Freckle and blemish removal

Freckle and blemish removal
Freckle and blemish removal

Freckles and blemishes can be removed with several treatments. The appearance of freckles and blemishes is a very common aesthetic problem, and sometimes also a health problem. Their appearance is associated to exposure of the skin to the sun or UV radiation, genetics, hormonal changes and darker skin type. Freckles and blemishes can be removed using several techniques.

Freckles can be genetically determined and are more common in individuals with light skin, red hair, light-coloured eyes, and appear as early as puberty.

Sun or age spots – solar lentigo – occur at a more mature age, as a cumulative effect of solar radiation. They are considered to be damage to the skin caused by UV radiation and typically occur after the photoexposed parts of the body such as hands, face and shoulders get sunburned. Solar lentigo is a benign change in the skin involving a larger number of melanocytes. Irregular growth of lentigo, with patches of more or less pigmentation, warns of the appearance of malignant lentigo, a deadly skin cancer, a superficially spreading melanoma.

In addition to solar, senile lentigo, melasma may appear on the face.

Hyperpigmentation caused by increased activity of melanocytes, pigment-bearing cells. Unlike freckles, melasma is not clearly demarcated from the surrounding skin and affects larger areas. The condition gets worse in the sun, regardless of the use of sunscreen. It is hormone dependent. It appears in pregnancy, when taking contraceptive pills, or in the event of slightest hormonal imbalance in genetically predisposed individuals.

Post-inflammatory hyperpigmentationoccurs at the sites of skin damage. It is more common in darker-skinned people. It can appear on any part of the body.

Procedures that involve removing pigmentation from the skin are complex and without the possibility of a promise that the pigmentation will disappear or never recur.

Freckle and blemish removal

Age spots, solar lentigo as well as congenital freckles can be removed by a Q switch laser, which has a short, powerful pulse. The laser beam breaks down the pigment from the third layer of the skin and allows the lymphocytes to carry it away. It is also the safest laser because it cannot leave scars. It takes a month to see the complete result of one treatment. 2 treatments are done with an interval of 5 weeks.

When a freckle is treated with a laser, its surface turns white. After a few hours, it becomes darker and the surface is rough. It takes a week for the treated blemishes to flake away and that is also the recovery time.

TCA peel can be combined with Q switch laser or used independently. This acid coagulates proteins, the treated area is dried and the blemish flakes away in 7 days. It perfectly removes all parts of the pigmentation found in the superficial and middle layer of the skin. The pigment found in the third layer cannot be removed without the Q switch laser without leaving scars.

Laser and peel are often combined in one treatment.

Liquid nitrogen, like TCA peel and radio waves, peels the skin and thus removes the accumulated pigment. It freezes the skin, so the possibility of reactive pigmentation is greater than with TCA peels.

Radiowave abrasion is possible in lesions with only a few mm in diameter. Abrasion could cause permanent hypopigmentation or scarring if applied to spots larger than 5mm.

IPL devices and lasers with long beam pulses can reduce solar lentigo.

Melasma removal is far more complex and its outcome is more uncertain compared to removal of sun spots. Melasma and reactive hyperpigmentation basically involve increased activity of melanocytes (pigment-producing cells) while their number is the same as in the surrounding skin. In the case of this type of pigmentation, it is not sufficient to reduce the number of cells, but it is necessary to act on the melanogenesis itself, i.e. the formation of pigment. Any treatment of such spots can worsen their appearance if the treatment is too aggressive.

Melasma treatment involves a combination of several treatments.

Several different acids can be combined in one treatment. Different acids have different effects on the production of pigment and its cells. Treatments are repeated as long as the patient experiences a noticeable improvement.

Q switch laser is used when stagnation occurs. Laser treatment can be combined with the vampire treatment – PRP or chemical peel.

PRP can also be used independently. With the restoration of the skin quality and a better arrangement of cells in the skin, a part of the pigmentation disappears. At least 4 treatments are needed in order to see an improvement.

The use of other lasers which have a longer pulse and greater retention in the skin compared to Q switch laser to treat hyperpigmentation can easily cause reactive pigmentation and a worse pigmentation appearance.

Microdermabrasion can alleviate hyperpigmentation but not remove it.

After treating the blemishes, it is necessary to use creams that contain retinol, hydroquinone, fruit acids, kojic acid or azelaic acid. These are the substances that regulate further production of melanin or regulate enzymes that participate in the production of pigment. Two months after the treatments, the skin can be exposed to the sun with mandatory use of SPF 30+ creams for sun protection.
Whether the pigmentation will return is completely individual. In the case of removal of freckles and age spots, it is less likely that the pigmentation will return. In the case of removal of melasma, that likelihood is higher, but the blemishes are significantly milder. In melasma removal, it is necessary to regulate the hormonal status or discontinue contraceptive pills in order to obtain a lasting result.

Svetlana Đurišić specijalista dermatovenerologije

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