Question: From Tshiamo Molete

Hi Dr. I am a 46 year old lady, and have hyperpigmentation on my face (cheeks,forehead and nose. I never had them during my 2 pregnancies. 7 years after my second child they erupted from nowhere and I struggled with them for 16 years. I got pregnant for a third time and after the birth they disappeared for 4 months, but they came out again. I consulted many doctors and specialists without any help. I used many recommended treatment but till today I am still struggling. Please help

Answer

Hello. What you are explaining here is typical of hormonal pigmentation. Pigmentation can increase or decrease with any hormonal fluctuation, this gets aggravated by long or excessive UV exposure. The cells that product our Melanin, the pigment of the skin, is situated in the epidermal layer of the skin (this is the top layer of the skin), the problem with hormonal pigment is that it actually drops into the dermis (the deeper layer of the skin). Once the pigment is in the dermis, it is nearly impossible to remove. Most aggressive lasers and Chemical peels will actually cause it to get worse due to the amount of inflammation they create. This however does not mean that ALL the pigment has dropped to the dermis, a lot of the pigmentation is still situated in the Epidermis of the skin and this is the pigment we can treat. Step one will be to start using a Tyrosinase inhibitor, a pigment suppressor, this will decrease the activity of the pigment producing cell and prevent more pigment from forming. Inflammation caused by the hormonal fluctuation, UV radiation, medication etc. needs to be reduced as much as possible. Treatments such as PDT (Photo Dynamic therapy) can be done weekly to reduce the inflammation in the skin. Once we have the pigment producing cells under control and the inflammation at bay we can start working on getting the pigment out.  Laser Genesis treatment can be done to break up the pigment cells in the epidermis making them easier to remove by superficial chemical peels. From a homecare perspective, topical products that contain pigment reducing ingredients can be used daily, Lamelle Luminesce is a good homecare range that includes a cleanser, day cream, night cream and serum. The use of a SPF minimum 50 is vital.

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