Hyperpigmentation prevention

A peel to the papillary dermis causes severe inflammation and strongly stimulates melanogenesis, often irregularly, with a risk of post-inflammatory hyperpigmentation. Preventive treatment of this is one of the most important phases in a peel to the papillary dermis. Areas of achromia may also appear when the peel has penetrated too far locally. 

In cases of patients with olive skin (Fitzpatrick skin type 3 or 4), the application of Kligman preparation is recommended to prevent reactive hyperpigmentation. 

After the procedure, the patient is advised to use water-based lotion creams and potent sunscreens. The erythema gradually resolves over about a 2-month period. During this time, makeup foundation is encouraged. In patients with dark skin (Fitzpatrick skin type 3 or 4), the application of Kligman preparation is recommended to prevent reactive hyperpigmentation. Systemic Isotretinoin is required in some patients and can be prescribed as soon as 2-3 weeks after the procedure, if no other surgical intervention is planned in the near future. 

In cases of patients with olive skin (Fitzpatrick Results of phenol-based peels for various inskin type 3 or 4), the application of Kligman dications are shown in Figs. 8.11,8.12,8.13, 8.14 preparation is recommended to prevent reac- and 8.15. tive hyperpigmentation. 

Flaking should not be helped along under any circumstances. Peeling off any bits of skin can result in uneven skin tone, infection, hyperpigmentation, scars or localized achromia. It is also essential to take preventive measures against infection after a papillary TCA-SAS peel, as the latter destroys most of the skin s defenses. An antibiotic cream is applied during the first week after the peel. The skin should be cleaned before each application of cream, and any occurrence of contact allergies, which can sometimes be confused with secondary infections, should be monitored. 

If prevention fails, treatment must follow. The more superficial the pigmentation, the better will it respond to treatment. If the hyperpigmentation originates in the dermis, it will not respond as well to treatment. It is often necessary to treat the actual inflammation that is maintaining the pigmentation. 

Placebo-controlled studies A placebo-controlled study evaluated the safety and efficacy of topical cidofovir in preventing beard hair growth in healthy men (n = 20) [ll ]. Participants received cidofovir (randomised to either 1% or 3%) and placebo, each applied to one side of the face after shaving (the side allocation was randomised), for either 6 or 8 weeks. There were adverse events reported in 12 subjects the most frequent was upper respiratory tract infection (n=4), and erythema or hyperpigmentation (n = 3), or local pruritus (n = 2). The local skin reactions were all mild and most resolved spontaneously within 8 weeks of the end of treatment. There were no significant changes in blood urea nitrogen or creatinine levels in this small study. 

Medium-depth peels are most appropriate for patients with moderate to advanced photodamage (Glogau types 11 and 111). Those with Glogau classification 11 will achieve the most significant benefit. Patients with Fitzpatrick skin types 111, ly y and VI are at an increased risk for postinflammatory hyperpigmentation and should be pretreated accordingly for prevention. As with superficial peels, sebaceous quality, skin thickness, and inflammation should be taken into account and treated accordingly to foster more even peel absorption and optimal clinical... 

Overflow of TCA should be removed by immediate and careful dipping motion with a Q-tip or gauze. Scarring associated with the TCA overflow is usually prevented by proper management of the crusts. However, posttreatment erythema and transient postinflammatory hyperpigmentation can develop. 

If hyperpigmentation occurs hydroquinone 4% or higher is the mainstay of treatment. Once the skin is sufficiently healed, tretinoin can be added to increase the bleaching effect. Commercial or compounded formulations that include these agents and a topical steroid are also useful. Patients should be advised to use sunscreens and avoid unnecessary sun exposure to the peeled areas as this can prevent further pigment changes and lessen the duration of the darker areas. Also, patients using birth... 

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