Skin pigmentations

Occurrence of dark spots – hyperpigmentation on the face is usually the consequence of the so called melasma, which commonly appears on the forehead, cheeks, chin and the upper lip. Along with that, post inflammatory hyperpigmentation can appear on the face and other parts of the body, where pigment accumulation is a consequence of earlier skin disease (for example, acne, eczema, lichen planus, etc.), and it is often joined with later Sun exposure. Also, some substances, for example perfumes and some types of fruit and vegetables can, in combination with Sun exposure, lead to the appearance of phototoxic reaction which can manifest itself with dark spots on the skin.

What causes melasma?

Melasma is most common in women, only 10% of the patients are men, and also in races with darker skin. There is a hereditary propensity for melasma appearance, and changes in hormonal status contribute to the appearance of darks spots in the face. Melasma often occurs during pregnancy (pregnancy mask). Contraceptive pills can also cause this type of change. It is important to know that this type of change is not a sign of any disease and it doesn’t affect the health of the person, and is more of an aesthetic problem.

Which factors cause the changes to become more expressive?

Ultraviolet radiation (sunlight, solariums, even stronger room lighting) can stimulate skin cells to produce pigment. In persons with darker complexion this effect is even more prominent, because their cells that produce pigment are more active. Exposure to sunlight is the number one cause of dark spots recurrence after successful melasma treatment.

How is melasma diagnosed?

Clinical picture of melasma is so characteristic that the diagnosis is usually given with an ordinary examination. Sometimes skin biopsy with pathohistological analysis is necessary in order to differentiate melasma from other hyperpigmentation. Also, an examination with Wood’s lamp (black light) by dermatologists helps to assess the depth and spread of the hyperpigmentation.

How is melasma and other types of hyperpigmentation treated?

There are a few types of local therapy for skin whitening and pigment removal, and some types of treatment that lead to the removal of the surface area of the skin, and therefore the excess pigment from the surface skin layers where the pigment can usually be found. In our center, hyperpigmentation treatment is performed with a combination of local therapy with appropriate creams relating to the look and type of changes, and with chemical peeling treatments and laser treatments with the appropriate wavelength for removing pigment from the skin.

Do dark spots on the skin reappear after removal?

A few months (and even years) after the successful pigmentation removal, a rigorous protection from the Sun is necessary, because hereditary propensity and hormonal status make the skin sensitive to ultraviolet solar radiation, and changes can easily reappear in a lesser or greater extent. That’s why regularly use of high protection factor creams is necessary to prevent the occurrence of new changes.

Spec. Dr. Svetlana Djurisic, dermatologist
Dermatological clinic DERMATIM