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Offline lamb  
#1 Posted : Monday, December 23, 2019 12:58:11 PM(UTC)
Rank: Advanced Member

Joined: 2/16/2009(UTC)
Posts: 1,255
Hi, I have two patches of hyperpigmentation on my forehead. I used 20% glycolic pads for a while but they didn't do much. Just started skinceuticals colourdefence from my dermatologist but am kinda skeptical. I don't want to do an all over peel or laser or hydroquinone.

Any recommendations on something that actually works for a spot treatment?

Thanks kindly
Offline Greg  
#2 Posted : Monday, December 23, 2019 2:44:58 PM(UTC)
Rank: Member

Joined: 9/20/2014(UTC)
Posts: 389
Man
If I understand correctly, you don't want to have an all-over-your-face laser or peel, but are open to treating just the darkened areas (?)
If so, pigmented patches respond well to spot treatment with the Picosure laser. It's designed specifically for removing such pigmented stuff (and tattoos). Requires 2-3 sessions.

https://www.cynosure.com/product/picosure/

There's also a derm-performed spot treatment called Melanage Peel which can lighten just the pigmented areas in 1 go, or maybe a second go later for clean up.
Offline lamb  
#3 Posted : Monday, December 23, 2019 3:27:50 PM(UTC)
Rank: Advanced Member

Joined: 2/16/2009(UTC)
Posts: 1,255
Thank you Greg :) yes just want to spot treat. Will look into both suggestions. I like the ideal of a peel spot treatment but not sure if my derm does the one you mentioned.

Edited by user Monday, December 23, 2019 4:34:31 PM(UTC)  | Reason: Not specified

Offline Greg  
#4 Posted : Monday, December 23, 2019 4:48:45 PM(UTC)
Rank: Member

Joined: 9/20/2014(UTC)
Posts: 389
Man
Originally Posted by: lamb Go to Quoted Post
Thank you Greg :) yes just want to spot treat. Will look into both suggestions. I like the ideal of a peel spot treatment but not sure if my derm does the one you mentioned.


Hi Lamb, one top derm that does Melanage is Dr. Tanzi in Washington D.C./Maryland, if that's at all close to you:

https://www.capitalskinl...ma-with-w-melanage-peel/

good luck!
Offline lamb  
#5 Posted : Monday, December 23, 2019 9:54:27 PM(UTC)
Rank: Advanced Member

Joined: 2/16/2009(UTC)
Posts: 1,255
Greg for some reason your posts are blank now.
Offline JB01  
#6 Posted : Tuesday, December 24, 2019 5:35:12 AM(UTC)
Rank: Newbie

Joined: 1/8/2019(UTC)
Posts: 16
lamb - how large and dark are the two discolorations? did your derm diagnose them as solar lentigos, or perhaps something more difficult to treat such as melasma? the treatment options for melasma can be more limited and finicky, as the pigmentation is sensitive to hormones, heat, irritation and anything else that can exacerbate inflammation and then lead to more pigmentation.

For topical treatments, something like Triluma (would require a prescription) would be much more effective than Skinceuticals' discoloration defense. Triluma is a combination of tretinoin, hydroquinone and a topical corticosteroid, and can lighten discolorations quite quickly. It's not meant for indefinite use, however, and your derm will likely recommend discontinuing use once sufficient lightening is achieved and start you on a maintenance regimen (possibly of continuing retinoid usage and/or less risky skin lightening agents, such as vitamin C in the form of ascorbic acid, azelaic acid, etc.). The individual components (tretinoin/other retinoids, hydroquinone) are also effective separately, as are the maintenance treatments (ascorbic acid, azelaic acid, etc.), but their effects are much more effective/faster when used in combination. The limitation is, of course, how much your skin can handle as several of these ingredients can cause irritation/redness/dryness/scaling if you don't build up your usage gradually.

For skin treatments, depending on what the pigmentation is being caused by (as well as skin tone), certain lasers and light treatments (such as the picosure laser as Greg recommends) can be helpful. Again, depending on the size/darkness of the discoloration, as well as overall skin tone, CO2 lasers in the a skilled clinician's hands can be a one-and-done deal to eliminate the hyperpigmentation, but its use is limited in darker skin tones and those with melasma. Superficial (glycolic/lactic/salicylic acids, Jessner's peel, etc.) and medium-depth peels (TCA peels, Obagi blue peel, etc.) are often used with more success on darker skin tones (beware of deeper peels such as phenol if you have a darker skin tone, as there is a risk of hypopigmentation) that are less tolerant of lasers and light treatments (they can cause more pigmentation in these skin tones), but a series of treatments (usually 3+) are usually required, and again the result is often dependent on the clinician's skill and experience.

For melasma, which is probably the most difficult type of hyperpigmentation to treat, oral tranexamic acid is often used with great success, often where lasers/peels/topicals have failed. There is a small risk of thrombosis, so you should take it under the guidance of a physician.

Edited by user Tuesday, December 24, 2019 8:24:38 PM(UTC)  | Reason: Not specified

Offline lamb  
#7 Posted : Tuesday, December 24, 2019 8:35:13 PM(UTC)
Rank: Advanced Member

Joined: 2/16/2009(UTC)
Posts: 1,255
Thank you for the informative and thoughtful post JB. They are about the size of a quarter on either side on the top of my forehead. Not too dark but noticeable. I am fair skinned, blue eyes. Just turned 40. Derm said sun damage but I think could be Melasma because of the symmetry.

I wouldn’t be able to do the oral medication because of those side effects.

Edited by user Tuesday, December 24, 2019 10:03:15 PM(UTC)  | Reason: Not specified

Offline Mike D  
#8 Posted : Thursday, December 26, 2019 1:17:42 PM(UTC)
Rank: Advanced Member

Joined: 7/24/2008(UTC)
Posts: 3,138
Location: Between the moon and NYC
The BBL laser by Sciton has worked well for my discoloration and for general skin improvement, but it’s not usually a “one and done” treatment and as such, I needed a series of treatments. I imagine like many of the lasers, it brings up a certain depth of discoloration and flakes it off at the surface of the skin over a week or so. If you have very superficial discoloration, it can sometimes respond with just one treatment. The others here are giving you great advice - just wanted to throw one more option in that has worked for me.
Offline lamb  
#9 Posted : Thursday, December 26, 2019 4:27:57 PM(UTC)
Rank: Advanced Member

Joined: 2/16/2009(UTC)
Posts: 1,255
Thank you Mike D, always appreciated!
Offline Hydroxyboy  
#10 Posted : Saturday, January 4, 2020 3:39:46 PM(UTC)
Rank: Member

Joined: 2/28/2009(UTC)
Posts: 553
Location: Amsterdam
You could spot treat yourself with tca. Plenty of tutorials on YouTube. I’ve had success with a stubborn mark on my cheek with it.
Offline lamb  
#11 Posted : Saturday, January 4, 2020 7:50:34 PM(UTC)
Rank: Advanced Member

Joined: 2/16/2009(UTC)
Posts: 1,255
Thanks for the suggestion Hydroxy
Offline IrishEyes  
#12 Posted : Saturday, January 11, 2020 7:38:57 AM(UTC)
Rank: Member

Joined: 4/27/2009(UTC)
Posts: 371
My face has no discolouration. But I had brown age spots on one hand. BBL seems to have addressed in one go. They’ve gone dark brown and are flaking off
Offline Sarah W  
#13 Posted : Sunday, January 12, 2020 3:39:18 AM(UTC)
Rank: Advanced Member

Joined: 6/4/2008(UTC)
Posts: 9,216
Woman
Originally Posted by: Hydroxyboy Go to Quoted Post
You could spot treat yourself with tca. Plenty of tutorials on YouTube. I’ve had success with a stubborn mark on my cheek with it.


Me too. A bit scary bit worked!
Offline lamb  
#14 Posted : Sunday, January 12, 2020 10:34:06 PM(UTC)
Rank: Advanced Member

Joined: 2/16/2009(UTC)
Posts: 1,255
Thanks Sarah.

Yea my concern with that is that the patches are about maybe a quarter size. Seems a bit large for me to do a TCA peel on my own?
Offline Sarah W  
#15 Posted : Monday, January 13, 2020 12:00:40 AM(UTC)
Rank: Advanced Member

Joined: 6/4/2008(UTC)
Posts: 9,216
Woman
Originally Posted by: lamb Go to Quoted Post
Thanks Sarah.

Yea my concern with that is that the patches are about maybe a quarter size. Seems a bit large for me to do a TCA peel on my own?


Yes, maybe it is. Plus I found I developed hypo pigmentation and it has stayed that way, since.
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