I got shingles a few months ago, and now have residual scars/hypopigmentation in small spots across the area. The skin is not raised or indented, so it looks mostly like a pigmentation problem (lighter than the surrounding areas). I have visited two dermatologists and they gave conflicting advice. One recommended Mederma and said the hypopigmentation would clear up in a year. The other said Mederma would be of little use and suggested fraxel laser. What is the best course of action?
Hypopigmentation from Shingles
Doctor Answers 4
Treating skin hypopigmentation- vitiligo, white scars
The shingles apparently killed some skin pigment cells called melanocytes leaving you with a white area of skin. The only way to improve or correct this is to get melanocytes back into this area of skin. Neither Mederma or Fraxel will accomplish that. In fact the CO2 laser in Fraxel can kill additional melanocytes. The Excimer laser can stimulate melanocytes from adjacent areas to move into the hypopigmented area but this probably only works if the area is no more than a few millimetes in width. Large patches of hypopigmentation as in vitiligo can be repigmented by dermabrading the skin surface and applying a paste made from a thin skin graft. This basically transfers melanocytes from one area of the body to another. The problem with this technique is the donor site from where the skin graft is obtained leaves some degree of scarring and it is only practical for larger hypopigmentation patches.
A good sunblock is your best bet right now
Mederma and Fraxel will do nothing to put color back into hypopigmented areas. Your scars are quite young and will likely change over the coming 12-18 months. Use a good sunblock daily (yes, even on cloudy days and days you don't plan to be outside). Give it time.
Have to disagree with both of my dermatology colleagues, especially in regards to Mederma. Mederma, derived from the onion by the way, MAY help with scars but would do nothing for pigmentary problems. There is some evidence that the Eximer laser, which is fairly effective for vitiligo, may be of use for hypopigmentation in general. Similarly, the IPL in the 350 nm range may also be of value.
Hypopigmentation from shingles
Time is probably your best friend. Neither intervention has been shown as an effective treatment to RESTORE pigmentation. They may improve the scars but time is likely to be your best and least expensive option. Avoid excessive sun exposure to the area during this period.