small (millimeters) tumor and we were simply going to watch it for a while.  Get MRI’s annually and see what it does.

I was shocked!!!! Really??

A tumor???

In an inoperable spot right next to her brainstem???

Only Bluebell could have this kind of luck.  We often joke, that when God created her, He mixed up lots of different kinds of health issues, and tossed them into her DNA, just to see how she could handle it.  We had already been through eye surgery, cervical cancer, a radical hysterectomy, benign thyroid tumor, lymphedema from the hysterectomy, a stapedectomy to correct her deteriorating ear bone……

I mean……. really???

An inoperable brain tumor??

So we did what we assumed everyone does in that situation.

We named the tumor.

Calvin.

He became her scapegoat.  Any time she did something and we got into an argument she said “Oops, must be Calvin.”  If she forgot something she would say, “thanks a lot Calvin”.  Basically poor Calvin was blamed for all her difficulties.  I almost felt bad for the poor little millimeter of tissue……   except that he parked himself right next to Bluebell’s brainstem….which is incidentally a VITAL organ….   If he had parked himself in a more accessible spot in Bluebell’s brain I would like him MUCH better!!!!

Bluebell's looks like this only hers is a bit smaller.  Not encroaching on the brainstem
Bluebell’s looks like this only hers is a bit smaller. Not encroaching on the brain-stem

Time went on and Bluebell continued to see Dr P.  After a year, Dr P decided that Calvin had grown just a smidge, and it was time for Bluebell to see someone else about Calvin.  A neurosurgeon who specialized in a particular procedure that could help either reduce Calvin’s size, or stop him from growing.  So she sent us to see a doctor at Riverside Hospital in Newport News named Dr Lesnick.  He is a surgeon who specializes in a procedure called Gamma Knife Radiation. 

Bluebell was scheduled an we went in at 6 am for Bluebell’s procedure.  She was given a twilight anesthesia cocktail which means she wouldn’t feel anything but would be alert enough to answer questions and respond to directions.  However, she wouldn’t remember anything, so of course I took advantage of that!  🙂

For the procedure they had to put a contraption on her head called a halo.  Then they buckle this helmet thing on in the machine and use a computer to pinpoint exactly where the radiation is to go.

 

Bluebell in hospital bed with halo on.
Bluebell in hospital bed with halo on.

To hold the halo in place so it won’t move they actually screw in into your skin in 4 places.  Two on the forehead and two in the back of the scalp.  Hence the anesthesia.

left side of forehead
left side of forehead

It was pretty much an all day procedure.  We didn’t get out of there until 4:00 in the afternoon.

It all went as well as they expected, and she was scheduled for a follow up visit in 6 months to do another MRI to see if Calvin was affected by the Gamma Knife.

The follow up MRI showed that Calvin had not grown, but he had not gotten smaller either, but Dr. Lesnick was very hopeful the procedure had worked.

So now Bluebell goes in every year to have an MRI done to see how Calvin is doing.  In May it will be time for her annual visit to check on Calvin.  Since she remains asymptomatic I feel pretty confident the Gamma Knife stopped him in his tracks.

I will say that one of the most touching moments I had during this entire situation was during a visit with Dr Lesnick.  I told him how grateful I was that a doctor of his prominence made this procedure available to those of us who use government healthcare insurance (Tricare) because I know Tricare does not reimburse doctors very well.  He responded it was the least he could do to honor people who served in the military!  Brought tears to my eyes!

I guess the moral of the story is that you never know what life will throw your way, and in the big picture we just do the best we can and keep marching forward to face the challenges head on.

Literally, in Bluebell’s case.  So Calvin is here to stay because he is in a place that no surgeon can get to.  He is a part of our life, and he is going to stay right where he is.