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!!!  🙂

Let’s talk about Acne

I have been working for a local dermatologist for over 8 years.  He has been the President of the  National Medical Association and was named the 2008 Practitioner of the Year by the National Medical Association.  He has been in private practice for over 27 years.

I have learned an amazing amount of information from him.  Prior to working for him as a medical assistant and Skin Care Specialist, I spent 20 years in the Navy as a corpsman, so I have over 25 years of expertise in the medical field as well.

Today I want to talk about acne, which affects 40 to 50 million Americans at any given time according to the American Academy of Dermatology (AAD).  Acne can affect people of all ages, and some women don’t develop their first case of acne until they are in their 40’s. Acne causes many people emotional distress!  They are embarrassed and upset by their skin.  Let’s be real, your face is the first thing most people look at, and we want to put our best face forward.

I can’t tell you how many times I have heard patients say, “I have NEVER had an acne bump….why am I getting them now in my 30’s..(or 40’s)…(or 50’s)???”  This is more common than you might think.  Often when an adult develops acne it is called “Rosacea” also referred to as “adult acne”.

However, let’s back up a bit and debunk a few myths about acne that most people think are true.  First of all, despite what your mother told you, (or what you are telling your kids), fried foods, soda, and how much water a person drinks has NOTHING to do with acne. Fried foods and soda do not make acne worse, so eat french fries and drink Mountain Dew to your heart’s content.  It will not make your acne worse.  It will however cause your waistline to increase, but that is not the topic for today.

Okay so now that you know what does NOT make your acne worse, let me tell you what DOES.  Hormone and stress levels are a huge factor in acne.  As a matter of fact many times I have heard from high school patients that their acne was doing really well after seeing the doctor and getting on a regimen of medication and products and procedures, but when they went off to college their acne got much worse.  Many patients come home on their first school break with their acne flaring out of control.  Let’s face it, going to school is stressful, especially if it is their first year away from home.

Many of my female patients will often tell me that their acne is worse just before their menstrual cycle.  Even if they no longer cycle due to menopause or birth control, they will notice that their acne goes through monthly cycles of better and worse.  That is because our bodies’ hormone levels still go up and down.

Acne is caused by the skin not shedding properly.  So the skin clogs the pores, thus backing up the oil in the pore causing whiteheads and blackheads (comedones) or larger “juicier” bumps also called pustules.  This is where acne medicine comes in.  For comedonal acne, (blackheads and small whiteheads) the retinoids are a great medicine to use.  These are medications such as Retin-A, Tretinoin, Tazorac, Epiduo, Differin, among others.

Topical medicines
Topical medicines

These medicines “teach” your skin to shed or slough properly so the oil can flow and not clog your pores.  They can sometimes be irritating or drying, (especially to sensitive skin), so there are a couple of “tricks of the trade” you can use to help combat the irritation.  1) Use the medicine every other night to start so your skin can get used to the medicine.  2) Mix a dab of moisturizer in with the amount of medication you are putting on your skin so the moisturizer acts as a  “buffer” it to make the medicine less irritating.  Even with all of that you may notice some peeling with these medications.  Of course if you have any concerns discuss them with your medical provider.

Comedonal acne
Comedonal acne

For the larger, “juicier” bumps, there are other things a medical provider can use.  Benzoyl Peroxide is a great medicine for larger bumps, as well as topical or oral antibiotics.  Benzoyl Peroxide can also be drying, so start that every other night also if you notice your skin being more dry than usual.

Pustular type acne
Pustular type acne

For people who have that really large acne all over their face that is painful and deep in the skin, (called cystic acne) they DEFINITELY need to seek out medical care.  I have seen many patients put on Isotretinoin (aka Accutaine, Isotret, and a few more).  This medication has many side effects and has to be monitored VERY closely by your dermatologist with monthly visits, blood tests, pregnancy tests (for females) among others.  However, I have seen this medication literally work miracles for patients.  I always think about the teenagers who went from kids with poor posture, hiding their faces behind their hair, poor self esteem before the medicine to kids who sit up straight, have improved self esteem, and smiling MUCH more.  It can make a HUGE difference, but as I said, it needs to be closely monitored by a medical professional.

Nodulocystic acne aka Cystic acne
Nodulocystic acne aka Cystic acne

There are also some great products that can be used to help with acne.  Glycolic acid cleansers are a wonderful product for people (even with sensitive skin in the right amounts) with oily, acne prone skin.  A couple of glycolic cleansers that we sell in the office that I like (they can be purchased at many dermatologist’s office or online) are:

Glyderm Gentle Cleanser
Glyderm Gentle Cleanser

Glyderm Gentle cleanser (made by Equalan Pharma) is a daily cleanser with 2% glycolic acid (also known as AHA or Alpha-hydroxy acid).  It is very gentle and can be used by most people.  The glycolic acid helps exfoliate the skin. However, it is a creamy cleanser and will NOT foam up.

Vivite daily cleanser
Vivite daily cleanser

Vivite Daily cleanser (made by Allergan) has a 12% glycolic acid compound in it, and is therefore a bit more exfoliating than the Glyderm.  It is also stronger and can irritate sensitive skin.  It is a creamy cleanser.
For those of you who LOVE to use a scrub, Vivite makes a nice one.  PLEASE stay away from scrubs with nut shells as the exfoliating ingredient….nut shells can be sharp and scratch the skin. I really like the Vivite Exfoliating cleanser.  It has a 15% Glycolic acid compound and very nice soft exfoliating beads that scrub without scratching or causing irritation.  It should be used no more than two to three times per week.

Vivite exfoliating cleanser
Vivite exfoliating cleanser

Other products to try:
We have some products made by Topix Pharmacuetical that I love.  You can also get these at many dermatologist’s office or online. One of the reasons I really like Topix products is because they use many botanical ingredients in their products.  I like botanics and more natural ingredients.

Glycolix/Topix 15% Glycolic pads
Glycolix/Topix 15% Glycolic pads

Topix 15% Glycolic pads.  I love these because they don’t make your face sticky at all.  You can use them in the morning after cleansing, or during the day if you get hot and sweaty and yucky……(love that medical term?)  I tell my clients you can out some in a baggie and carry them with you during the day or to the gym, or the beach, etc.

Topix/Glycolix 5/2 Gly/Sal pads
Topix/Glycolix 5/2 Gly/Sal pads

These are Gly/Sal 5-2 pads.  They have 5% glycolic and 2% salicylic.  They are great for acne spot treatment.

Glycolix/Topix 10/2 Gly/Sal pads
Glycolix/Topix 10/2 Gly/Sal pads

ly/Sal 10-2 are pads with 10% Glycolic and 2% Salicylic acid.  Stronger than the 5-2 pads, they are also great for acne spot treatments.

There are lots of other products out there, too many to name them all.  I shared with you just a few of my favorite acne treatment products.  Generally speaking a product with salicylic acid can help with bumps.  Glycolic acid is also a good product for skin too sensitive for Salicylic acid.

I am happy to answer any questions you all may have, and if you are local to the Hampton Roads area I do offer free skin care consultations at the doctor’s office where I work, so you can call me or email me, or comment to schedule an appointment.  🙂  Please note I do NOT get paid by any of these companies, nor do I get paid for FREE consultations……

Skin care procedures can make a world of difference!

I work for a local dermatologist in Hampton Roads.  He has been practicing for over 27 years and not only is he a board certified by the American Board of Dermatology, he is also recognized as a fellow in the American Academy of Dermatology and has served as the Chairman for the Dermatology Section of the National Medical Association. In 2008 he was voted Practitioner of the Year by the National Medical Association.

I have been working at the derm practice for over 8 years, and not only am I a Medical Assistant, but I have also been trained as a Skin Care Specialist.  As a skin care specialist I see my own patients and perform skin care consults, microdermabrasions and chemical peels.  I have a regular clientele and meet new patients all the time.  It is a really great job!

One of the things I love most about my job is that I am able to make a positive difference in people’s lives.  Most of my patients are women and most of them are between 25 and 65 years old.  That is not because women under the age of 30 don’t have skin problems, but because for some reason most women don’t decide to take care of their skin until they are in their late 20’s.

micro

Until then they have spent most of their time and energy taking care of their husbands, boyfriends and/or their kids.  For some reason we women don’t think we should take care of ourselves.  We put ourselves last and take care of every one else’s needs first. I have quite a few men clients as well.  Taking care of your skin is not just for the ladies, it is for all of us!!

peel

Unfortunately insurance doesn’t pay for the services I offer, and the cost is out of pocket.  By the time people choose to spend the money for themselves they are usually extremely frustrated.  They have dark spots, acne scarring, uncontrolled acne, dull lifeless skin, and more.

They have tried hundreds of products, none of which solved their problem, and they have what I refer to as a “product graveyard”.  A drawer or cabinet full of products they have purchased but didn’t work,  They hang on to them in hopes that maybe they will work someday or they can pass them on to a friend.  The products don’t get thrown away because most of the time they were expensive and is seems wasteful to throw out an almost full container of something, even if it was junk.

So my job is to help these people feel better about the face they have and what they show the world.  Let’s be honest, your face is the first thing someone sees when they talk to you.  People who have dark spots, acne or acne scarring feel like that is what people are noticing because that is what they notice about themselves when they look in the mirror.  We always notice first the things that bother us the most.

To be frank, I cannot erase everything with the procedures I administer.  People may still have dark spots or acne, or acne scarring, but I will tell you with 100% certainty that EVERYONE has some improvement.  I always tell people I can’t erase everything but we can always make an improvement.  How much better each person gets is individual, but we always get to a place where they can be comfortable looking in the mirror.

acne scarring before and after microdermabrasion

I LOVE what I do, and the positive impact I am able to make in people’s lives.  I know that when people feel better about themselves their whole lives are better and the lives of those around them are better!  I am so thankful I am able to play a small part in that!!