Dyschromias

Dyschromias refer to various pigmentation issues that can affect the skin’s appearance, impacting individuals of all ages. These conditions include sunspots, melasma, age spots, post-inflammatory hyperpigmentation and medication-induced dyschromia. Understanding the types, causes and treatment options available is crucial for effective management.

Types of Dyschromias

Dyschromias can be classified into four main types, which are essential for determining the appropriate treatment:

Epidermal type: Characterized by superficial brown spots caused by excess melanin in the upper layers of the skin. This type typically responds well to treatments such as chemical peels, laser therapy, and topical agents.
Dermal type: Involves deeper pigmentation with unclear boundaries and a darker hue. Treatments may be less effective and often require a combination of therapies, including laser treatments designed for deeper penetration.
Mixed type: A combination of both epidermal and dermal characteristics. This type can be challenging to treat and often requires a multi-faceted approach.
Undefined type: More common in individuals with darker skin tones, exhibiting varied characteristics. Treatment often requires careful evaluation and customized therapy.

Common causes

Solar lentigo (Sunspots): Caused by prolonged sun exposure, these flat brown spots typically appear on areas frequently exposed to sunlight, such as the face, shoulders, and hands. They result from melanin overproduction triggered by UV radiation.
Melasma (Chloasma): Often referred to as “the mask of pregnancy,” melasma is associated with hormonal changes. It manifests as larger, irregular brown patches primarily on the forehead, cheeks, and upper lip. It can also occur during hormonal treatments or in women taking oral contraceptives.
Post-Inflammatory Hyperpigmentation (PIH): This type occurs after an injury or inflammation to the skin, such as acne or eczema. The skin darkens as part of the healing process, resulting in brown or dark spots at the site of inflammation.
Age spots: These small, darkened patches appear with aging due to cumulative sun exposure over the years. They usually occur after the age of 55 and are commonly found on the face, hands, and forearms.
Drug-induced hyperpigmentation: Certain medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), tetracyclines, and some neurological drugs, can lead to increased melanin production, resulting in skin discoloration.

Diagnosis

Understanding the type of dyschromia is essential for choosing the right treatment. Diagnosis typically involves:

Clinical examination: Assessment of the color, size, and distribution of the pigmentation.
Wood’s lamp examination: This test uses ultraviolet light to highlight different types of pigmentation, helping distinguish between epidermal (superficial) and dermal (deeper) types.

Treatment

Treatment for dyschromias varies based on the type and cause of the pigmentation:

Fractional laser therapy: Effective for melasma and other hyperpigmentation issues, this laser targets specific areas of pigmentation without damaging surrounding tissue.
Q-Switch laser: This advanced laser treatment is particularly effective for removing pigmented lesions and is safe for various skin types. It works by delivering short, high-energy pulses to break down excess melanin, making it suitable for conditions like age spots and melasma, as well as post-inflammatory hyperpigmentation.
Chemical peels: Customized based on skin type, these peels remove excess melanin and typically require several sessions or a combination with other methods.
Cryotherapy: Suitable for localized sunspots or age spots, this method involves freezing the pigmented areas, causing them to peel away.
Microdermabrasion: A gentle exfoliation treatment that helps rejuvenate the skin by removing dead skin cells, gradually improving the appearance of dyschromias.
Mesotherapy with brightening agents: Involves injecting a cocktail of ingredients, such as glycolic acid and vitamin C, to regulate melanin production and hydrate the skin.
Topical agents: Creams containing hydroquinone, retinoids, azelaic acid, or kojic acid can help lighten hyperpigmentation gradually.

Preventive measures

To maintain results and prevent further hyperpigmentation:

Sunscreen: Daily use of broad-spectrum sunscreen is crucial to protect against UV radiation, which can exacerbate existing pigmentation.
Skin care routine: Use gentle, non-irritating products to avoid triggering inflammation that could lead to PIH.
Regular check-ups: Dermatologists must monitor skin changes and adjust treatment plans as needed.