I am mixed with Chinese and East Indian and I have developed age spots on my cheeks. How can I get rid of them? Many of the solutions I have read about work best on fair skin, especially lasers, which although effective, seem to be potentially harmful to darker skins. My skin type is a combination of Chinese and Indian.
What's the Best Way to Get Rid of Age Spots on Asian or Ethnic Skin?
Doctor Answers (7)
Sun damage on Ethnic Skin
Treating age or sun damage on Ethnic Skin can be tricky because IPL/BBL lasers can make it worse, these type of laser's pick up pigment in the skin and can not differentiate between your natural pigment and a sun spot, risking burn's or hypo-pigmentation (white spots). We always pre-treat our ethnic skin patients with a 4% Hydroquinone topical cream for at least 4 weeks to settle down the pigment cells. My preferred method is using pro-fractional treatment laser for this pigment. If the spots are resistant to that treatment we do use BBL laser's at very low settings for multiple treatments to get improvement. Remember with any laser you are at risk for Hypo-pigmentation problems.
Careful pretreatment and post treatment care and combination therapy
As you pointed out, treating ethnic skin is a challenge as potential side effects are more common and can be significant. There should be a strict pre and post treatment care, specially after light base treatment such as laser, to avoid common problem such as post inflammatory hyperpigmentation. In our experience, a carefully designed combination treatment that typically involves topical treatment (e.g. hydroquinone, tretinoin), IPL with very conservative settings, and light chemical peels. It is very important, again, to adhere to strict pre and post care. Lastly,each patient's treatment should be specifically designed for that individual patient based on skin tone, age, etc.. Good luck!
Age Spots on Ethnic Skin
One of the most effective ways to reverse the effects of age spots and chronic sun damage on ethnic skin is by using a combination of two prescription strength medications: tretinoin cream and 4% hydroquinone. Unlike the unsubstantiated claims made by over-the-counter skin care products, the results of using these creams are backed by real medical science. More aggressive treatments such as lasers in ethnic skin are more of a risk to cause increased pigmentation. We recommend the Obagi Nu-Derm System which uses both tretinoin cream and hydroquinone to visibly lighten age spots as well as the fine lines and wrinkles that are due to chronic sun exposure.
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Be conservative with age spot removal on ethnic skin
As you intimated, one has to be careful with light devices such as IPL in your case.
I would recommend topical treatment first. There are many agents which can help with these lesions, dyschromia. I would recommend Retin A microgel 0.04.
A recent paper in the dermatology literature showed that the weaker strength Retin A worked better since it did not cause the inflammation, which could only make things worse. Retin A works by casuing the cells to move out faster and making it difficult for the pigment to linger.
Hydroquinone products are also helpful and are in a host of products. It works by interfering with tyrosinase the enzyme that helps manufacture the pigment.
Kojic acid, licorice, niacinomide all interfere with the transfer of the pigment into the skin cells from the cells that make the pigment (melanoctye).
Definity by Oil of Olay is a nice product. Neostrata also makes a great product. These are both inexpensive.
Prescription agents like Epiquin, Tri-Luma (which contains Retin A, a mild steroid and hydroquinone), Lustra, Aclero, and Solaquin are all excellent.
If topicals fail to work, gentle cryotherapy (freezing) might work. However, sometimes this makes the situation worse and must be applied gently.
The darker spots can also be templated out. The normal colored skin is protected and the IPL (Intense Pulsed Light) is delivered to the dark areas only.
Good luck and thank you for your question.
Fraxel Dual For Age Spots in Ethnic Skin
Indeed most lasers are potentially harmful to darker skin. Skin coloration and age spots are made of a pigment called melanin. Melanin tends to absorb laser energy very easily. So patients who have more melanin (hence darker skin tone) will absorb more of the laser energy than those with very fair skin.
This can pose the risk of overheating and scarring, which develops as a result.
However, there are some lasers that use very specific wavelengths which are relatively more resistant to being absorbed by melanin in the surrounding areas. They will target the problematic melanin in age spots, but not so much the melanin that gives your skin its color.
Fraxel Dual is an example of a laser that is actually very safe for ethnic skin. It uses the 1550nm wavelength and the 1927nm wavelength. When addressing age spots the 1550nm wavelength will break up the organelles in your skin containing the melanin.
And the remains are carried away by your lymphatic system. Here is a video of an Asian patient who underwent Fraxel Dual.
Help for age spots
Creams such as retinoids (Retin A, Differin and Tazarac) may be mildly helpful for age spots. However, use of lasers such as Medlite or Ruby in non-summer months with appropriate preparation and precaution are usually the most effective.
In my recent interviews, I have discussed this topic as well as other age related skin rejuvenation methods/treatments.
Please refer to my recent articles:
Don’t Let Age Spots Show Your Age
Which Age-Defying Method Is Right for You?
How to look your best during each decade of your life
Slow and steady...
OK - here is my tip
1. Q switch lasers are great in fair skin types, you can get away with 532 QSL, but you MUST use sunscreen and bleaching creams after.
2. For a safer approach I would recommend the following (usually my standard treatment)- Fraxel 1927, conservative type 4 settings (less passes, lower energy) - up to 4 treatments, 6 weeks apart. Add Lytera and HQ 4% between treatments, and sunscreen.
3. Low strength TCA peels can be done 8-12%, multiple treatments.
4. IPL can be done - once again conservative settings. Combine this with HQ and Lytera +/- Vitamin A cream.
Essentially an assessment needs to be conducted prior to treatment. I usually go thru life style factors, including your sun exposure on a daily and recreation basis.
Treating Asian skin can be difficult, but slow and steady is the key.
Dr Davin Lim