Dr. Sherry Ingraham explains facial depigmentation causes and effective new treatments.

Whether you rely on a high-tech laser or a topical cream, with the right plan, you can erase pigmentation, making cover-up optional. The first crucial step is identifying the pigmentation's origin. Not only is the right treatment key, the wrong treatment can make discoloration darker. Most dark spots stem from three sources: CAUSES: 1. UV EXPOSURE: This can trigger a growth of excess skin cells called solar lentigo, aka sunspots, liver spots or age spots. The cells, pigmented with melanin, cluster together, forming a circular mark a few shades deeper than your skin tone. 2. HORMONES: Estrogen fluctuations due to pregnancy or birth control pills stimulate melanocyte cells to work overtime and create melasma, unwanted pools of melanin in the skin. However, unlike sunspots, these patches don't stay confined to a circle. 3. SCARS: Injuries such as a curling-iron burn or a swollen pimple can also jump-start melanin production (especially in Asian, Hispanic, or black skin), leaving a stubborn mark called post-inflammatory hyperpigmentation (PIH). TREATMENTS: Because UV rays worsen all depigmentation sources, it is best to minimize sun exposure and always wear sunscreen of SPF 30 or higher. 1. LIGHTENING CREAMS. Pigmentation responds to topical bleaching creams utilizing the bleaching agent hydroquinone which can cause irritation and peeling. Dr. Ingraham recommends SkinMedica Lytera Skin Brightening Cream, a new, non-prescription and hydroquinone-free skin brightening cream safe for all skin types and can be applied at home. Regardless of the lightening cream, it is very important to also use with a form of retinol and a sunscreen of SPF 30 or higher. 2. COSMELAN DEPIGMENTATION TREATMENT. Cosmelan is the treatment of choice for melasma and especially for sensitive skin types prone to hyperpigmentation from sun exposure, heat or blemishes. Cosmelan is a two-part treatment product: STEP 1: The initial treatment is an in-office procedure of the Cosmelan cream mask (Cosmelan 1), to stay on from 4 - 8 hours depending on the patient's skin type. The patient removes the mask with a neutral cleanser and applies the special post treatment Hydra Vital Factor K Cream included in the product pack. STEP 2: A board certified dermatologist will instruct the patient as to when to begin the maintenance creams (Cosmelan 2) which will be used daily to keep skin smooth, clear and maintain the lightening achieved with the Cosmelan 1.


News Reporter: Getting your skin looking its best before summer arrives is the job of board certified dermatologist, Dr. Sherry Ingraham. She's here with some do's and don'ts. Good morning to you.

Dr. Sherry Ingraham: Hi.

News Reporter: Hey, a lot of people have problems with discolored skin, but you have some great ideas to help that out. Because a lot of times you think these things are a farce, but there's stuff that works?

Dr. Sherry Ingraham: It can be very disconcerting for people when they have dark spots on their face. And in the past, some of the treatments were not as effective, I think, as we would like. But now there are new options.

News Reporter: What are some of the discolorations, and what causes that? Are we talking about sun damage? Or birth defects? What would it be?

Dr. Sherry Ingraham: Both. Really, the major things we see in practice are sun damage. So, chronic sun exposure, you get lentigines, what people call liver splotches. They have nothing to do with the liver. And then melasma, otherwise known as chloasma, which is that pigmentation you see, more commonly in women. It affects women most often. Usually 90% of cases are females, but it's that brown mask, where you see blotches on the forehead. It can be across the cheeks, nose and chin.

News Reporter: A lot of the times we always heard of laser before. Is that still a good treatment for it? Or is it actually creams now that's working well?

Dr. Sherry Ingraham: Yes and no. With lasers, you have to be careful because of the type of pigmentation. Anything that induces heat, so sunlight, laser light, will stimulate melanocytes and make more pigment, so I usually tell patients who have melasma specifically to avoid laser treatment. If the brown spots are actually due to sun, like little brown spots, those can respond to intense pulse light, or photofacial. So creams are really the domain we use for that melasma or hormone induced pigmentation in women.

News Reporter: What is in it that does it? I mean you think of bleach if it's taking out the color. What is it?

Dr. Sherry Ingraham: Well we call it bleach, but it's actually hydroquinone, so previously the most common ingredient, which was prescription based 4% hydroquinone. Over the counter you can get 2% hydroquinone. So 4% hydroquinone was this very potent product that we use. But you can only use if for short periods of time. About four months. It can cause irritation in some people. It can cause rebound hyperpigmentation in darker skinned individuals so you have to use it very judiciously, so companies searched for products that were more non-hydroquinone based, like the Lytera system I brought.

News Reporter: And so if you do something like this, how does it work? You're able to put it on yourself, at home.

Dr. Sherry Ingraham: Right. So the Lytera system is unique in that it involves several ingredients. There's vitamin C, there's resorcinol, there's an algae based product. And they found in their clinical studies that it was actually as effective as a 4% hydroquinone. So this is something you can do at home that you can purchase at your dermatologist, do at home, and you can actually maintain the results. Say you're out in the sun again over the summer, you get a few more spots, you can use this at home for maintenance.

News Reporter: And we were just looking at some of the pictures of given people an idea of some of the skin conditions, and you can see a big difference once they have it done. Any side effects from this?

Dr. Sherry Ingraham: From the Lytera system, no, other than if you use it with a rednoid that's included to boost it, you can get some peeling. Cosmelan, which is a much more powerhouse product that's applied at a dermatologist's office. You have to be careful going out in the sun immediately after because it's a much deeper peeling product. You can get some localized irritation and inflammation, but it is, having gone through it myself, I tell patients it's well worth it. The results from Cosmelan, which again are only available through your dermatologist's office, are really incredible.

News Reporter: When we look at these pictures right here, I mean you can tell the before pictures on the left side of your screen, and the right side. And these pictures haven't been touched up. She doesn't have makeup or anything on the right side. That's really the result you're going to get.

Dr. Sherry Ingraham: Yes. In most individuals you can get pretty significantly clearing. Previously we didn't have an option for these patients. These are typically patients with darker skin types. Your Latino patients, patients with a three, four, five and six skin type. Where in the past, we couldn't use a lot of these bleaching products.

Dr. Sherry Ingraham: Cosmelan is a great option for them. And with this mask particularly, you also get some anti-wrinkle benefit, which is nice because it's got a very potent retinoid in it as well.

News Reporter: Bet you won't get any complaints out of that. Thanks Dr. Ingraham, for being here today.