Dark spots can be very hard to beat, and for those with darker skin tones, a treatment plan must be approached carefully or matters can get even worse. But, as a recent before-and-after showing an epic bounce back courtesy of Birmingham, AL dermatologist Rayna Dyck, MD proves, it can be done.
The Dark Spot Issue
So, why should patients with darker skin tones be mindful of the dark spot treatments they undergo? “My black and brown patients come in for treatment of hyperpigmentation more than lighter skin types. This is because of the larger melanin content in our melanosomes,” explains Birmingham, AL dermatologist Corey Hartman, MD.
“When inflammation occurs in darker skin, the skin cells are disrupted and the pigment is deposited into the dermis where it can sit for months. Any inflammatory condition such as acne, atopic dermatitis or seborrheic dermatitis can cause significant hyperpigmentation—or the stain left behind. Often the hyperpigmentation is more distressing for the patient than the inciting condition and is usually the reason that that patient presents for treatment.”
Dr. Hartman says another big issue is that most of the procedures to correct and improve the skin’s texture and tone, like chemical peels and lasers, are actually controlled injuries. “It takes experience and clinical acumen to know how to perform these procedures in darker patients safely. If too much heat is applied or too strong a chemical is used, the result can be worse. All lasers, devices and peels are not safe for darker skin tones and knowledge of the physiology of the skin and the nuances of different ethnicities is paramount to safe and effective treatment.”
A Combination Approach
For the patient in the before-and-after case above, Dr. Dyck explains that first she examined her current treatment plan. “She had been taking an oral antibiotic off and on for a year, as well applying a topical steroid to the face twice daily. The first concern was she was taking the antibiotic randomly when her acne was flaring. The second issue was the chronic topical steroid use. While steroids can calm breakouts temporarily, they can actually prevent long-term clearance. Some patients can suffer from steroid dependency and can experience redness, itching, burning, etc. when they stop using the steroid.”
To start her patient’s skin on its journey of recovery, Dr. Dyck prescribed a topical antibiotic in the morning and a retinoid and benzoyl peroxide combination gel at night. “This combination was to address her inflammatory lesions, as well as her comedonal ones,” says Dr. Dyck. “She continued using her gentle facial wash and oil-free moisturizer. Once facial tolerance was established, we added a 5% benzoyl peroxide wash. She was also placed on a three-month course of oral doxycycline. The other important piece of her initial treatment was weaning her off the topical steroid over a two-week period.”
To address hyperpigmentation in darker skin types, the doctors say solutions like superficial- and medium-depth chemical peels are recommended. “Microneedling, with and without platelet-rich plasma (PRP), is also an effective therapy,” adds Dr. Hartmen. “The Fraxel laser is a workhorse in our practice for stubborn dark spots, acne scars, melasma and wrinkles for black and brown skin. The Picosure laser is also a safe way to break up stubborn pigment, and Clear + Brilliant provides good maintenance between Fraxel treatments. And, of course sun protection is integral to any treatment plan.”
Dr. Dyck adds that patience is key, as the results of her case show it can take more than six months to see improvement, but the result is clear, smooth skin. “If you are suffering from disorders that are leaving you with discoloration and/or scarring, I recommend seeing a board-certified dermatologist to help you get an accurate diagnosis and an effective treatment plan,” notes the doctor.
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