What skincare can help improve the appearance of pigmentation ?
Topical vitamin A creams such as Zorac will stimulate cell turnover and reduce existing pigmentation. Using an effective sunscreen with both UVA and UVB protection will help prevent further sun damage and subsequent pigmentation from reoccurring.
Hydroquinone (HQ) is the most commonly used prescription medication. It is a strong inhibitor of melanin production but its effects are slow and can take months. Evidence of improvement with HQ is usually observed at 4-6 weeks, with improvement appearing to plateau at approximately 4 months. Efficacy is directly linked to concentration, but the incidence of adverse effects also increases with concentration. Retinoids (Stieva A) improve the effectiveness of HQ. At Cosmos Clinic we commonly prescribe Stieva A with 4% hydroquinone for melasma and Post Inflammatory Hyperpigmentation (PIHP). The patient is advised to use HQ and Stieva A for 4-6 months to ‘turbo start’ the treatment before moving the patient onto over the counter preparations like Kojic Acid, Vitamin C, Vitamin B3, AHAs, Vitamin A, Arbutin, Mulberry, and Licorice.
Azelaic acid, available as a 20% cream-based formulation called Finacea, appears to be as effective as 4% HQ and superior to 2% HQ in the treatment of melasma. The mechanism of action is not fully understood. Unlike HQ, Azelaic Acid seems to target only hyperactive melanocytes and thus will not lighten skin with normally functioning melanocytes. The primary side effect is skin irritation, which is higher than that experienced with HQ. Regardless, Azelaic Acid is definitely a consideration for skin lightening if you have had problems using hydroquinone.
Other de-pigmenting agents that have been studied in the treatment of melasma are Kojic Acid, Ascorbic Acid/Vitamin C, 4-N-butylresorcinol, Phenolic-thioether, 4-isopropylcatechol.
Light based treatments with lasers can help with freckles, sun spots and may help superficial cases of melasma and PIHP.
To remove a large number of freckles in one single setting, a medium depth chemical peel with trichloroacetic acid is performed. Patients require 5-7 days downtime.
How can you prevent brown spots long term?
Regardless of the treatments used, all will fail if sunlight is not strictly avoided. Prudent measures to avoid sun exposure include hats and other forms of shade combined with the application of a broad spectrum sunscreen with UV A and UV B protection is essential. Seek shade between 10am and 4pm, when the sun’s rays are most intense. Sun protection should begin in childhood because it is estimated that 80 percent of lifetime sun exposure occurs before age 18.
Wear light-coloured, tightly woven, protective clothing and wide-brimmed (three-inch) hats. Cessation of the pill is also factor that can cause melasma.