Focusing on how our skin’s color changes

The aging face has three basic changes: volume loss, collagen loss and color changes. A lot has been made of the use of fillers such as Juvederm, or fat to replace age-related volume loss.

We have previously written about using topical creams, chemical peels and lasers for the restoration of collagen loss, but this month I want to focus on the color changes that we see in the face and what we can do about them. Like collagen, the three basic modalities for treatment are topical creams, chemical peels and laser.

What makes the three color changes in the face particularly annoying is that most of these changes are “spotty” in nature. What we like to see is smooth, even skin. White, red and brown spots mess this up. Before we consider the benign color changes, a quick word about cancer.

Melanoma is scary — any spots that are changing or look significantly different than other spots need to be evaluated for malignancy.

Now let’s consider white spots. There’s a common reason for white spots include, vitaligo, hypomalanoisis and scars. The only treatable cause is a fungal infection called tinea versicolor.

Unfortunately, for most of those unwanted white spots there is no good treatment. Sunscreen and make-up are the mainstays of treatment. Sunscreen won’t actually help the white; it just reduces the contrast between the patch and the normal skin.

Red in the skin consists of two basic problems-distinct vessels and rosacea.

There are four stages of rosacea, which can range from “rosy” cheeks to severe acne forms of rosacea.

Topical creams can help for mild pinkness to the cheeks, products containing caffeine will temporarily reduce the redness and for more severe forms of rosacea, topical and oral antibiotics are sometime helpful.

Chemical peels and microdermabrasions generally are not helpful.

This leaves lasers, which really are the best treatments for reds in the face. Broken capillaries and vessels respond very well to our “YAG” laser in one to three treatments. For diffusing redness, there are two lasers that help, IPL’s or “Photofacial’s” and the Genesis. With more severe symptoms the combination of the two lasers works the best. These lasers are effective, have minimal discomfort and have no down time associated with them.

The last and most common color change that we have to deal with is brown spots.

There are several causes of these spots and books can be written on the variety. Sun-induced changes such as freckles, solor-lentigenes and common moles make up the majority of these spots.

The other problem is melasma. The first step in treating brown spots is prevention. Sunscreen, sunscreen, sunscreen! Hats and clothes also prevent the formation and progression of pigment-related problems. It’s OK to enjoy our beautiful San Diego weather, but always protect yourself.

The next things to consider are topical agents. These products, often referred to as “bleaching agents,” don’t actual remove the pigment, but they block the production of new pigment. It will take two to three months for the skin to remove the pigment, so be patient for the results.

My favorite is hydroquinone. This product has been used for over 20 years and has been shown to be very safe in humans (you may be out of luck if you are a lab rat). Exfoliating procedures, such as microdermabrasions and peels will also help with reduction of dark pigment in the skin. Finally, there are lasers that I find to be the best treatment for brown spots. IPL’s or “Photofacials” work very well for most pigment.

Unfortunately, IPL cannot be used on African-American skin and we also need to be careful with medium-dark skin tones. Fraxel is the other laser choice for dark spots, and is the treatment of choice for melasma. In addition to helping with pigment, Fraxel is a great choice for collagen stimulation.

If evening out your complexion is a concern for you, come talk with our staff or schedule a consultation. We can look at your skin and come up with a plan that will help you achieve your goals.