Treatments
Blemishes removal
Devices based on the use of light have been used for decades for the treatment of blemishes. Nowadays, we have safe and effective laser devices to achieve the elimination of different types of spots, achieving very good aesthetic results. Given the different nature or origin of some blemishes, the combination of different devices allows us to treat lesions that are not easily removed by other procedures.
What are blemishes
The appearance of blemishes on the face is one of the main reasons for consultation in dermatology. Other common locations are the neckline and the back of the hands. They usually appear due to excessive exposure to the sun over the years, although this varies according to skin colour (phototype) and genetic predisposition, among other factors.
Types of blemishes
(Source: Visual DX)
Sunspots
Sunspots, also known as solar lentigines or senile lentigo, are those that appear in areas exposed to solar radiation (especially on the face, neckline, back of the hands or back). At first, they usually have a faint color and small size, and they can progressively grow and present a certain degree of darkening.
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The correct dermatological diagnosis of these lesions is essential, as they can sometimes be confused with malignant lesions (such as lentigo maligna melanoma, for example) or with lesions that will not respond satisfactorily to the laser usually used for pigmented lesions (such as flat seborrhoeic keratoses).
Facial sun spots, together with fine wrinkles, dull skin and enlarged pores are the consequence of exposure to the sun over the years. This is known as photo-ageing.
(Source: Visual DX)
Hormonal patches or melasma
Hormonal patches, also known as melasma, appear mainly in women and in the facial region, usually on the moustache, cheeks or forehead. They are usually symmetrically arranged and are related to sun exposure, genetic factors, taking contraceptives or pregnancy.
Women with dark skin (phototype 3 or higher) are more likely to have this type of patches.
Treatment
The definitive treatment for sunspots or solar lentigines are light devices and lasers for spots.
IPL (intense pulsed light) and lasers such as Q-switched pico or nanoseconds are some of the most effective tools for this. The selection of the device and complementary treatments depends on aspects such as the patient’s skin colour, the extent of the blemishes, previous treatments, pain tolerance, or the recovery time the patient is willing to assume. Despite the effectiveness of these devices, maintenance treatment is often necessary to maintain the effect, as new lesions may appear as a result of indirect sun exposure and the passage of time.
These light devices can be used to treat lesions in isolation (just one or a few spots) or in a generalised manner. The treatment of blemishes in a generalised or global manner is known as photorejuvenation, and allows for the elimination of blemishes, brightening the skin and improving its texture.
Here are the different steps involved in the treatment of melasma:
- Suspension of the cause whenever possible.
- Use strict sun protection in the form of sunscreens in cream and clothing (hats, sunglasses).
- Apply topical treatment such as magistral formulas with depigmenting agents that are adapted to the patient’s tolerance and skin condition.
- Consider combining peelings in consultation or microneedling sessions with depigmenting agents.
- Use an appropriate cosmetic routine that includes depigmenting agents to maintain the effect of the treatments.
- Consider light sources such as IPL or soft Q-switch as a last option.
Frequently asked questions
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The main cause of the appearance of facial blemishes is sun exposure and sun damage accumulated over a lifetime. The best way to prevent their appearance is strict sun protection from the earliest years of life, both with physical measures (hats and caps, sunglasses, scarves, UPF clothing) and with creams that include broad-spectrum sun protection. In addition, it is advisable to avoid direct exposure to the sun during the central hours of the day and to seek shade whenever possible.
The diagnosis of facial blemishes by the dermatologist is the key to the successful removal of these lesions. The most common spots are solar lentigines, which usually respond satisfactorily to intense pulsed light and nanosecond and picosecond lasers. In the case of melasma or hormonal patches, topical treatments with depigmenting active ingredients are recommended, while lasers and light sources are considered when previous treatments have not worked.
Assuming that the spots we wish to remove are solar or senile lentigines, there are currently various devices available that can attenuate or eliminate these lesions. The selection of these devices will depend on the phototype of the patient, the appearance, location and colour of the spot to be treated and the experience or preference of the physician. Intense pulsed light and nanosecond and picosecond lasers are the most effective.
Although the intention of spot treatment with lasers and light sources is to permanently remove blemishes, in some cases it can be a challenge for the dermatologist. Several sessions may be necessary to eliminate almost all facial lesions, and annual maintenance sessions may be required for long-term effects to persist.
The most common reasons for the persistence of these spots are incorrect initial diagnosis (melasma, nevus, flat seborrhoeic keratosis, café-au-lait spot, etc.), the presence of little pigment in the spots (i.e. little chromophore in the target lesion, as in the case of lentigines with little pigment in white skin) or the use of inadequate parameters in the device used. Maintenance sessions are usually required over the years, as new lesions may appear despite strict sun protection.
To remove most facial blemishes with lasers or light sources, we usually need between two and three sessions. Despite the initial good results, it is advisable to have annual maintenance sessions to eliminate new lesions as they appear, which will also improve the quality of the skin texture.
Diagnosis by a dermatologist is essential to determine the risk of malignancy of a facial blemish. Most facial lesions are benign lesions such as sun spots (solar lentigines), ephelides, melasma, nevus, seborrhoeic keratosis, basal cell carcinoma, café-au-lait spots, or lentigo maligna melanoma, among others. Dermatologists use dermoscopy to make a diagnostic approach, and in doubtful cases we must resort to skin biopsy to confirm the diagnosis.
Among the most common facial blemishes, those corresponding to melasma or chloasma can be improved with topical treatment. There are cosmetics that include active ingredients such as kojic acid, niacinamide, tranexamic acid or azelaic acid, which can help to slightly lighten their appearance and prevent them from worsening. However, to achieve clear results, it is usually necessary to apply a depigmenting master formula (prescribed by the dermatologist and adapted to the type of skin and the appearance of the blemish), strict sun protection and combination with certain medical treatments such as microneedling or laser. In some cases, it may be necessary to combine with oral treatment.
The blemishes that appear on the face during pregnancy or while taking contraceptives correspond to melasma or chloasma. These are brownish spots that appear in the facial region and usually occur symmetrically on the forehead, cheekbones and upper lip.
Various tools are available for the treatment of melasma to control and attenuate its appearance. These include magistral formulas, peelings and oral pharmacological treatment. Lasers and light sources can be used when other treatments have not been effective and must always be carried out by a dermatologist who is an expert in the treatment of this type of spots, due to the risk of hyperpigmentation. In this link I will tell you more.
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