Hyperpigmentation 4 Weeks After a 25% TCA Peel, What Are my Options?

Question

I'm 38 and have light skin. I was due to have 3 more peels but my doctor has advised no more peels! He thinks this is due to sun exposure, and not applying sunscreen properly. What can I do to actively manage down the hyperpigmentation? Does this really mean no more peels, even with more discipline on sun protection? I also cannot have microdermabrasion because of broken blood vessels, and am looking for a treatment that would offer similar freshening results

Samir Shureih, MD · Answer

Hyperpigmentation after a peel can be of different reasons.

	Treatment is long and need patience. I ususlly put my patients on skin care with retin A (OBAJI SKIN CARE)

	Then light peels. and graduate to TCA or Fractional co2 laser.

	I may add Cosmolan as bleaching masks as well

Hratch Karamanoukian, MD, FACS · Answer

Before you spend $$ on peels or IPL, try these topicals.
This is called post-inflammatory hyperpigmentation (PIH). 
I recommend Melarase AM and Melarase PM creams from Kare Skin as well as a broad spectrum sunblock like Spectrase. Bothe are from Kare Skin. Scler-x post inflammatory hyperigmentation relief complex is a great supplement to take as well. See link below. 
Spectrase is a wide spectrum sunblock SPF 50+that is also recommended to prevent ongoing inflammation.

Mark Taylor, MD · Answer

It is extremely important to protect the skin 100% from sun exposure until the skin returns to normal color after a TCA peel. I recommend a Shoulder-to-Shoulder hat, a good bleaching product after the skin has healed, such as Obagi NuDerm Blender with 4% hydroquinone and tretinoin. In the light complected individual the pigmentation will usually fade away withing a few weeks.

Brian E. Dubow, MD · Answer

Did you pre-treat your skin with a hydroquinone or other bleaching compound for at least 4 weeks before the peel as well as use sunblock every day? I find that this is very useful in reducing post peel pigmentation. Most hyperpigmentation will fade especially in fair skin. How long has it been since the peel? As far as your broken capillaries you are correct that microdermabrasion or any abrasive procedure (including exfoliating scrubs) are not good for you but pulse dye laser treatments should easily reduce the broken blood vessels with one to three treatments.

Mohsen Tavoussi, MD, DO · Answer

Some type of prescription strenght bleaching cream for several weeks with retin-A usually works well. Occasionally, more aggressive treatment is needed but it will eventually resolve. If it does resolve with treatment, then you can still have more peels provided you have been pretreated at least 4 weeks before and then after the peels with bleaching cream, retin-A and steroid.

Hyperpigmentation 4 Weeks After a 25% TCA Peel, What Are my Options?

Answers (5)