What can you advise after my 4-year journey to get a straight answer on poikiloderma to no avail? (Photo)

nothing will get rid of this completely. you will need BBL/fraxel or halo or moxi treatments in office and at home cosmelan/enlighten peels. full sun protection and sunisdin pills.

at home peels like cosmelan, enlighten and aerify along with dermarolling (EmerageSkin roller with anteage AERIFY MD ampules weekly, see link) should be started now to prevent further aging.

For facial rejuvenation, I would suggest a combination approach of
1) skin care with products and PRP/microneedling
2) PDT light therapy few times a month with growth factors
3) laser treatments like clear and brilliant regularly and a few times a year Fraxel/halo Viva, Co2/Erbium
4) Sculptra injections a few times a year for collagen production with fillers like juvederm/restylane/belotero/radiesse/bellafill
5) thermage/ultherapy for yearly skin tightening with or without PDO or cone based instalift threads for lifting
6) botox every 2-3 months to stop movement lines and prevent lines at rest
7) deep microneedling RF like Fractora/morpheus8 for tightening of the skin
8) Vascular laser like vbeam/excel V or BBL forever young treatment every quarter (3-4 months)

Best, Dr. Emer.

Dear Tara:

Poikiloderma responds beautifully to treatments, it’s really not that difficult to see a response. You may do better with a laser rather than light device, which will be more specific to the hemoglobin in the visible blood vessels, since you have more red than brown in your poikiloderma. NdYag or Alex would work well to diminish the redness. Then, to thicken the skin, you could have CO2 with PRP immediately after, or microneedling with PRP, and topical biostimulatory agents for some months before and after.

The area should be shaved or waxed before any treatments for best results.

All the best to you from the upper eastside of New York City,
Sheryl Clark MD FAAD