Lightening Up

Updated 3/2017 -- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

MedEsthetics has a nice article on skin lightening in the March/April 2010 issue written by Linda Lewis.

Skin lightening is often needed to improve postinflammatory hyperpigmentation, dyschromia, and melasma. Others have uneven skin tones due to sun damage.

Several physicians were interviewed for the article. All agree that a good skin care regimen before, during, and after treatment is key.

For uneven pigmentation:

Marta Rendon, MD (dermatologist) -- “For mild photodamage, I start with antioxidants and retinoids, and then add peels or lasers for stubborn cases.”

Joel Schlessinger, MD (dermatologist) -- “Typically, these patients do well with intense pulsed light (IPL) or laser treatments, but these should always be accompanied by a homecare treatment regimen, such as Nu-Derm by Obagi or another hydroquinone-containing product such as Tri-Luma or Epiquin Micro by SkinMedica.”

Leslie Baumann, MD (dermatologist) – “For patients with light skin I recommend monthly IPL treatments. For home care I suggest a glycolic cleanser, NIA24 niacinamide moisturizer or Aveeno Positively Radiant active soy, and a good sunscreen in the morning. For nighttime use, I prescribe Tri-Luma. For patients with darker skin, I use the same home care regimen, but offer a Jessner’s peel solution every two weeks instead of IPL. ”

Tina Alster, MD (dermatologist) -- “For light-skin patients I use IPL or a Q-switched pigment specific laser (alexandrite or Nd:YAG), with or without mild to moderate chemical peels. For daytime home care, I suggest a topical vitamin C with sunscreen (SPF 30 or higher) and at night glycolic/retinoic/kojic acid on an alternating basis.”

For melasma:

Dr. Baumann “I recommend a glycolic cleanser in the morning, followed by a vitamin C serum, such as Skinceuticals CE Ferulic, and a moisturizing sunscreen, such as LaRoche Posay Anthelios 60 Sunscreen Fluid. At night, the patient uses the same glycolic cleanser followed by Tri-Luma topped with a moisturizer if they have dry skin.” She also recommends microdermabrasion followed by Jessner’s solution TCA peels twice a week until the hyperpigmentation clears.

Dr. Alster “For melasma, I use only mild to moderate chemical peels (resorcinol, glycolic/lactic/mandelic or trichoracetic acid) in the office.”

It’s interesting to see the similar yet different approaches. It is extremely important to use sunscreen daily during and after treatment for any skin pigmentation issues.

Other reference:

Melasma; eMedicine, Dec 16, 2009; Andrew D Montemarano, DO, Hugh Lyford

Drug-Induced Pigmentation; eMedicine, Dec 10, 2008; David F Butler, MD, Deborah Zimmer Henderson, BA, MPH,