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Disorders of Pigmentation
2007-07-13
Dear Dr. Proskiw;
I am a 46 year old mother of three and I have developed several dark spots on my face after a winter holiday to Cuba. I have also noticed an area of reddish brown pigment on both sides of my neck. What can be done to remove and prevent these pigmentations from recurring?
Answer:
The pigmented areas on your face sound like solar lentigos that commonly appear on sun exposed areas of the skin of adults. They may appear on the back of hands, shoulders and face and are most common in lightly pigmented and red-haired individuals. Sun exposure is closely associated with these lesions. They are benign but a biopsy is indicated if there is any suspicion or doubt as to the diagnosis. These lesions should always be assessed and treated by a physician. The pigmentation on your neck is most likely a condition called Poikiloderma of Civatte. It is caused by chronic sun exposure and is dependent on the duration and intensity of sun exposure. It may also be associated with a similar appearance of the chest. The chest area is very commonly affected by associated actinic changes which have a premalignant potential.
Question:
This sounds like something I need to address and have treated particularly if it is something I have just become aware of. What do you suggest?
Answer:
The diagnosis of pigmented lesions is particularly challenging and for this reason only your physician should assess your skin and then discuss treatment options with you. There are several lesions of pigment that need to be considered when assessing the skin; seborrheic keratosis-small to large rough raised skin lesions that appear to be stuck on the skin, nevii or moles, freckles, lentigo maligna, and melanoma. These may all mimic lentigos. Melasma and general dyspigmentation are usually easy to diagnose and less sinister. The pigmentation on your neck is also a more straight forward diagnosis.
Question:
What treatment options are available for me?
Answer:
Lesions of questionable diagnosis should be biopsied or excised. However benign pigmented lesions and general pigmentation problems can be treated with topical creams, liquid nitrogen, Intense Pulsed Light and Lasers. Topical creams that contain hydroquinone may lighten some lesions if used daily for several months. Liquid nitrogen may be used to remove or lighten many lesions and is available in most physician offices. A limitation of liquid nitrogen therapy is controlling the depth and treatment area precisely. Post treatment redness and pigmentation can sometimes be a complication of treatment by this method.
Intense Pulsed Light and Lasers have the advantage of being able to treat pigment precisely and effectively. Pigmented lesions usually require a combination of lasers and no one laser can treat all types of pigment. It is therefore important to ask the laser surgeon if the laser or IPL device are specific and tested to treat your particular condition.
Question:
How can I prevent pigmentation?
Answer:
Regular use of sunscreen applied to sun exposed areas is you best defense. Retinoic acid, Tazorac, chemical peels and microdermabrasion are all excellent preventative measures for maintaining external skin health. A healthy lifestyle that includes a diet with plenty of vegetables, drinking water, no smoking and regular exercise will all contribute to healthy skin.
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