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2023.05.30 17:01 YourBrilliantLayer A Comprehensive Guide to Hyperpigmentation and How to Treat it
Hey-Oh! So, I see some form of this question multiple times per day in various skin and personal care subs: How do I deal with my hyperpigmentation? I also asked myself this question a few years ago. See, I'm prone to freckles and a little melasma and I set out to figure out a way to solve it with years of research, trial and error, testing, talking to dermatologists and professionals, and scouring every medical article I could get my hands on. I wanted to share my findings and research since this is a common concern, especially among people in their 30s. This started as a small post about my routine and ballooned into a massive book about hyperpigmentation. I hope it's helpful!
DISCLAIMERS:
Table of Contents
Freckles: Freckles are incredibly common, especially for people with lighter skin tones. They are small, brown or reddish-brown dots often clustered on the skin. They develop on the surface and are not raised bumps. Freckles can appear anywhere on the body but are common on the face. Freckles are permanent, but the color, contrast and severity can vary and be tempered.
Melasma: Melasma appears as dark patches or splotches around the face, though usually found on the forehead, upper lip, and high on the cheeks. Melasma forms deeper in the skin and appears more amorphous than freckles, moles, or age spots. It can create a “muddy” appearance and is very common among pregnant and postpartum women due to hormonal factors. But it can literally happen to anyone and anywhere on the body.
Post-Inflammatory Hyperpigmentation (PIH): Post-inflammatory hyperpigmentation (PIH) occurs when damaged skin forms melanin during the healing process leaving dark spots. This is common after acne, injuries, eczema, burns, and other trauma to the skin. Exposure to UV rays during healing can make PIH worse. Post-inflammatory erythema (PIE) is similar, but leaves pink or red marks on the skin as a result of damage to the capillaries from injury or inflammation. Basically, when skin is compromised by injury, as part of the immune response cells will begin to generate melanin in an attempt to prevent further damage from UV exposure, so what will happen is the wound/legion/blemish will heal but the pigmented skin remains.
Age Spots: This is kind of a forgotten form of hyperpigmentation. Sun spots, also referred to as liver spots, and solar lentigines are large spots/patches of dark skin with distinct borders. They vary in color from light brown to almost black. They develop on the surface of the skin usually later in life, but reflect damage that often occurred from improper sun protection at a younger age. They can appear on the face, neck, chest, hands, and arms, usually on areas that had UV exposure. For many people, they can begin to appear in your 30s or 40s.
Genetics can play a role in the development of hyperpigmentation and dark spots in several ways:
When the skin is exposed to UV radiation, the melanocytes (cells that produce melanin) in the skin go into overdrive, producing more melanin to protect the skin from further damage. This increased melanin production can result in dark spots or areas of hyperpigmentation on the skin.
Hormones. In addition to genetic determination of melanin production, hormones and hormonal sensitivity is a leading internal cause of hyperpigmentation and the formation of dark spots.
One of the most well-known examples of hormonal hyperpigmentation is melasma, a condition characterized by dark, amorphous patches on the face, particularly on the cheeks, forehead, nose, and upper lip. Melasma is often associated with hormonal changes, such as those that occur during pregnancy, hormonal therapy, or birth control pill use. The hormonal changes can stimulate an increase in melanin production, resulting in dark spots or areas of hyperpigmentation. This can happen irrespective of UV exposure, though the sun does exacerbate it.
Hormones can also affect melanin production by altering the skin's metabolism and pigmentation pathways. For example, high levels of cortisol, a hormone produced by the adrenal glands during stress, can trigger an increase in melanin production, resulting in hyperpigmentation.
Inflammation, Injury & Trauma to the skin can result in hyperpigmentation by triggering an increase in melanin production. When the skin is inflamed or injured, it triggers a response from the body's immune system, which can stimulate an increase in melanin production as a protective measure.
For example, acne breakouts or other skin injuries can result in post-inflammatory hyperpigmentation (PIH), which is characterized by dark spots or areas of discoloration on the skin. The dark spots are a result of an increase in melanin production in the affected area, which occurs in response to the inflammation or injury. In addition to acne and other skin injuries, other conditions that can result in PIH include eczema, psoriasis, and insect bites.
Medication Side Effects. Certain medications can cause hyperpigmentation on the skin. Medications that can cause hyperpigmentation include:
Retinoids that increases cell turnover. Retinoids like tretinoin, adapalene, retinol et al, can help treat hyperpigmentation by promoting the turnover of skin cells and increasing cell growth, which can help fade dark spots and improve overall skin tone by replacing pigmented skin cells at the surface. While retinoids are extremely effective, they do have some caveats. First, they can be sensitizing to a lot of users, but this can be tempered by using different form functions, different application methods, or different concentrations. Second, because it's constantly turning over skin exposing delicate new skin cells to the elements, it can actually worsen hyperpigmentation if you're not vigilant about sun protection and avoidance. Tretinoin and other retinoids are firewalled behind a prescription in some countries and may be more difficult to obtain. But retinol/al is available in OTC forms.
SPF represents a class of many ingredients designed to protect the skin from UV rays and the damage that occurs from exposure. UV exposure is one of the biggest causes of fine hyperpigmentation and wrinkles so adequate protection is essential. I know I'm not winning any science awards for this declaration, but a lot of people who struggle with hyperpigmentation aren't adequately protecting themselves from the sun. But you also have to be kind of realistic. Even with perfect protection and avoidance, sometimes your hyperpigmentation will still flare. This happens during the summer for a lot of people and something even I grapple with. The key is to do your best and SPF actually works well with numerous other ingredients (like the ones listed below) to help solve that problem.
Arbutin is a Tyrosinase Inhibitor that blocks melanin production. Arbutin, or the synthesized version called alpha arbutin, is a favorite brightening ingredient because it's a slow-release derivative of hydroquinone that inhibits melanin production. This results in both healing and prevention of dark spots, especially when paired with topical acids. It metabolizes on the skin into hydroquinone which is super effective for hyperpigmentation while being a less controversial and hard-to-come-by ingredient than pure hydroquinone. More on hydroquinone in part 6.
Tranexamic acid is another Tyrosinase Inhibitor. This was first used in wound care and it was found to have profound effects on hyperpigmentation. Although it's an acid, it's not a chemical exfoliant, kinda like how hyaluronic acid is not a chemical exfoliant. The exact mechanism by which tranexamic acid works to reduce hyperpigmentation is not fully understood, but it is believed to work by reducing inflammation by blocking plasmin which contributes to melanin production when unchecked. It is particularly effective in treating melasma and one of my personal favorite ingredients.
Kojic Acid is another Tyrosinase Inhibitor. Kojic acid is a natural skin brightener that is derived from various fungi. Kojic acid can also help to exfoliate because it's a slight chemical exfoliant, which can remove dead skin cells that contribute to hyperpigmentation and improve overall appearance. But it does both things: block melanin production and turn skin cells over.
Azelaic Acid has a lot of things going for it that can help with hyperpigmentation. It's an anti-inflammatory and antiseptic that disrupts melanin production. Azelaic acid works by inhibiting the production of melanin in the skin like those other tyrosinase inhibitors. In addition, azelaic acid also has anti-inflammatory and antibacterial properties, which help to improve the overall health and appearance of the skin by reducing melanin production as a result of injury or inflammation. It's also an anti-acne ingredient that can address the root cause of PIH by reducing acne on the skin. It's pretty awesome and available in OTC and prescription strengths.
Niacinamide is another one that directly and indirectly addresses hyperpigmentation. It's a skin soother that decreases inflammation and it naturally reduces sebum production which can curb acne which can curb PIH. It actually took me a little while to figure out that this was another solid hyperpigmentation treatment for these reasons because I used to look at it as being more of an acne treatment. Niacinamide is a form of vitamin B3 that works by inhibiting the transfer of pigment within the skin, which can help to reduce the appearance of dark spots and uneven skin tone. So while it doesn't block tyrosinase, it prevents transfer of pigmented skin cells to the surface.
Vitamin C aka L-ascorbic acid is an antioxidant that fights free radical damage. It treats and prevents hyperpigmentation in three ways. First, it reduces free radical damage from UV exposure which helps increase the effectiveness of SPF when worn together. Second, it is also a tyrosinase inhibitor that blocks melanin production. And finally, vitamin C encourages skin cell turnover. The key is finding a nice stable version of it.
Glycolic and Lactic Acid. Since this list is getting long I am going to group these together. Glycolic Acid is a water-soluble alpha hydroxy acid that penetrates into the pores to treat pigmentation by providing general exfoliation and resurfacing of the skin. The result is improvements in dark spots, texture and other signs of aging. Lactic Acid is also an AHA but with a slightly larger molecular size than glycolic acid so it doesn't penetrate as deep and acts more as a surface exfoliant. As a result it provides more gentle exfoliation to buff away surface pigmentation with an added benefit of acting as a humectant to seal moisture into the skin.
Licorice Extract is a plant extract that inhibits melanin production. Licorice root extract contains a compound called glabridin, which has been shown to have skin brightening effects as, you guessed it, a tyrosinase inhibitor. In addition, licorice root extract also has anti-inflammatory properties, which can help to reduce redness and inflammation associated with hyperpigmentation. I'm seeing more and more of this pop up in skin care.
Soy Proteins are another plant extract that inhibits melanin production. They contain compounds known as isoflavones, which have been shown to help reduce the amount of melanin produced by melanocytes in the skin. Additionally, soy proteins have antioxidant properties that can help to protect the skin from damage caused by free radicals, which can contribute to hyperpigmentation.
A few caveats:
AM routine -- The Goal: Heal, Protect, and Prevent. In order of application following a lukewarm water rinse:
For Azelaic Acid, this is the ingredient for serious treatment. It's considered one of the most effective ways to reverse melasma aka serious hyperpigmentation short of hydroquinone -- which is both controversial and hard to get. It brings a little bit of exfoliation to the table in addition to inhibiting UV melanin production, but it also has a slight antiseptic property which can help with acne. Paula's choice Azelaic Acid Booster is the only one I've really tried after sampling the Ordinary's in-store and not liking the texture. I get about 6 months out of a tube and a little bit goes a long way.
For Alpha Arbutin, the Ordinary's formulation is pretty solid. I prefer the Ordinary's AA 2% + HA as opposed to their AA 2% + Ascorbic Acid 8% as I don't believe the quality and stability of their Ascorbic Acid (Vitamin C) is great. That's why I opt for a separate Vitamin C serum step. But the AA + HA also has a little bit of lactic acid in it which provides some gentle exfoliation and encourages AA deeper into the skin where it's more effective. Lactic acid is mild enough that it's safe for use in a morning routine, but you still want to protect with SPF. There are a couple AA products floating around but I think TO's product is probably the best, most straightforward one. Alpha Arbutin metabolizes into hydroquinone on the skin so is basically one of the best OTC pigment correctors you can get.
For Vitamin C, the gold standard really is Skinceuticals CE Ferulic. This is stupid expensive though so I’m going to suggest Timeless Vitamin C. I like that it comes in an airless pump that prevents oxidation over time. Vitamin C is an antioxidant that increases the rate of skin cell turnover bringing forward new, skin cells while simultaneously improving the effects of SPF. It's a great foundation for a fix.
These ingredients can be layered on one right after the other then topped with your moisturizer (I like a basic one like cetaphil daily lotion), then topped with your SPF. The SPF I would recommend is Canmake UV mermaid gel in clear as this will not leave a white cast on your skin and it’s generally a very elegant SPF. It's SPF 50 which means it gives really good protection, but there are numerous SPFs you can try. I personally like anything from La Roche Posay, any Neutrogena SPF that's not formulated with ethylhexylglycerin, Supergoop Unseen Sunscreen, Biore Aqua Rich (another Japanese brand), Trader Joe's SPF if you can get your hands on it, and EltaMD.
Of all the products I’ve tried that could act as a stand-in for vitamin c, azelaic acid, and alpha arbutin, there’s one Japanese serum from Hada Labo called “whitening lotion” which has had the biggest impact on my hyperpigmentation in a single product of anything I’ve tried. This might be a little too effective though, I actually find that it washed me out within the first 2 weeks of twice daily use, so now I only use it in the morning. And I’m not a fan of the translation… which is a direct but mistranslation. It’s not a bleaching lotion, it also relies on a form of vitamin C and tranexamic acid to brighten skin. But it's a really interesting to try if you wanted a simplified morning routine in which case I would apply this, then your moisturizer, then your SPF.
PM routine -- The Goal: Renew and Reveal. In order of application:
For your Buffer this is an important step that can be done prior to using a chemical exfoliant or retinoid: applying an occlusive that will block the active from more sensitive skin. I recommend buffering around your eyes and nostrils with La Roche Posay Cicaplast balm because it kind of doubles as a nice eye cream, but this can also be done with basic vaseline or aquaphor for a more budget-friendly option.
For Tranexamic Acid, my holy grail TXA product, La Roche Posay Glycolic B5 is actually a multipurpose serum that combines ingredients to treat hyperpigmentation with chemical exfoliants. It contains two hyperpigmentation heavy hitters -- Tranexamic acid and Kojic Acid which are great for melasma -- and two exfoliants -- Glycolic Acid and Lipo-Hydroxy Acid (LHA) which is like fancy salicylic acid -- so it both reveals new skin cells that are less prone to pigmenting from UV exposure while sloughing away your old skin cells. You can use this 2 or 3 nights per week. On off nights, just cleanse and moisturize.
For a Retinoid if you can get prescription tretinoin, this is going to be the best bet. Your doctor will advise you on the concentration. More on that in part 6. It will help speed up the rate of cell turnover bringing new, unpigmented skin cells to the surface faster. Some other OTC options include differin (which is rated more for acne but uses the same mechanism for cell turnover so it's also effective in this use case) and retinols. Now, I haven't tried every retinol on the market but I have two that I stand by: SkinCeuticals retinol and L'Oreal retinol serum. The SkinCeuticals is, in my opinion, the closest to RX tretinoin in terms of efficacy, but it's a little pricey. The L'Oreal also does a really good job and is a little more affordable. It's currently my go-to OTC on the days I'm not using my RX retinoid tazarotene. You can use this 2 or 3 nights per week. On off nights, just cleanse and moisturize.
** My recommendations for tranexamic acid and retinoids CANNOT be used in the same night. You'll nuke your skin. And for most people, both aren't necessary, you can get away with using one or the other. If I had a preference, I would say use the TXA serum instead of a retinoid, but if you can build up a tolerance to using them both without damaging your barrier, they work really well together. So, proceed with caution. If you want to use both, use them on alternate nights and give yourself a night or two without either to let your skin recover. For me personally, I do retinoids on Sundays, and Wednesdays, chemical exfoliants on Mondays and Thursdays, and I let my skin rest (cleanse, moisturize, squalene oil) on Tuesdays, Fridays, and Saturdays.
On top of whichever active you choose, apply your moisturizer. You can use the same one you use in your morning routine, the Cetaphil daily lotion as it’s nice and light. I also like La Roche Posay Toleraine double repair for a ceramide-based cream alternative if you want something richer. You do not want to "slug" over actives. This advice gets mixed in a lot. Slugging refers to applying an occlusive layer over your skincare such as vaseline, aquaphor, oils like squalene oil, or healing balms like La Roche Posay Cicaplast balm. While this can be done on hydration nights, it should not be done on nights when you're using chemical exfoliants or retinoids as this may make them too effective causing irritation and breakouts.
To be perfectly clear, these are the areas you should not be applying skincare: labia majora, labia minora, vaginal entrance or vagina, clitoral hood, perineum, anus, intergluteal cleft aka inside your butt crack, penis, or scrotum. And I say this as someone who chaffed the precipice of her "intergluteal cleft" in an unfortunate crunches-in-the-wrong-gym-shorts accident leaving me with some deeply incriminating hyperpigmentation and earning me the nickname "skid mark" from my ever loving boyfriend. It faded after a year but you can still send prayers.
These are areas you can apply skincare but do so with absolute caution and at your own risk: bikini line, mons pubis, inner thigh up to the groin fold, butt cheeks.
Ok, now that we've got the disclaimers out of the way, let's move forward. Hyperpigmentation can also occur on body skin for the same reason it appears on the face, but it can also be triggered by friction. And because body skin is different from facial skin, it requires a slightly different approach. This is my recommendation for both hyperpigmentation and KP (Keratosis pilaris) because they rely on the same mechanism for treatment: chemical exfoliation.
In the case of body hyperpigmentation, I recommend a two prong approach: a body wash in the shower and a topical treatment to be used after. Oh, and SPF again if there are areas that are exposed to the sun, and I have a holy grail SPF recommendation for this.
Now you may have noticed in my facial skin recommendation that I did not mention CeraVe as a treatment brand. I have posted numerous takedowns of CeraVe on other threads so I won't rehash them here suffice it to say that it's no longer a brand I can in good faith recommend since it's acquisition by L'Oreal. This is often the brand that's considered when treating KP on the body, but I don't believe their formulations and ingredient quality works for everyone.
For the body wash, I recommend Neutrogena body clear with Salicylic acid. This is an exfoliating body wash that will help clear away dead skin cells on the surface allowing new ones to come through. To be effective, you want it to sit on your skin for a little while. I recommend lathering it up and applying it after turning off your shower faucet and letting it sit for 2 or 3 minutes. This is when I like to knock out shower emails. Then rinse away.
On towel dried skin after your shower, apply AmLactin Bumps Be Gone. Again, this is formulated for KP but the reason I like it is because it contains lactic acid which will also give the assist on brightening hyperpigmented body skin. The wash and this should be effective, but you might also want to mix in a few drops of the alpha arbutin serum I recommended for your facial routine, maybe three drops per application area (each leg, each arm, chest, etc). I generally don't encourage facial products on the body because it's not an economical use for them, and also because body skin is a little more resilient and doesn't need skincare that's formulated for more sensitive facial skin. The AA serum from the Ordinary is very affordable however and is a good hyperpigmentation generalist.
Another one that I mentioned in the facial hyperpigmentation portion that can work well on the body is the Hada Labo whitening lotion. Again, this is formulated around tranexamic acid which is very effective for hyperpigmentation and a little bit if this stuff goes a long way. I buy it in bulk from Japanese Importers though it's also available on Amazon for a slightly higher price. If you find yourself in Asia, stock up on it. I use this specifically for fading tan lines that happen (even with diligent/neurotic SPF use) around my fitness watch and the straps of my workout tops that I run in.
You also want to wear SPF on areas that are exposed to the sun to prevent pigmentation from occurring. The one I absolutely love that’s not your 90’s banana boat is Aveeno Protect + Hydrate lotion with SPF 60. This is a great SPF for a lot of reasons: it finishes like a lotion instead of a sunscreen, it dries down totally clear, and it has a pleasant, slight sweet scent. On a scale of 1-10 with 1 being bare skin, 10 being banana boat slathered on by your mom in 1997, and regular body lotion being a 2, I give Aveeno Protect + Hydrate a 2.5 in terms of texture and feel-finish. I use it as my daily lotion on my neck, arms, shoulders, and chest. If you're more active you might need a heavier hitter here like a sport sunscreen.
Side note: I haven't listed every possible compounded medication because there are a lot, and many compounded meds are formulated to tackle multiple issues like acne and hyperpigmentation. I also tend to favor single note skin care (aka, products with very few ingredients) as this allows you to combine or remove certain actives and gives you a better sense of reactivity.
For tougher-to-treat hyperpigmentation such as melasma, if your topical routine doesn't totally clear the problem in 6 to 8 months, a visit to the dermatologist might be helpful. Here are the heavier-hitting procedures and topicals that can go the extra mile after you've exhausted other options.
Medical Grade Peels: Medical grade chemical peels can be done by dermatologists. Trichloroacetic acid (TCA) or phenol peels may be done for cases of severe hyperpigmentation, but high concentration BHA or AHA peels are also commonly used. I do these twice a year. Because of the strength of the acids used, these must be done by a medical professional with careful followup.
***IPL Therapy and Laser Therapy may not work for everyone and in some cases may exacerbate hyperpigmentation so you really want to work with dermatologists with a lot of experience in treating cases similar to yours to determine if these interventions are appropriate for you.
IPL Treatment: Intense Pulsed Light (IPL) therapy can treat hyperpigmentation by targeting the melanin in the skin with a broad spectrum of light wavelengths, heating and breaking the melanin down. IPL is particularly effective for treating sun damage and age spots, as well as other forms of hyperpigmentation. The treatment is relatively non-invasive, with minimal downtime, making it a popular option. This is also a great treatment for the redness associated with enlarged blood vessels (often confused for broken capillaries) on the surface of the skin which can also appear alongside hyperpigmentation. There isn't any clinical evidence to support at-home IPL devices being effective in the same way. That doesn't mean it's not possible, it's just not studied enough to be certain. Most at-home IPL devices do not operate in effective wavelengths the way professional grade ones do.
Laser Therapy: Fractional and CO2 lasers can be used to treat a range of hyperpigmentation issues, including sun damage, age spots, and melasma. The treatment works by removing the top layers of skin, which contain the excess pigmentation, revealing fresh, healthy skin cells underneath. The lasers also stimulate the production of collagen, which helps to improve skin texture and reduce the appearance of fine lines and wrinkles.
Hydroquinone: This isn't an in-office procedure like the aforementioned treatments, but it is firewalled behind a prescription meaning you can only access hydroquinone in effective concentrations by working with a doctor. This is a somewhat new development at least in the US following some covid-era rejiggering of prescription clearances. HDQ is controversial because it's a skin bleaching agent which has some cultural implications in places where light skin is favored over natural pigmentation. HDQ technically works the same way other OTC tyrosinase inhibitors do (in fact arbutin actually metabolizes into HDQ when applied to the skin), pure HDQ happens to be the most powerful version of them. It lightens any skin it touches, not just hyperpigmented skin in higher concentrations which can make it tough to use. This effect isn't as profound in the other tyrosinase inhibitors I mentioned making them much easier to use over HDQ which, in high concentrations, must be dotted on the skin in only hyperpigmented areas. So HDQ is really reserved for intervention in extreme or OTC treatment-resistance cases.
Tretinoin and Prescription Retinoids: This is going to be dependent on what part of the world you're in, but in a lot of countries, tretinoin and its counterparts like tazarotene are only available through prescription. I mentioned retinoids in the routine so if you're able to get your hands on a prescription from a doctor, it may be more effective than OTC retinols. Most doctors will prescribe a retinoid over hydroquinone, so this is usually easier to procure and can be quite effective on its own as a hyperpigmentation treatment. OTC differin is the only retinoid available over-the-counter (in the US) which can also be used for hyperpigmentation.
Prescription Azelaic Acid: This is another one that's available in lower concentrations over-the-counter (which can still be quite effective) but there are prescription strength grades of azelaic acid. This is usually reserved for rosacea treatment as it tends to target redness and flushing, or as an acne treatment because of its antiseptic properties, but it can also be an effective hyperpigmentation treatment for its tyrosinase-inhibiting ability.
If you made it this far, congratulations! I hope this information is helpful. While it is extensive and based on massive amount of research, experience, experimentation and work with professionals, it may not be perfect and it may not be suitable for everyone. Feel free to offer any constructive criticism or ask any questions in comments. I am always open to expanding my understanding.
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DISCLAIMERS:
- I use the term "brightening" instead of "lightening" which is a subtle distinction. None of the ingredients or methods I recommend bleach your skin as "lightening" would suggest, but they can reduce the appearance of hyperpigmentation. "Brightening" tends to be a confusing term in skincare, but for the purposes of this post, I use it as a descriptor for anything that helps prevent or reduce melanin in hyperpigmented skin.
- I will use the term "hyperpigmentation" ad nauseam as a catch-all term for excess pigmentation in the skin including freckles, melasma, PIH and dark spots. This does not encompass moles which are different. This is also different from redness, which is a whole other post.
- Speaking about hyperpigmentation requires some sensitivity to very real issues around it including cultural implications. This post is not intended to moralize hyperpigmentation nor is it intended to alienate the normal melaninization of skin across various tones. Hyperpigmentation refers to excess melanin production on the skin in the form of spots that are darker than the surrounding skin. It's not bad or wrong, nor does it speak to anyone not "doing a good enough job" of taking care of themselves.
- I do repeat myself a few times in here but that is for people who are skipping around the article. I want to be as thorough as possible even if you're jumping to the parts of the post you need.
- I do run an online dermatology practice and skin care consultancy, but in order to protect the integrity of my advice, I do not promote my business, I don't give direct medical advice, I don't link to any products/websites, and I don't have any products I've formulated myself to promote.
Table of Contents
- Types of Hyperpigmentation
- What Causes Hyperpigmentation?
- How To Treat Hyperpigmentation Part 1: The Ingredients
- How to Treat Hyperpigmentation Part 2: The Routine and Recommendations
- Body Hyperpigmentation
- Nuclear Options
Types of Hyperpigmentation
Hyperpigmentation refers to excess melanin production in the skin, but it can actually take a couple different forms. Knowing the type of hyperpigmentation you're experiencing is key to understanding if and how it can be treated.Freckles: Freckles are incredibly common, especially for people with lighter skin tones. They are small, brown or reddish-brown dots often clustered on the skin. They develop on the surface and are not raised bumps. Freckles can appear anywhere on the body but are common on the face. Freckles are permanent, but the color, contrast and severity can vary and be tempered.
Melasma: Melasma appears as dark patches or splotches around the face, though usually found on the forehead, upper lip, and high on the cheeks. Melasma forms deeper in the skin and appears more amorphous than freckles, moles, or age spots. It can create a “muddy” appearance and is very common among pregnant and postpartum women due to hormonal factors. But it can literally happen to anyone and anywhere on the body.
Post-Inflammatory Hyperpigmentation (PIH): Post-inflammatory hyperpigmentation (PIH) occurs when damaged skin forms melanin during the healing process leaving dark spots. This is common after acne, injuries, eczema, burns, and other trauma to the skin. Exposure to UV rays during healing can make PIH worse. Post-inflammatory erythema (PIE) is similar, but leaves pink or red marks on the skin as a result of damage to the capillaries from injury or inflammation. Basically, when skin is compromised by injury, as part of the immune response cells will begin to generate melanin in an attempt to prevent further damage from UV exposure, so what will happen is the wound/legion/blemish will heal but the pigmented skin remains.
Age Spots: This is kind of a forgotten form of hyperpigmentation. Sun spots, also referred to as liver spots, and solar lentigines are large spots/patches of dark skin with distinct borders. They vary in color from light brown to almost black. They develop on the surface of the skin usually later in life, but reflect damage that often occurred from improper sun protection at a younger age. They can appear on the face, neck, chest, hands, and arms, usually on areas that had UV exposure. For many people, they can begin to appear in your 30s or 40s.
What Causes Hyperpigmentation?
There are a number of factors that can contribute to the formation of hyperpigmentation. Generally, it forms as the result of a combination of genetic and environmental influences. Everyone is unique, but these are some of the most common causes of hyperpigmentation and dark spots:Genetics can play a role in the development of hyperpigmentation and dark spots in several ways:
- Melanin production: Melanin is the pigment that provides color to our skin, hair, and eyes. The amount of melanin produced and distributed in the skin is largely determined by genetics. People with a greater genetic predisposition to melanin production in their skin are more likely to experience hyperpigmentation and dark spots as a result of sun exposure, hormonal changes, and other factors. People with darker skin are also more prone to melanin production in the form of hyperpigmentation.
- Genetic anomalies: Certain genetic anomalies, such as oculocutaneous albinism, can affect melanin production and distribution in the skin, leading to an increased risk of hyperpigmentation and dark spots.
- Family history: If you have a family history of hyperpigmentation or dark spots, you may be more likely to develop these conditions yourself.
- Enzymes and genes: The enzymes that control melanin production and distribution are regulated by specific genes. Variations in these genes can impact melanin production, leading to an increased risk of hyperpigmentation and dark spots.
When the skin is exposed to UV radiation, the melanocytes (cells that produce melanin) in the skin go into overdrive, producing more melanin to protect the skin from further damage. This increased melanin production can result in dark spots or areas of hyperpigmentation on the skin.
Hormones. In addition to genetic determination of melanin production, hormones and hormonal sensitivity is a leading internal cause of hyperpigmentation and the formation of dark spots.
One of the most well-known examples of hormonal hyperpigmentation is melasma, a condition characterized by dark, amorphous patches on the face, particularly on the cheeks, forehead, nose, and upper lip. Melasma is often associated with hormonal changes, such as those that occur during pregnancy, hormonal therapy, or birth control pill use. The hormonal changes can stimulate an increase in melanin production, resulting in dark spots or areas of hyperpigmentation. This can happen irrespective of UV exposure, though the sun does exacerbate it.
Hormones can also affect melanin production by altering the skin's metabolism and pigmentation pathways. For example, high levels of cortisol, a hormone produced by the adrenal glands during stress, can trigger an increase in melanin production, resulting in hyperpigmentation.
Inflammation, Injury & Trauma to the skin can result in hyperpigmentation by triggering an increase in melanin production. When the skin is inflamed or injured, it triggers a response from the body's immune system, which can stimulate an increase in melanin production as a protective measure.
For example, acne breakouts or other skin injuries can result in post-inflammatory hyperpigmentation (PIH), which is characterized by dark spots or areas of discoloration on the skin. The dark spots are a result of an increase in melanin production in the affected area, which occurs in response to the inflammation or injury. In addition to acne and other skin injuries, other conditions that can result in PIH include eczema, psoriasis, and insect bites.
Medication Side Effects. Certain medications can cause hyperpigmentation on the skin. Medications that can cause hyperpigmentation include:
- Tetracycline antibiotics: Tetracycline antibiotics, such as doxycycline and minocycline, can cause discoloration of the skin and teeth when taken in high doses or for an extended period of time.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as ibuprofen and naproxen, can cause hyperpigmentation in some individuals, especially if taken in high doses or for an extended period of time.
- Chemotherapy drugs: Certain chemotherapy drugs, such as doxorubicin and daunorubicin, can cause hyperpigmentation, especially in areas of the skin that have been exposed to the sun.
- Hormonal medications: Hormonal medications, such as birth control pills and estrogen replacements, can cause hyperpigmentation in some individuals, especially if they are taken for an extended period of time.
- Antimalarial drugs: Antimalarial drugs, such as chloroquine and hydroxychloroquine, can cause hyperpigmentation in some individuals, especially if taken in high doses or for an extended period of time.
- Isotretinoin aka accutane when taken for acne can cause hyperpigmentation due to the increase of cell turnover and exposing delicate new skin cells to UV rays before they have shored up.
How To Treat Hyperpigmentation Part 1: The Ingredients
When looking for skin care products to treat and prevent hyperpigmentation and dark spots, it's important to look for ingredients that can help encourage cell turnover, curb melanin production, and block harmful UV rays. A lot of these things overlap with treatments for other conditions like acne and general anti-aging, but I've noted ones that specifically work on the mechanisms controlling melanin production. Now, this is an extensive list, but I know it doesn't have everything. I've included the ingredients that had the most compelling evidence and/or worked the best for me or people at my practice. But it's also not necessarily a shopping list. You don't have to have all of these things to treat hyperpigmentation, but I'll get to that in the routine portion. This is more to be used as a tool that can help you diversify your routine if you find one ingredient or another doesn't work for you. And it can help you determine if a product targets hyperpigmentation based on its ingredients. There's lot's of options. Some of the key ingredients to look for include:Retinoids that increases cell turnover. Retinoids like tretinoin, adapalene, retinol et al, can help treat hyperpigmentation by promoting the turnover of skin cells and increasing cell growth, which can help fade dark spots and improve overall skin tone by replacing pigmented skin cells at the surface. While retinoids are extremely effective, they do have some caveats. First, they can be sensitizing to a lot of users, but this can be tempered by using different form functions, different application methods, or different concentrations. Second, because it's constantly turning over skin exposing delicate new skin cells to the elements, it can actually worsen hyperpigmentation if you're not vigilant about sun protection and avoidance. Tretinoin and other retinoids are firewalled behind a prescription in some countries and may be more difficult to obtain. But retinol/al is available in OTC forms.
SPF represents a class of many ingredients designed to protect the skin from UV rays and the damage that occurs from exposure. UV exposure is one of the biggest causes of fine hyperpigmentation and wrinkles so adequate protection is essential. I know I'm not winning any science awards for this declaration, but a lot of people who struggle with hyperpigmentation aren't adequately protecting themselves from the sun. But you also have to be kind of realistic. Even with perfect protection and avoidance, sometimes your hyperpigmentation will still flare. This happens during the summer for a lot of people and something even I grapple with. The key is to do your best and SPF actually works well with numerous other ingredients (like the ones listed below) to help solve that problem.
Arbutin is a Tyrosinase Inhibitor that blocks melanin production. Arbutin, or the synthesized version called alpha arbutin, is a favorite brightening ingredient because it's a slow-release derivative of hydroquinone that inhibits melanin production. This results in both healing and prevention of dark spots, especially when paired with topical acids. It metabolizes on the skin into hydroquinone which is super effective for hyperpigmentation while being a less controversial and hard-to-come-by ingredient than pure hydroquinone. More on hydroquinone in part 6.
Tranexamic acid is another Tyrosinase Inhibitor. This was first used in wound care and it was found to have profound effects on hyperpigmentation. Although it's an acid, it's not a chemical exfoliant, kinda like how hyaluronic acid is not a chemical exfoliant. The exact mechanism by which tranexamic acid works to reduce hyperpigmentation is not fully understood, but it is believed to work by reducing inflammation by blocking plasmin which contributes to melanin production when unchecked. It is particularly effective in treating melasma and one of my personal favorite ingredients.
Kojic Acid is another Tyrosinase Inhibitor. Kojic acid is a natural skin brightener that is derived from various fungi. Kojic acid can also help to exfoliate because it's a slight chemical exfoliant, which can remove dead skin cells that contribute to hyperpigmentation and improve overall appearance. But it does both things: block melanin production and turn skin cells over.
Azelaic Acid has a lot of things going for it that can help with hyperpigmentation. It's an anti-inflammatory and antiseptic that disrupts melanin production. Azelaic acid works by inhibiting the production of melanin in the skin like those other tyrosinase inhibitors. In addition, azelaic acid also has anti-inflammatory and antibacterial properties, which help to improve the overall health and appearance of the skin by reducing melanin production as a result of injury or inflammation. It's also an anti-acne ingredient that can address the root cause of PIH by reducing acne on the skin. It's pretty awesome and available in OTC and prescription strengths.
Niacinamide is another one that directly and indirectly addresses hyperpigmentation. It's a skin soother that decreases inflammation and it naturally reduces sebum production which can curb acne which can curb PIH. It actually took me a little while to figure out that this was another solid hyperpigmentation treatment for these reasons because I used to look at it as being more of an acne treatment. Niacinamide is a form of vitamin B3 that works by inhibiting the transfer of pigment within the skin, which can help to reduce the appearance of dark spots and uneven skin tone. So while it doesn't block tyrosinase, it prevents transfer of pigmented skin cells to the surface.
Vitamin C aka L-ascorbic acid is an antioxidant that fights free radical damage. It treats and prevents hyperpigmentation in three ways. First, it reduces free radical damage from UV exposure which helps increase the effectiveness of SPF when worn together. Second, it is also a tyrosinase inhibitor that blocks melanin production. And finally, vitamin C encourages skin cell turnover. The key is finding a nice stable version of it.
Glycolic and Lactic Acid. Since this list is getting long I am going to group these together. Glycolic Acid is a water-soluble alpha hydroxy acid that penetrates into the pores to treat pigmentation by providing general exfoliation and resurfacing of the skin. The result is improvements in dark spots, texture and other signs of aging. Lactic Acid is also an AHA but with a slightly larger molecular size than glycolic acid so it doesn't penetrate as deep and acts more as a surface exfoliant. As a result it provides more gentle exfoliation to buff away surface pigmentation with an added benefit of acting as a humectant to seal moisture into the skin.
Licorice Extract is a plant extract that inhibits melanin production. Licorice root extract contains a compound called glabridin, which has been shown to have skin brightening effects as, you guessed it, a tyrosinase inhibitor. In addition, licorice root extract also has anti-inflammatory properties, which can help to reduce redness and inflammation associated with hyperpigmentation. I'm seeing more and more of this pop up in skin care.
Soy Proteins are another plant extract that inhibits melanin production. They contain compounds known as isoflavones, which have been shown to help reduce the amount of melanin produced by melanocytes in the skin. Additionally, soy proteins have antioxidant properties that can help to protect the skin from damage caused by free radicals, which can contribute to hyperpigmentation.
How To Treat Hyperpigmentation Part 2: The Routine and Recommendations
This is adapted from numerous comments, posts and DMs I've written on the topic and also comprises a large portion of my own personal routine and routines we recommend to patients. This is a generalist routine meaning it targets all the forms of hyperpigmentation I've mentioned; freckles, melasma, PIH, and age spots though it can be tweaked to address these individually more specifically. This is really my jumping off point for people to get a good idea of what they can achieve as a baseline with OTC ingredients before fine tuning or enlisting the help of a dermatologist. For a lot of people, this is enough to fully resolve, but even if it gets you part of the way there, this should give you a good idea of reactivity.A few caveats:
- Freckles cannot ever be 100% eradicated. You can however reduce their appearance and prevent them from getting darker. It's important to have realistic goals and understand that sometimes our genetics will overrule any routine we have.
- This routine and any hyperpigmentation routine will not address moles. Moles are a totally different thing that can only be eradicated through removal by a medical practitioner. Moles can be raised or not, but no amount of topicals will get rid of them.
- Melasma is a beast. Sometimes it can be treated with OTC topicals, sometimes it requires prescription strength topicals like hydroquinone, sometimes you need in-office procedures like fractal lasers or IPL. Again, this routine is a jumping off point to see what you can accomplish at home before going down that road (and more on that at the bottom in part 6).
- You'll notice I don't mention products with all the ingredients I listed above. This is because the more you put on your face, the greater your risk of causing irritation. Again, you can adjust and tweak by switching out products with these ingredients or add/subtract as it suits your personal needs.
- If you're struggling with hyperpigmentation while pregnant or breastfeeding, these recommendations may need to be paused.
AM routine -- The Goal: Heal, Protect, and Prevent. In order of application following a lukewarm water rinse:
- Azelaic acid
- Alpha Arbutin
- Vitamin C serum
- Moisturizer
- SPF
For Azelaic Acid, this is the ingredient for serious treatment. It's considered one of the most effective ways to reverse melasma aka serious hyperpigmentation short of hydroquinone -- which is both controversial and hard to get. It brings a little bit of exfoliation to the table in addition to inhibiting UV melanin production, but it also has a slight antiseptic property which can help with acne. Paula's choice Azelaic Acid Booster is the only one I've really tried after sampling the Ordinary's in-store and not liking the texture. I get about 6 months out of a tube and a little bit goes a long way.
For Alpha Arbutin, the Ordinary's formulation is pretty solid. I prefer the Ordinary's AA 2% + HA as opposed to their AA 2% + Ascorbic Acid 8% as I don't believe the quality and stability of their Ascorbic Acid (Vitamin C) is great. That's why I opt for a separate Vitamin C serum step. But the AA + HA also has a little bit of lactic acid in it which provides some gentle exfoliation and encourages AA deeper into the skin where it's more effective. Lactic acid is mild enough that it's safe for use in a morning routine, but you still want to protect with SPF. There are a couple AA products floating around but I think TO's product is probably the best, most straightforward one. Alpha Arbutin metabolizes into hydroquinone on the skin so is basically one of the best OTC pigment correctors you can get.
For Vitamin C, the gold standard really is Skinceuticals CE Ferulic. This is stupid expensive though so I’m going to suggest Timeless Vitamin C. I like that it comes in an airless pump that prevents oxidation over time. Vitamin C is an antioxidant that increases the rate of skin cell turnover bringing forward new, skin cells while simultaneously improving the effects of SPF. It's a great foundation for a fix.
These ingredients can be layered on one right after the other then topped with your moisturizer (I like a basic one like cetaphil daily lotion), then topped with your SPF. The SPF I would recommend is Canmake UV mermaid gel in clear as this will not leave a white cast on your skin and it’s generally a very elegant SPF. It's SPF 50 which means it gives really good protection, but there are numerous SPFs you can try. I personally like anything from La Roche Posay, any Neutrogena SPF that's not formulated with ethylhexylglycerin, Supergoop Unseen Sunscreen, Biore Aqua Rich (another Japanese brand), Trader Joe's SPF if you can get your hands on it, and EltaMD.
Of all the products I’ve tried that could act as a stand-in for vitamin c, azelaic acid, and alpha arbutin, there’s one Japanese serum from Hada Labo called “whitening lotion” which has had the biggest impact on my hyperpigmentation in a single product of anything I’ve tried. This might be a little too effective though, I actually find that it washed me out within the first 2 weeks of twice daily use, so now I only use it in the morning. And I’m not a fan of the translation… which is a direct but mistranslation. It’s not a bleaching lotion, it also relies on a form of vitamin C and tranexamic acid to brighten skin. But it's a really interesting to try if you wanted a simplified morning routine in which case I would apply this, then your moisturizer, then your SPF.
PM routine -- The Goal: Renew and Reveal. In order of application:
- Cleanse
- Buffer
- Tranexamic acid and exfoliant OR retinoid**
- Moisturize
For your Buffer this is an important step that can be done prior to using a chemical exfoliant or retinoid: applying an occlusive that will block the active from more sensitive skin. I recommend buffering around your eyes and nostrils with La Roche Posay Cicaplast balm because it kind of doubles as a nice eye cream, but this can also be done with basic vaseline or aquaphor for a more budget-friendly option.
For Tranexamic Acid, my holy grail TXA product, La Roche Posay Glycolic B5 is actually a multipurpose serum that combines ingredients to treat hyperpigmentation with chemical exfoliants. It contains two hyperpigmentation heavy hitters -- Tranexamic acid and Kojic Acid which are great for melasma -- and two exfoliants -- Glycolic Acid and Lipo-Hydroxy Acid (LHA) which is like fancy salicylic acid -- so it both reveals new skin cells that are less prone to pigmenting from UV exposure while sloughing away your old skin cells. You can use this 2 or 3 nights per week. On off nights, just cleanse and moisturize.
For a Retinoid if you can get prescription tretinoin, this is going to be the best bet. Your doctor will advise you on the concentration. More on that in part 6. It will help speed up the rate of cell turnover bringing new, unpigmented skin cells to the surface faster. Some other OTC options include differin (which is rated more for acne but uses the same mechanism for cell turnover so it's also effective in this use case) and retinols. Now, I haven't tried every retinol on the market but I have two that I stand by: SkinCeuticals retinol and L'Oreal retinol serum. The SkinCeuticals is, in my opinion, the closest to RX tretinoin in terms of efficacy, but it's a little pricey. The L'Oreal also does a really good job and is a little more affordable. It's currently my go-to OTC on the days I'm not using my RX retinoid tazarotene. You can use this 2 or 3 nights per week. On off nights, just cleanse and moisturize.
** My recommendations for tranexamic acid and retinoids CANNOT be used in the same night. You'll nuke your skin. And for most people, both aren't necessary, you can get away with using one or the other. If I had a preference, I would say use the TXA serum instead of a retinoid, but if you can build up a tolerance to using them both without damaging your barrier, they work really well together. So, proceed with caution. If you want to use both, use them on alternate nights and give yourself a night or two without either to let your skin recover. For me personally, I do retinoids on Sundays, and Wednesdays, chemical exfoliants on Mondays and Thursdays, and I let my skin rest (cleanse, moisturize, squalene oil) on Tuesdays, Fridays, and Saturdays.
On top of whichever active you choose, apply your moisturizer. You can use the same one you use in your morning routine, the Cetaphil daily lotion as it’s nice and light. I also like La Roche Posay Toleraine double repair for a ceramide-based cream alternative if you want something richer. You do not want to "slug" over actives. This advice gets mixed in a lot. Slugging refers to applying an occlusive layer over your skincare such as vaseline, aquaphor, oils like squalene oil, or healing balms like La Roche Posay Cicaplast balm. While this can be done on hydration nights, it should not be done on nights when you're using chemical exfoliants or retinoids as this may make them too effective causing irritation and breakouts.
Body Hyperpigmentation
Ok, I need everyone to be a grownup for two seconds. These products and methods (both from the prior section and this section) should NOT be used on your genitals. First, you can cause serious irritation or infection by applying active skincare to your genitals. Second, it's really not going to do anything to change the pigmentation of the skin there. The skin on your genitals is different than your body and facial skin and it pigments in different ways for different reasons so it's not going to respond to topicals the same way the rest of your body does. Don't even try it.To be perfectly clear, these are the areas you should not be applying skincare: labia majora, labia minora, vaginal entrance or vagina, clitoral hood, perineum, anus, intergluteal cleft aka inside your butt crack, penis, or scrotum. And I say this as someone who chaffed the precipice of her "intergluteal cleft" in an unfortunate crunches-in-the-wrong-gym-shorts accident leaving me with some deeply incriminating hyperpigmentation and earning me the nickname "skid mark" from my ever loving boyfriend. It faded after a year but you can still send prayers.
These are areas you can apply skincare but do so with absolute caution and at your own risk: bikini line, mons pubis, inner thigh up to the groin fold, butt cheeks.
Ok, now that we've got the disclaimers out of the way, let's move forward. Hyperpigmentation can also occur on body skin for the same reason it appears on the face, but it can also be triggered by friction. And because body skin is different from facial skin, it requires a slightly different approach. This is my recommendation for both hyperpigmentation and KP (Keratosis pilaris) because they rely on the same mechanism for treatment: chemical exfoliation.
In the case of body hyperpigmentation, I recommend a two prong approach: a body wash in the shower and a topical treatment to be used after. Oh, and SPF again if there are areas that are exposed to the sun, and I have a holy grail SPF recommendation for this.
Now you may have noticed in my facial skin recommendation that I did not mention CeraVe as a treatment brand. I have posted numerous takedowns of CeraVe on other threads so I won't rehash them here suffice it to say that it's no longer a brand I can in good faith recommend since it's acquisition by L'Oreal. This is often the brand that's considered when treating KP on the body, but I don't believe their formulations and ingredient quality works for everyone.
For the body wash, I recommend Neutrogena body clear with Salicylic acid. This is an exfoliating body wash that will help clear away dead skin cells on the surface allowing new ones to come through. To be effective, you want it to sit on your skin for a little while. I recommend lathering it up and applying it after turning off your shower faucet and letting it sit for 2 or 3 minutes. This is when I like to knock out shower emails. Then rinse away.
On towel dried skin after your shower, apply AmLactin Bumps Be Gone. Again, this is formulated for KP but the reason I like it is because it contains lactic acid which will also give the assist on brightening hyperpigmented body skin. The wash and this should be effective, but you might also want to mix in a few drops of the alpha arbutin serum I recommended for your facial routine, maybe three drops per application area (each leg, each arm, chest, etc). I generally don't encourage facial products on the body because it's not an economical use for them, and also because body skin is a little more resilient and doesn't need skincare that's formulated for more sensitive facial skin. The AA serum from the Ordinary is very affordable however and is a good hyperpigmentation generalist.
Another one that I mentioned in the facial hyperpigmentation portion that can work well on the body is the Hada Labo whitening lotion. Again, this is formulated around tranexamic acid which is very effective for hyperpigmentation and a little bit if this stuff goes a long way. I buy it in bulk from Japanese Importers though it's also available on Amazon for a slightly higher price. If you find yourself in Asia, stock up on it. I use this specifically for fading tan lines that happen (even with diligent/neurotic SPF use) around my fitness watch and the straps of my workout tops that I run in.
You also want to wear SPF on areas that are exposed to the sun to prevent pigmentation from occurring. The one I absolutely love that’s not your 90’s banana boat is Aveeno Protect + Hydrate lotion with SPF 60. This is a great SPF for a lot of reasons: it finishes like a lotion instead of a sunscreen, it dries down totally clear, and it has a pleasant, slight sweet scent. On a scale of 1-10 with 1 being bare skin, 10 being banana boat slathered on by your mom in 1997, and regular body lotion being a 2, I give Aveeno Protect + Hydrate a 2.5 in terms of texture and feel-finish. I use it as my daily lotion on my neck, arms, shoulders, and chest. If you're more active you might need a heavier hitter here like a sport sunscreen.
Nuclear Options
In general, I recommend trying OTC topical solutions for any skin concern before heading down the in-office procedure route. Part of this is because you can usually put a good dent in what you're struggling with by using OTC topicals, making in-office procedures and RX treatments easier and more effective. Part of it is so you have a good maintenance routine in place to use after the fact to preserve the results of your in-office procedure which can sometimes be costly. Lastly, while some procedures can solve the immediate problem completely, topical skincare can be really effective at treating other adjacent conditions like redness, acne, and fine lines.Side note: I haven't listed every possible compounded medication because there are a lot, and many compounded meds are formulated to tackle multiple issues like acne and hyperpigmentation. I also tend to favor single note skin care (aka, products with very few ingredients) as this allows you to combine or remove certain actives and gives you a better sense of reactivity.
For tougher-to-treat hyperpigmentation such as melasma, if your topical routine doesn't totally clear the problem in 6 to 8 months, a visit to the dermatologist might be helpful. Here are the heavier-hitting procedures and topicals that can go the extra mile after you've exhausted other options.
Medical Grade Peels: Medical grade chemical peels can be done by dermatologists. Trichloroacetic acid (TCA) or phenol peels may be done for cases of severe hyperpigmentation, but high concentration BHA or AHA peels are also commonly used. I do these twice a year. Because of the strength of the acids used, these must be done by a medical professional with careful followup.
***IPL Therapy and Laser Therapy may not work for everyone and in some cases may exacerbate hyperpigmentation so you really want to work with dermatologists with a lot of experience in treating cases similar to yours to determine if these interventions are appropriate for you.
IPL Treatment: Intense Pulsed Light (IPL) therapy can treat hyperpigmentation by targeting the melanin in the skin with a broad spectrum of light wavelengths, heating and breaking the melanin down. IPL is particularly effective for treating sun damage and age spots, as well as other forms of hyperpigmentation. The treatment is relatively non-invasive, with minimal downtime, making it a popular option. This is also a great treatment for the redness associated with enlarged blood vessels (often confused for broken capillaries) on the surface of the skin which can also appear alongside hyperpigmentation. There isn't any clinical evidence to support at-home IPL devices being effective in the same way. That doesn't mean it's not possible, it's just not studied enough to be certain. Most at-home IPL devices do not operate in effective wavelengths the way professional grade ones do.
Laser Therapy: Fractional and CO2 lasers can be used to treat a range of hyperpigmentation issues, including sun damage, age spots, and melasma. The treatment works by removing the top layers of skin, which contain the excess pigmentation, revealing fresh, healthy skin cells underneath. The lasers also stimulate the production of collagen, which helps to improve skin texture and reduce the appearance of fine lines and wrinkles.
Hydroquinone: This isn't an in-office procedure like the aforementioned treatments, but it is firewalled behind a prescription meaning you can only access hydroquinone in effective concentrations by working with a doctor. This is a somewhat new development at least in the US following some covid-era rejiggering of prescription clearances. HDQ is controversial because it's a skin bleaching agent which has some cultural implications in places where light skin is favored over natural pigmentation. HDQ technically works the same way other OTC tyrosinase inhibitors do (in fact arbutin actually metabolizes into HDQ when applied to the skin), pure HDQ happens to be the most powerful version of them. It lightens any skin it touches, not just hyperpigmented skin in higher concentrations which can make it tough to use. This effect isn't as profound in the other tyrosinase inhibitors I mentioned making them much easier to use over HDQ which, in high concentrations, must be dotted on the skin in only hyperpigmented areas. So HDQ is really reserved for intervention in extreme or OTC treatment-resistance cases.
Tretinoin and Prescription Retinoids: This is going to be dependent on what part of the world you're in, but in a lot of countries, tretinoin and its counterparts like tazarotene are only available through prescription. I mentioned retinoids in the routine so if you're able to get your hands on a prescription from a doctor, it may be more effective than OTC retinols. Most doctors will prescribe a retinoid over hydroquinone, so this is usually easier to procure and can be quite effective on its own as a hyperpigmentation treatment. OTC differin is the only retinoid available over-the-counter (in the US) which can also be used for hyperpigmentation.
Prescription Azelaic Acid: This is another one that's available in lower concentrations over-the-counter (which can still be quite effective) but there are prescription strength grades of azelaic acid. This is usually reserved for rosacea treatment as it tends to target redness and flushing, or as an acne treatment because of its antiseptic properties, but it can also be an effective hyperpigmentation treatment for its tyrosinase-inhibiting ability.
If you made it this far, congratulations! I hope this information is helpful. While it is extensive and based on massive amount of research, experience, experimentation and work with professionals, it may not be perfect and it may not be suitable for everyone. Feel free to offer any constructive criticism or ask any questions in comments. I am always open to expanding my understanding.
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2023.05.29 08:46 4Saken33 What could cause full body hairloss, from my toes to my head, my nose hairs are disappearing, and my beard is patchy. I was Dx'd with mites, is that it?
Male, 41, Central Ohio. 5'10, 215-225 lbs wt Varies. Non smoker. I've had depression, anxiety, arthritis, and hormone issues. Such as Low TSH, but normal Levels of T3, etc. I don't think that's related, as the Hairloss has been noticeable for 7 months on my head, maybe a little longer in the rest of my body. I'm on Testosterone replacement, have been for many years. I have never been concerned that hairloss was in my future. Every hairstylist/Barber I've EVER Had, would comment on how thick my hair was, how insanely quickly it grew, and how Thick and long my beard was. I've always had healthy looking hair, now it looks dead in a lot of places, with "stripes or lacerations" every few CM's on almost every strand of hair. Wasn't sure if that was from the mites or if something else could be causing this? I'm positive I still have mites, an Opthalmologist told me last week, he suspects DEMODEX mites, and I have had "Demodex frost" or what looks like it, tremendously bad in the past, and accumulation of mites in my eyelashes, however my dog also has the same tiny, essentially microscopic "dots" floating off of him 24/7, so we could have SarCoptic Mange AKA scabies mites between the two of us. I recently read that there are over 100 species of arthropods in the average household. I'm not against the idea of me having more than one but in my home from lack of housekeeping and self care, hygiene. I'm coming out of the "funk" now, literally and figuratively. I'm being treated dermatologically with clobetasol, 2 anti fungal shampoos, triamcinolone, and finasteride, in case this is MPB, being accelerated by mites. I've also had the most stressful year of my life, so "Telogen effluvium," does it present this way? What do you think this is?
My dog was Dx'd with mites, and I have been a few times in the last year. Treated with ivermectin and permethrin cream, 4 times I have no relief. My dog was treated once with a monthly version of ivermectin, no result. Is that what's causing my hair to stop growing, essentially all together? I used to have to get a haircut every 2 weeks or I would have a curly afro, it has been 4 months now and my hair has grown a half inch if that. Less, on the very top. Same with my beard, only I have huge thin spots in my chin area, from below my mouth to around my jaws, like the areas a strap on a football helmet would cover. I guess I have thin spots throughout my beard and my head. Thin spots around the chin, Is that rosacea, potentially caused by (demodex?) mites? They cause rosacea, according to the Opthalmologist. My chin area feels rough, and again has stopped growing, along with my whole Beard. My hairloss on my head is concentrated on the top, the front top, the rear top, the sides, especially my temples, above and around my ears, and the back of my head is kinda random. I have patchy hairloss almost like a shower head effect, choppiness, if that makes sense? My hairline is slightly receding like MPB would cause, but this all started and progressed very rapidly, coinciding with the mite symptoms. I've lost the majority of my pubic hair, my arm and leg hair as well, is very thin. I'm very distraught over this and if this is mites, is this permanent? What about stress? Permanent hairloss? I think I had a fungal infection at one point in The Fall. I saw what looked like hairs "gooped" together, with what looks an awful lot like puss, in videos I "accidentally" caught myself in, as I didn't look in the mirror, shower, or take a picture of myself for a month or two due to mental health issues. I'm not proud. I'm quite embarrassed that I walked around with my curly hair in puss filled knots, with patches of effing hair missing. Sorry for the long post, I'm extremely passionate and distraught over this whole situation. Not showering didn't help the mites go away any faster. I don't go months, but I will go 3 or 4 days between shower's, even still. I need inpatient treatment, but it's not possible ATM bc of my work, an aggressive Rottweiler, and schedule. Just saving you the time of telling me I need that, I definitely have insight on my condition. Thank you for any information and recommendations you may have for me.
submitted by 4Saken33 to AskDocs [link] [comments]
My dog was Dx'd with mites, and I have been a few times in the last year. Treated with ivermectin and permethrin cream, 4 times I have no relief. My dog was treated once with a monthly version of ivermectin, no result. Is that what's causing my hair to stop growing, essentially all together? I used to have to get a haircut every 2 weeks or I would have a curly afro, it has been 4 months now and my hair has grown a half inch if that. Less, on the very top. Same with my beard, only I have huge thin spots in my chin area, from below my mouth to around my jaws, like the areas a strap on a football helmet would cover. I guess I have thin spots throughout my beard and my head. Thin spots around the chin, Is that rosacea, potentially caused by (demodex?) mites? They cause rosacea, according to the Opthalmologist. My chin area feels rough, and again has stopped growing, along with my whole Beard. My hairloss on my head is concentrated on the top, the front top, the rear top, the sides, especially my temples, above and around my ears, and the back of my head is kinda random. I have patchy hairloss almost like a shower head effect, choppiness, if that makes sense? My hairline is slightly receding like MPB would cause, but this all started and progressed very rapidly, coinciding with the mite symptoms. I've lost the majority of my pubic hair, my arm and leg hair as well, is very thin. I'm very distraught over this and if this is mites, is this permanent? What about stress? Permanent hairloss? I think I had a fungal infection at one point in The Fall. I saw what looked like hairs "gooped" together, with what looks an awful lot like puss, in videos I "accidentally" caught myself in, as I didn't look in the mirror, shower, or take a picture of myself for a month or two due to mental health issues. I'm not proud. I'm quite embarrassed that I walked around with my curly hair in puss filled knots, with patches of effing hair missing. Sorry for the long post, I'm extremely passionate and distraught over this whole situation. Not showering didn't help the mites go away any faster. I don't go months, but I will go 3 or 4 days between shower's, even still. I need inpatient treatment, but it's not possible ATM bc of my work, an aggressive Rottweiler, and schedule. Just saving you the time of telling me I need that, I definitely have insight on my condition. Thank you for any information and recommendations you may have for me.
2023.05.29 07:26 WonderfulFalcon506 All about Skin Cancer: Symptoms, Risks, Prevention and Treatment
 | Are you worried about skin cancer? Get the guidance you need from Ayuhealth hospitals! Our team of experts will provide accurate information on the symptoms, risks, and treatments for skin cancer so you can make informed decisions about your health. With years of experience in dermatology and cancer research, we offer the best skin cancer services available. Don't wait: get the help you need to protect yourself and your family today with Ayuhealth hospitals! submitted by WonderfulFalcon506 to u/WonderfulFalcon506 [link] [comments] https://preview.redd.it/1cqqjpuehp2b1.png?width=1024&format=png&auto=webp&s=ebdbfffec14df9a7591f67011ae620635ba36c17 |
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2023.05.28 16:32 healeybeatrice009 Platelet-Rich Plasma Injections in Rochester Hills: Harnessing the Healing Power of Blood Components
Platelet-Rich Plasma Injections in Rochester Hills: Harnessing the Healing Power of Blood Components
Platelet-rich plasma (PRP) injections have gained popularity as a non-surgical treatment option for various medical conditions in Rochester Hills and beyond. This innovative therapy utilizes the patient's own blood components to promote healing and tissue regeneration. In this article, we will explore the concept of PRP injections, their potential benefits, and their applications in Rochester Hills.Understanding Platelet-Rich Plasma (PRP) Injections
PRP injections involve the extraction of a small amount of blood from the patient, which is then processed to concentrate the platelets and growth factors. Platelets are responsible for blood clotting, but they also play a crucial role in tissue repair and regeneration. By concentrating these platelets, PRP injections deliver a higher dose of growth factors to the targeted area, stimulating healing and promoting the body's natural regenerative processes.Benefits and Applications in Rochester Hills
- Orthopedic Injuries and Osteoarthritis: PRP injections have shown promising results in the treatment of orthopedic injuries, such as tendonitis, ligament sprains, and muscle strains. In Rochester Hills, athletes and individuals with musculoskeletal conditions have benefited from PRP therapy to reduce pain, improve joint function, and accelerate recovery.
- Dermatology and Aesthetics: PRP injections have gained attention for their potential benefits in improving skin quality and promoting hair growth. In Rochester Hills, individuals seeking non-surgical options for skin rejuvenation, scar reduction, and hair loss have turned to PRP treatments, as they can help stimulate collagen production and enhance tissue regeneration.
- Dental and Oral Surgery: PRP injections have also found application in dental and oral surgery procedures. Dentists and oral surgeons in Rochester Hills have utilized PRP therapy to enhance healing after tooth extractions, implant placements, and periodontal surgeries. By promoting tissue regeneration, PRP injections can potentially reduce pain, swelling, and complications associated with these procedures.
- Chronic Tendon Conditions: Patients in Rochester Hills suffering from chronic tendon conditions, such as Achilles tendonitis or tennis elbow, have explored PRP injections as a potential treatment option. The concentrated growth factors delivered through PRP therapy can aid in reducing pain and inflammation while promoting tissue healing and regeneration.
- Non-Surgical Facial Rejuvenation: PRP injections have gained popularity as a non-surgical alternative for facial rejuvenation in Rochester Hills. Commonly known as the "vampire facelift," this procedure involves the use of PRP injections to promote collagen production and improve skin texture, resulting in a more youthful appearance.
Conclusion
Platelet-rich plasma injections have emerged as a promising treatment modality in Rochester Hills, offering a non-surgical option for various medical conditions. By harnessing the regenerative potential of the patient's own blood components, PRP therapy aims to promote healing, reduce pain, and enhance tissue regeneration. While further research is needed to fully understand its effectiveness and long-term benefits, PRP injections have already shown promising results in orthopedics, dermatology, dentistry, and other fields. If you're considering PRP therapy, it's crucial to consult with a qualified healthcare professional in Rochester Hills who can provide personalized guidance based on your specific condition.
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2023.05.28 06:17 kkmm2323 School List
Working on my school list and would appreciate some help.
516 MCAT, 3.96 GPA, Illinois resident, California undergrad, ORM
Significant paid clinical experience in a dermatology clinic and fertility clinic (1000+ hours)
110 hospital volunteer hours, 120 hours volunteering doing health screening in underserved communities, 25 hours teaching elementary schoolers health
1 publication (7th author) and 1 poster abstract in cancer research (120 hours in this lab doing wet-lab work). And 150 hours doing data extraction for an environmental health research lab (not published, will be within a few more years)
Not the best writer; don't love my personal statement and feel like I have any standout circumstances to write
Feeling pretty uncertain about what types of schools are on target for me and align with my experiences. I don't want to apply anywhere that has unrealistic volunteering expectations given my app. Would appreciate any guidance!
So far: Colorado, Case Western, Einstein, GWU, Miami Miller, NYMC, Ohio State, UCI, UCLA, UCSD, UCSF, UIC, USC, Dartmouth, Loyola, Tulane, Tufts.
Thank you!!
submitted by kkmm2323 to premed [link] [comments]
516 MCAT, 3.96 GPA, Illinois resident, California undergrad, ORM
Significant paid clinical experience in a dermatology clinic and fertility clinic (1000+ hours)
110 hospital volunteer hours, 120 hours volunteering doing health screening in underserved communities, 25 hours teaching elementary schoolers health
1 publication (7th author) and 1 poster abstract in cancer research (120 hours in this lab doing wet-lab work). And 150 hours doing data extraction for an environmental health research lab (not published, will be within a few more years)
Not the best writer; don't love my personal statement and feel like I have any standout circumstances to write
Feeling pretty uncertain about what types of schools are on target for me and align with my experiences. I don't want to apply anywhere that has unrealistic volunteering expectations given my app. Would appreciate any guidance!
So far: Colorado, Case Western, Einstein, GWU, Miami Miller, NYMC, Ohio State, UCI, UCLA, UCSD, UCSF, UIC, USC, Dartmouth, Loyola, Tulane, Tufts.
Thank you!!
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2023.05.27 12:36 amiskinandhairclinic TIPS FOR STAYING SAFE IN THE SUMMER SUN, AVOIDING TANNING & HOW CHEMICAL PEEL PROCEDURE USE IN SUN TAN
 | Do you enjoy being outside but despise getting a tan? We can't help but feel conflicted about the sun. Although many appreciate having a healthy glow, they'd rather avoid the risks of tanning. Those who despise tanning can always get rid of their tan or burn, but spending too much time in the sun is unsafe. Don't worry; we've got your back: here are our best-kept secrets for staying safe in the sun. submitted by amiskinandhairclinic to u/amiskinandhairclinic [link] [comments] Here are some ways to avoid sunburn and protect your skin from additional damage: - At its zenith, the sun - First, you should stay inside between 11 a.m. and 4 p.m., when the sun is at its highest. This is when the sun is at its peak intensity, and the effects will be most severe. However, the precise time may vary depending on where you are located. Avoid going outside during that time, no matter how pleasant the weather is. Take the shaded path whenever possible. - Only spend a little bit of time outside. Protect skin from the sun by staying indoors or in a shaded area whenever possible. Find some shade if you can look at the beach, as the reflected sunlight from the ocean and sand will make you sunburn more quickly. Always, always, always the cover-up. - Put on garments that will keep your skin safe from the sun. When out in the sun, keep your arms and legs covered. Wear appropriate clothing for the temperature and activity. Put on long-sleeved garments to protect yourself from the sun. https://preview.redd.it/ljsgba7h8e2b1.jpg?width=1080&format=pjpg&auto=webp&s=b93fe631be63263a7b6531ee796be21fa6201e82 Sunscreen should be worn for safety. - Even if it's overcast, you should apply sunscreen liberally for 20 minutes before heading outside. When out in the sun for long periods, it's important to reapply sunscreen every three to four hours. You'd be safe using any high-quality sunscreen over 30 SPF. Keep your lips covered if you plan on spending time in the sun. - Both smoking and sun exposure can cause your lips to darken. Lip balms with sun protection factors (SPF) should be used. Put on your sunnies! - The skin around your eyes is among the most delicate on your entire body. Wearing sunglasses blocking UV rays is necessary if you plan to go outside. Choose a lens size that completely envelopes your under eyes for the best effect. Select Sun-Safe Makeup - Use a moisturizer during the day to ensure your skin gets the hydration it needs. Use mineral-based chemicals instead of cream-based cosmetics. Perfumes might make your skin more sensitive to heat, so avoid applying them. Avoiding dehydration - Avoid dehydration and dry skin by consuming 15–20 glasses of water daily. Even tanning damage can be repaired with this method. You should face-wash twice a day, minimum. Keep your skin healthy and clean by washing your face twice daily. Adopt a diet that will prevent you from burning in the sun. Vegetables and fruits are high in fiber, strengthening the immune system and protecting the skin from the inside out. The antioxidants and vitamins you consume can also shield your skin from the knowledge. Now the question is, Can the chemical peel method achieve a suntan? To remove the tanned skin layers and speed up the exfoliation and regeneration of new skin cells, chemical peels are often utilized. For instance, a chemical peel of the face can be used to treat acne. A chemical peel is a non-invasive method of renewing the skin by exfoliating its outer layers using mild acids generated from natural sources. A chemical peel uses a chemical solution to peel away the outer layers of skin, revealing younger skin underneath. In addition, it can help diminish the appearance of blemishes, scars, discolorations, and wrinkles. Before beginning the chemical peel technique, please keep the following guidelines in mind:
Mild Peels — such as alpha-hydroxy acid, are used in superficial peels, which exfoliate the skin's surface without going more profound than that. Medium peels– which employ acids like glycolic acid to remove damaged skin cells from deeper layers are the most popular. Peels that go deep into the skin, such as those done with phenol, can remove damaged cells from the dermis. If you are suffering from your skin problem and looking for best Dermatology clinic in Kandivali, AMI Skin & Hair Clinic is one of the best clinics for skin treatment in Kandivali. We have Best dermatologist in Kandivali Mumbai. Call now us for appointment today 022-28860900/ 9106183902 and online visit for more information - https://www.amiskinhairclinic.com/ Please go visit our social media :Facebook :- https://www.facebook.com/AMISkinHairPlease do follow on Instagram Instagram :- https://www.instagram.com/amiskinhai More Post :- BENEFITS OF ENDYMED IFINE, MINI, MNR |
2023.05.27 08:02 Candid-Town2124 Durex Chewing 12 Gum
 | submitted by Candid-Town2124 to u/Candid-Town2124 [link] [comments] Ship Mart Durex Chewing Gum in PakistanStraight walled and teat ended, Durex Chewing Gum in Pakistan flavored condoms are made of natural rubber latex that smells good. For single use only. If used properly, Durex condoms can help reduce the risk of transmission of HIV(AIDs) & many other sexual transmitted infections (STI). Dermatologically tested. Durex Chewing Gum Extra Time is manufactured by Reckitt Benckiser Pakistan Ltd. It falls under the category of Pain. Durex Chewing Gum Extra Time is available at Next Health. Next Health offers delivery of Durex Chewing Gum Extra Time in Lahore, Karachi, Islamabad, Peshawar and also across other cities in minimum time.Experience Durex’s new range of sensually flavoured condoms; lubricated to provide a better experience Brand; Durex Composition: Yohimbinum jelly Royal Damiana Ginseng Nux Vom kali Phose DOSE:One Chewing Gum 10 mints before the intercourse.Is Durex bubble gum safe? https://shipmart.pk/product/durex-chewing-gum/ https://shipmart.pk/product/durex-chewing-gum/ |
2023.05.26 01:19 misses_mop Advice on daughter's (11F) skin growths.
My daughter (11F) Medications: multivitamins She has no health problems. Her BMI classifies her as overweight. (Not by much) Only symtom is the 3 skin growths, on her face. Close to her left ear.
This started around 12 months ago. Skin growth number 1 started off smaller than skin growth number 3. As it started to grow I took daughter to see a GP. He didn't seem worried and said it was probably harmless. As growth number 1 grew, growth number 2 appeared, small, but it too also began to grow. I then revisited the GP and asked for a referral to a dermatologist. Referral was made, in January. In April, growth number 3 appeared, although still small it has grown slightly, since last month. They all continue to grow. Since I hadn't heard back from dermatology, I got in touch to give them an updated photo, with all 3 growths. Daughter now has an appointment on 12th June.
They are flat, pinky red and have a slight texture to them. Growth number 3 is now slightly raised, but only a tiny bit.
I have always taken necessary precautions with sun protection (I'm an anxious mam) although, while in her dad's care, she has caught the sun a few times, although it was never a full on 'burn.'
Daughter has pale skin, freckles and red hair.
I will post photos in comments.
submitted by misses_mop to AskDocs [link] [comments]
This started around 12 months ago. Skin growth number 1 started off smaller than skin growth number 3. As it started to grow I took daughter to see a GP. He didn't seem worried and said it was probably harmless. As growth number 1 grew, growth number 2 appeared, small, but it too also began to grow. I then revisited the GP and asked for a referral to a dermatologist. Referral was made, in January. In April, growth number 3 appeared, although still small it has grown slightly, since last month. They all continue to grow. Since I hadn't heard back from dermatology, I got in touch to give them an updated photo, with all 3 growths. Daughter now has an appointment on 12th June.
They are flat, pinky red and have a slight texture to them. Growth number 3 is now slightly raised, but only a tiny bit.
I have always taken necessary precautions with sun protection (I'm an anxious mam) although, while in her dad's care, she has caught the sun a few times, although it was never a full on 'burn.'
Daughter has pale skin, freckles and red hair.
I will post photos in comments.
2023.05.25 17:38 KSPediatrics 𝐊𝐒𝐏 𝐇𝐞𝐚𝐥𝐭𝐡 𝐓𝐚𝐤𝐞 𝐜𝐨𝐧𝐭𝐫𝐨𝐥 𝐨𝐟 𝐲𝐨𝐮𝐫 𝐚𝐥𝐥𝐞𝐫𝐠𝐢𝐞𝐬 𝐚𝐧𝐝 𝐚𝐬𝐭𝐡𝐦𝐚!
 | 𝐊𝐒𝐏 𝐇𝐞𝐚𝐥𝐭𝐡 𝐓𝐚𝐤𝐞 𝐜𝐨𝐧𝐭𝐫𝐨𝐥 𝐨𝐟 𝐲𝐨𝐮𝐫 𝐚𝐥𝐥𝐞𝐫𝐠𝐢𝐞𝐬 𝐚𝐧𝐝 𝐚𝐬𝐭𝐡𝐦𝐚! submitted by KSPediatrics to u/KSPediatrics [link] [comments] KSP Health provides fast and effective relief from allergies and asthma for adults and children. Get an appointment within 15 hours! 📷 Breathe Easier Today! 📷 316-516-2853 📷 https://ksphealth.org/allergies-and-asthma/ #ksphealth #allergies #allergiessuck #allergiesgotmelike #allergiesbegone #AsthmaCare #AllergiesandAsthma #PediatricInpatientcare #ADHDinChildren #PediatricDermatology #PediatricEndocrinology #PediatricGastroenterology #PediatricHematology #Urology #PediatricERConsultation #Newborncare #Mentalhealth #Behaviroalhealth #Psychiatry #Psychiatrist #psychotherapy #Anxiety #Depression #Pediatrician #Inattention #therapyforkids #Appointments #inspiring #constipation #acidreflux https://preview.redd.it/sc8ehi3pg12b1.jpg?width=1080&format=pjpg&auto=webp&s=587b74d5537444c15f837b7ee08a1de27b0c9409 |
2023.05.25 09:35 SarveshHospitals Expert Dermatology Care at Your Fingertips
The Importance of Dermatology Care for Healthy Skin
Dermatology care is essential for maintaining healthy skin throughout your life. Regular check-ups with a dermatologist can help prevent and treat various skin conditions, including skin cancer.Dermatologists can also provide guidance on how to care for your skin at home, including recommendations for skincare products and lifestyle changes that can improve the health and appearance of your skin.
Common Skin Conditions Treated by Dermatologists
Here are some of the most common skin conditions treated by dermatologists:Acne
Acne is a common skin condition that occurs when hair follicles become clogged with oil and dead skin cells. Dermatologists can provide effective treatments to help clear up acne and prevent scarring.Eczema
Eczema is a chronic skin condition that causes dry, itchy, and inflamed skin. Dermatologists can help manage eczema symptoms and provide recommendations for skincare products that can help soothe the skin.Psoriasis
Psoriasis is a chronic autoimmune condition that causes skin cells to build up rapidly, resulting in thick, scaly patches on the skin. Dermatologists can provide treatments to help manage psoriasis symptoms and reduce flare-ups.2023.05.24 13:10 kbeck001 Thank you, DFL!
- Legal recreational cannabis Will also expunge low-level cannabis offenses.
- Largest transportation bill since 2008. Includes funding for passenger rail service from the Twin Cities to Duluth.
- Child tax credits. Up to $1,750 per child for households making $35,000 a year.
- One-time tax rebates $260 for single filers making up to $75,000 and $520 for couples making up to $150,000.
- Gun safety Universal background checks and red flag laws.
- Abortion access. Signed into law in late April.
- Protection of gender-affirming care. Signed into law in late April.
- Banning conversion therapy. Signed into law in late April.
- Free meals for students in public schools. Takes effect July 1st.
- Voting right rights Anyone convicted of a felony who has served their time will have their voting privileges restored.
- Driver's licenses for all. Regardless of immigration status.
- Healthcare Increased funding for child care providers, expands childcare assistance, keeps low-income children covered for health care longer without the need for re-applying
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