The main advantage of this device is its great versatility. With it, we can attenuate or eliminate some types of spots, vascular lesions and even stimulate the production of collagen and elastin, improving the texture and luminosity of the skin.

What are the advantages of IPL?

Many dermatologists consider IPL to be the foundation of any skin treatment intended to improve the health and appearance of the skin. The improvement of skin texture and the removal of blemishes and vascular lesions make this device a useful tool for most skin types.

A well-indicated IPL performed with parameters that are appropriate for the patient (sufficiently powerful to achieve evident results and sufficiently conservative for the procedure to be safe) are the key to success. For this, it is essential that the procedure is performed by a dermatologist, who is the most qualified professional to perform it.

In addition, it is a treatment that can be enhanced with the combination of cosmetics that include active ingredients such as topical retinoids or acids, or procedures such as peelings or botulinum toxin.

What are the disadvantages of IPL

Although the procedure is generally well tolerated, it can be uncomfortable and even painful in some patients. For this, and in selected cases, we can use topical anaesthesia (although this is not usually recommended) and even local cold.

In addition, patients with many spots or a lot of vascular damage may experience swelling or intense darkening of the spots during the following days. And although during these days the lesions can usually be made up, they may be evident in some patients, especially during the first sessions.

Finally, it is a procedure that, in order to be carried out effectively and safely, needs to be performed by a dermatologist trained and experienced in its management, and sometimes access to a dermatologist can be delayed.

What should I expect from IPL treatment?

IPL is one of the best dermatological treatments for improving the overall appearance and health of the skin, although it must be individualised in each case (ruling out lesions that should not be subjected to the procedure, or very high phototypes that may hyperpigment, for example). In addition, we must consider a maintenance treatment over time so that the effects persist over the years.

La entrada What is IPL or pulsed light used for? se publicó primero en Dra. Sara Gómez Armayones.

Why does the skin on our hands age?

The factor most implicated in premature skin ageing, especially in exposed areas (face, neck, décolleté and back of hands), is exposure to ultraviolet radiation over the years.

Sun exposure leads to collagen degeneration, which causes skin thinning and loss of skin elasticity. In addition, sun spots appear progressively, which are small, benign brownish spots that are another marker of the sun damage we have received throughout our lives. Naturally, over the years, the skin loses moisture and subcutaneous fatty deposits are reabsorbed.

The first signs of ageing on the skin on the back of the hands will appear around the age of 40, especially if sunscreen has not been used consistently. This skin will become progressively more fragile and thinner, and the underlying structures such as the veins or the extensor tendons of the fingers will become more evident.

What factors influence the ageing of the skin on the hands?

The ageing of the skin on the back of the hands is subject to:

• The genetics of each person
• The colour of our skin (phototype)
• Accumulated sun exposure over the years, depending on our work or leisure activities
• Use of hand protection (either sunscreen creams or physical barriers such as gloves).
• The amount of subcutaneous fat deposit

What treatments improve hand ageing?

• Laser and light sources The definitive removal of spots on the back of the hands can be done with pulsed light or (IPL), Q-Switched laser and picosecond laser. The light emitted by these devices is selectively captured by the spots or lentigines of the skin, producing a superficial burn, which will turn into a crust and subsequently cause it to lighten or disappear. More than one session may be necessary, and it is usually advisable to have further sessions in the future as new spots appear over the years. Pulsed light also has the ability to treat small vascular lesions and induce the formation of new collagen, so the overall result of the skin on the back of the hands may be superior to that treated with other types of lasers. The dermatologist will recommend one tool or another depending on the type of blemish, the patient’s phototype and the response to previous treatments.
• HYALURONIC ACID The loss of fatty tissue on the back of the hands can be improved by the infiltration of filler materials such as hyaluronic acid. This must be fluid, easily mouldable and must adapt to the movements of the hands. We are interested in rehydrating and thickening the skin, so that the surface is more even, the underlying veins and tendons are less visible, improving the elasticity and appearance of the skin. This procedure is usually tolerated without anaesthesia, and is performed using a technique of superficial micropunctures or by using a cannula and making linear deposits. The results usually last between 12 and 18 months, depending on the material used.
• Mesotherapy and platelet-rich plasma (PRP) Although the result is not usually as spectacular and long-lasting as with the two previous techniques, procedures such as mesotherapy (infiltration of a combination of active ingredients with antioxidants, moisturisers and depigmenting agents in micropunctures) and PRP (injection of the plasma in our own blood which is rich in platelets and other growth factors, promoting the regeneration and repair of the tissues where it is applied) may be useful. Their effects are less evident and do not have the capacity to significantly increase skin thickness, although they do produce a temporary improvement in the luminosity and appearance of the skin.
• Peelings Some peelings can be used to improve the quality of the skin or attenuate solar lentigines, but the skin on the hands is thinner and more delicate than that of the facial region (the area where this technique is classically used), which limits the depth and type of peeling that can be used, and therefore its effectiveness. They can improve the luminosity and texture of the skin, and even fade some superficial lentigines, and are best used in combination with other techniques depending on the case.

How to prevent or mitigate premature ageing of the hands?

• Maintain barrier function by using mild cleansers
• Wash with lukewarm water, avoiding very hot water.
• Avoid intense friction during drying.
• Apply emollients or moisturisers frequently, especially in the cold months.
• Wear gloves to protect your hands from the cold and the sun.
• Wear gloves when in contact with irritating products.
• Use daily sunscreen on the back of the hands.

La entrada How to treat aging of the hands? se publicó primero en Dra. Sara Gómez Armayones.

Melasma is a frequent concern of our patients and one that we see very often, especially in young women and high phototypes.

These are brownish spots that appear on the facial region and usually occur symmetrically on the forehead, cheekbones and upper lip. Although in some cases it affects other locations such as the forearms, this form usually appears around menopause.

What are the causes?

Different factors play a role in its origin, which makes treatment difficult and can be a challenge for the dermatologist.

Known factors include:

• Exposure to solar radiation, both ultraviolet and visible light.
• Hormonal changes: use of contraceptives, fertility treatments, pregnancy.
• Genetic predisposition: most patients have a family history of melasma.
• Skin colour: it is much more frequent in dark skin phototypes III to V.

How can we prevent melasma?

The most important factor for prevention is strict photoprotection. This must be broad-spectrum, used all year round and repeatedly.

Physical measures are another fundamental aspect; the use of hats, caps, sunglasses or seeking shade are indispensable measures to achieve correct control of the disease. In addition, sun exposure should be avoided during the central hours of the day.

Also, the selection of cosmetics adapted to skin with melasma can help to maintain the effects of the treatments. Here are some product recommendations.

How to treat melasma?

Before starting treatment for melasma, it is essential that the dermatologist makes a correct diagnosis, as this condition can be confused with other types of blemishes, and treatment can worsen the lesions if it is incorrectly selected.

Treatment must be individualised. We must consider the patient’s phototype, previous skin alterations (acne, rosacea, scars, seborrhoea, seborrhoeic or atopic dermatitis…) or the time of year in which we are going to treat it.

In terms of topical treatments, we find:

• Magistral formulas prescribed by the dermatologist that combine active ingredients at different concentrations depending on each case, and which may include hydroquinone, retinoids, glycolic acid, tranexamic acid, azelaic acid, kojic acid and even corticoids for a specific period of time to reduce the appearance of melasma.
• Chemical peels: these can be an effective treatment and are generally used as a complement to topical treatments. Here we can use various active ingredients in combination such as phenol, hydroquinone, glycolic acid, salicylic acid, trichloroacetic acid, etc., and generally at much higher concentrations than in cosmetics.
• Lasers and light sources: Although they are not considered a first-line treatment, they can be effective if combined with other treatments or when these are not effective. However, they should be used with caution and always by a dermatologist, as the risk of post-inflammatory hyperpigmentation is high. Some devices such as IPL (intense pulsed light) or picosecond laser can be effective.
• Oral tranexamic acid: this drug has been shown to be effective in the treatment of melasma; however, its use is off-label and the dermatologist must assess the risk-benefit ratio on an individual basis.
• Microneedling with depigmenting active ingredients. The small holes generated in the skin by the application of the devices with microneedles allow these products to enter the deep layers of the skin, achieving significant improvements in some cases, especially when combined with other treatments.

Despite all the treatments carried out, we must assume that, with all these tools, we intend to control (not eliminate) melasma, as it has a natural tendency to recur. The key to success in controlling melasma is correct diagnosis by the dermatologist and the combination of treatments according to the patient’s characteristics.

What cosmetics are suitable for melasma skin?

Here are some examples of cosmetics that can help control melasma skin (although they are not a treatment).

Photoprotectors: it is important that photoprotection is broad-spectrum (coverage against UVA, UVB, visible light and infrared), and should be applied frequently (every 2 hours if we are exposed).

1. Heliocare 360 Pigment Solution Fluid:
2. Fotoutra Age Repair Isdin
3. Advance Brightening UV Defense de Skinceuticals

Cleansers: This is a fundamental step in any routine as it helps to exfoliate and helps treatments to work more effectively

1. Rilastil Aqua face cleanser (https://rilastil.es/producto/aqua-limpiador-facial)
2. Bioderma Sebium Gel Moussant Actif (https://www.bioderma.es/nuestros-productos/sebium/gel-moussant-actif)
3. Basiko PS-Active Mousse de Cosmeclinik (https://cosmeclinik.com/en/basiko-sensitive-skin/basiko-ps-active-mousse-138)

Other cosmetics with depigmenting agents:

1. ACM Dépiwhit Lightening Film Mask (https://www.labo-acm.com/es/depiwhite/148-depiwhite-mascarilla-peliculable-aclarante-3760095250106.html)
2. Neoretin Discrom Control Concentrate by Neostrata (https://www.cantabrialabs.es/productos/neoretin-discrom-control-concentrate/)
3. Advanced Pigment Corrector by Skinceuticals (https://www.skinceuticals.com/advanced-pigment-corrector-883140023234.html)

La entrada How to treat melasma? se publicó primero en Dra. Sara Gómez Armayones.