80% of the patient populace here has some complaint or the other related to skin colour. This ranges from people who want to become Fair drastically to those who have brown-black marks on the skin. A smaller percentage of the patients want to have an even skin colour & not ‘Shades’. Just proves how aware & skin conscious we have become over the years & how good our media projections are !
Pigmentation comes in many forms. Hyper pigmentation means an increase in the skin pigment (melanin).
This can be the post inflammatory type i.e after some sort of skin infection or inflammation, eg Acne, chicken pox, trauma, fungal infections etc. This pigmentation is easy to treat ……PATIENCE…being the key word. It can subside by itself and can also be easily hastened by usage of certain creams & peels.
To make a person FAIR, is another media blitzkrieg which is difficult to explain to a patient. Most of the fairness creams contain sun screens, vitamins & extracts for lightening skin pigmentation. Here again it is important for the patient to remember that you CANNOT become Fairer than the colour you were born with, unless you develop Vitiligo or use industrial bleach to destroy your Melanocytes ! What happens as we grow up is that the sun exposure causes normal darkening, this is reduced by using sunscreen & lightening agents cause small spots & dark areas to even out , giving an overall impression of fairness.
Every person who is bothered about his or her skin must remember to go in for Quality products & proper guidance for their use. Beauty pushers can sell you anything, what is important is to use your own discretion !
The commonest & worst pigmentation we see here is the Black-Brown marks on the Butterfly Area of the face & forehead this is called ‘MELASMA ( in females) & Chloasma(in males).’
Melos, means black in Greek. It is commonly seen on the cheeks, nose, forehead & upper lip. It is seen in Females following pregnancy, hormaone therapies & rarely it is spontaneous. In males it is seen in growing nos these days probably increased by sun exposure.
It is INHERENT, Not inherited i.e it is a tendency.
It increases due to Sun Exposure BUT only Sun is NOT the Cause.
It is overactivity of the NORMAL Skin colour inducing Hormone so it is impossible to give any anti hormones unless you wish to destroy the entire skin surface colour !
It can be exacerbated by wrong cosmetic usage.
Medically, I examine the patient to see what type of pigmentation it is……..Epidermal ( superficial),………Mixed or Dermal( deep). Results with Epidermal are good & as the pigment is steeped deeper in the skin the treatment becomes more prolonged & frustrating. Patients feel the doctor is not doing anything but its not so easy to just standardise a treatment. Skin differs in each person in texture. tone & reactions ! There is no Universal treatment for this. It is for the Dermatologist to start with the best & monitor the response. I can understand when a patient feel frustrated because of financial constraints 7 of course we always have lots of ‘Well wishers’, who know someone or the other who was ‘Cured Completely’ by doing this or that treatment, Here or there.
First and foremost the Doctor Patient relationship should have trust as an important element. The dermatologist should explain all the pros & cons to the patient. Broad spectrum Sunscreen is a must and has to be used Life long. Skin lightening ‘Medical” creams are given as treatment. Oral Antioxidants, proteins, liver stimulants are all adjuvant therapies. Medical creams are emerging every day & its very necessary for ur Dermats to know which ones are better & which are now being viewed with trepidation . Studies are constantly ongoing so updates are a must. Sometimes it becomes necessary to mix a nos. of creams . I rely on my experience & common sense as to what to use & what to avoid, because no measured yardstick exists. One cannot promote one single constituent to be the be all and end all treatment for all skin problems because the root cause of all is so varied ! Any obvious cause is pinpointed. Face peels are used to hasten the process.
But remember this cosmetic problem is chronic. If it recurs the patient should know what to use & when. Never tell a patient it is a permanent cure because the hormones & the sun are ubiquitous. The patient on the other hand should also understand that this is not a disease but a Cosmetic condition & definitely treat it to the hilt & mantain it to its maximum !
