Spots and Scars on Legs and Thighs: Will Skin Peeling Remove Them?

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. 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 decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Injury to the skin, especially Asian, Brown, East Indian or Black, is prone to hyperpigmenttion after injury, bites, surgery, sclerotherapy ...Sometimes, it takes up to 3 cycles of skin growth, 180 days each, for the hyperpigmentation to fade, if at all, without adjunctive therapy:
There are some topical creams that we use for patients with hyperpigmentation from a myriad of causes in the legs: from venous insufficiency, following wounding, following surgery, following sclerotherapy ...
We recommend Sclerovase and Scleroquin plus topical creams.
You can add retinoid RR Complex Retinoid Repair Cream as well. 
Scler-x post inflammatory hyperigmentation relief complex is a great supplement to take as well. See link below. 

The legs very easily hyperpigment due to trauma, insect bites and the like.  Often what looks like scarring is just "postinflammatory hyperpigmentation" which is pigment that occurs with skin healing.  This problem can take a great deal of time to resolve.  I prefer to avoid any aggressive peels or laser treatments because of the risk of additional postinflammatory pigmentation as a result of the procedure.  You might consider one or more of the following: a retinoid (differin, retin-a), a low potency corticosteroid cream, hydroquinone.

The problem you have is called "post inflammatory hyperpigmentation", and is a very difficult problem to fix particularly on the legs.  Pigmentation in this area can often last 2 years or longer.  First of all, every time you get a bite, apply hydrocortisone and a bandaid to keep from scratching.  For the spots that are already there, and are healed, try a prescription cream, hydroquinone, just to the spots twice a day.  You can also use a glycolic acid containing moisturizer on the entire leg which will help the spots slightly.  I don't believe peels or laser procedures help significantly with post inflammatory hyperpigmentation.  However, if you decide to give it a try, make sure you go to an experienced physicians office because it is very easy to injure legs (as you have learned).

Hope that helps.

Madeline Krauss, M.D.

I love the responses from the other dermatologists and completely agree with their opinions on this challenging condition. I usually recommend a lotion containing some type of mild exfoliatiant such as glycolic acid, salicylic acid or urea or a combination of those. Tretinoin can also be helpful but is more expensive and can be a bit irritating. I have seen nice results using these creams but it takes a long time - many months.