I am a 60-year-old female who has had issues with hyperpigmentation since my 20s. Why doesn't it respond to treatment?

I have worn a high SPF sunscreen, Retin-A (at night), hydroquinone, and hats since I was 25, year round. It seems to be exacerbated by an injury to the skin. Would a peel help? Or make it worse? I had some Restylane filler a few times and now have patchy brown spots where the needle was manipulated. I have had laser therapy twice now for this, and both times it made it slightly worse - no one seems to know why.

Doctor Answers 3

Postinflammatory hyperpigmentation and Melasma can be treated with a combination of treatment modalities.

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Hyperpigmentation can be very difficult to treat especially in type IV through VI skin types.  Aggressive treatments sometimes make the problem worse.  For those patients that do not responds to simple treatments with bleaching agents, the best treatment that I use is the Cosmion Iontophoretic Mask with a preservative-free gel containing, Ascorbic Acid, Phytic Acid, Arbutin and enzyme.  I often combine this with a gentle nanosecond  1064/755 laser or PicoSure 755 fractional or full-beam treatment to break up the pigment. On some cases, I use the Fraxel Dual Laser or the Palomar 1540nm Laser.  Not all abnormal pigment responds well to the same treatment.  Epidermal melasma responds differently that dermal melanoma.   It is critical to always use a shoulder-to-shoulder hat, an excellent UVA/UVB sunblock like Laroche Possay Anthelios 60 and a good bleaching agent such as Obagi Nuderm especially while undergoing treatment.

Salt Lake City Dermatologic Surgeon
4.2 out of 5 stars 18 reviews

Hyperpigmentation and chemical peels

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Chemical peels can be a great option for reducing some causes of hyperpigmentation such as sun spots, sun damage, melasma, and post-inflammatory pigmentation.  It is important to see a physician to be evaluated as to the cause of the pigmentation prior to initiating any therapy.  Caution should especially be advised in patients with melasma as incorrect chemical peels can exacerbate the problem.   See a Board-certified dermatologist for evaluation of the brown spots as these could be age spots known as seborrheic keratosis which would not respond to topical therapies.

Kyle Coleman, MD
New Orleans Dermatologic Surgeon
5.0 out of 5 stars 11 reviews


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Pleas post a photo to help you.  It sounds as if you have Melasma which would definitely get worse from lasers.  I would recommend you seek an expert in the field of cosmetic dermatology and consider chemical peels or Cosmelan treatment.  Best, Dr. Green

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.