Patients with skin pigment problems may have areas of too much color (hyperpigmentation) or too little color (hypopigmentation). Birthmarks, moles, sun damage, and tattoos are a few of the most common causes of undesirable skin pigment. Pigment irregularities are a well-known potential complication after all forms of skin resurfacing and laser treatments, especially with any subsequent ultraviolet light exposure. Treatment options for hyperpigmentation include topical bleaching agents, surgical excision, laser treatments, and chemical peels, but each condition requires a correct diagnosis before an appropriate treatment plan can be developed.
Lasers might seem like the perfect tool for pigment reduction, but in fact, most lasers have limited usefulness because their effects are either too specific or too broad. Unwanted pigment is often present in more than one skin layer; narrow target lasers miss some pigment and broadly destructive lasers are too likely to cause scarring. Therefore, although many pigment conditions require more than one type of laser for maximal eradication, most physicians do not have the luxury of access to a large variety of lasers.
When considering treatment of a pigmented lesion, patients should know that (1) lesions with any potential for malignancy should be removed intact and examined under a microscope; laser or other destructive treatment of many moles is not appropriate for this reason. (2) Resurfacing procedures may help reduce the extent of many types of hyperpigmentation, but the risks of creating new pigment irregularities are increased in darker skin types. Complete removal of undesirable pigment in biological lesions and tattoos is often impossible, and the resulting blotchiness or blurred image may not be an aesthetic improvement over the original condition. (4) Regardless of treatment, recurrence of biological hyperpigmentation is common, especially in patients with sun damage who are not willing to be compulsive about protection from the sun.
Too little skin pigment (hypopigmentation) can be congenital (vitiligo) or related to injury, even in the absence of scarring. There is no good treatment for loss of skin pigment. Tattooing rarely leads to a natural result. Makeup is usually the best, albeit temporary, treatment.
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