What can I do about these marks on my legs?

Question

I’m not sure what caused it, but they appeared a few years ago on my shin area. My legs just look.. blotchy? Or streaky? Any idea what this could be?? They don’t hurt, itch, burn or anything and my skin feels perfectly smooth and normal. It looks like it’s just hyper pigmentation but it’s so ugly. I don’t necessarily want any cosmetic procedures done, but is there anything I can do at home to help with this? Would a bleaching cream help?

Anna Chacon, MD, FAAD · Answer

I'm sorry to hear about the marks on your legs. Based on your description, it sounds like you might be dealing with a type of hyperpigmentation, which can occur for various reasons, including sun exposure, inflammation, or injury to the skin. However, without a proper diagnosis, it's difficult to recommend a specific treatment.

Here are some general steps you can take at home that might help improve the appearance of hyperpigmented skin:

1. **Sun Protection**: Use a broad-spectrum sunscreen with at least SPF 30 on your legs daily. Sun exposure can worsen hyperpigmentation.

2. **Moisturization**: Keep the skin well-moisturized to support skin health. Products with ingredients like hyaluronic acid, glycerin, or ceramides can be beneficial.

3. **Topical Treatments**:
   - **Vitamin C**: This antioxidant can help brighten the skin and reduce pigmentation.
   - **Niacinamide**: Known for its anti-inflammatory properties and ability to lighten dark spots.
   - **Retinoids**: These can help speed up cell turnover and fade pigmentation over time. However, they can be irritating, so start with a low concentration and use it gradually.
   - **Hydroquinone**: This is a common bleaching agent used to lighten dark spots. Over-the-counter options typically contain 2% hydroquinone, but higher concentrations require a prescription.

4. **Exfoliation**: Gentle exfoliation can help remove dead skin cells and promote new cell growth. Use a mild chemical exfoliant like glycolic acid or lactic acid a few times a week.

5. **Natural Remedies**: Some people find success with natural remedies like aloe vera, licorice extract, or green tea extract, which can have skin-lightening properties.

6. **Healthy Lifestyle**: Maintain a balanced diet rich in vitamins and antioxidants to support overall skin health.

Before starting any new treatment, it's a good idea to do a patch test to ensure you don't have a reaction, especially with stronger ingredients like retinoids or hydroquinone.

However, it's important to consult a dermatologist for a proper diagnosis and personalized treatment plan. They can help determine the exact cause of the pigmentation and recommend the most effective treatment options for your specific condition.

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis.  We see atrophic and hypertrophic scars, as well as scars that have hypo and hyperpigmentation. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to discuss the best treatment options for your type of skin. .

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

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