- Lentigines Pigmented Lesions
- Freckles (or ephelides) Pigmented Lesions
- Melasma
- Poikiloderma of Civatte
- Café au lait spot
- Becker naevus
- Nevus of Ota
- Campbell de Morgan
- Venous Lake
- General treatment
- Superficial Pigmentation
- Deep dermal pigmentation
- Clinical Process
Lentigines Pigmented Lesions:
Blemish (age spots) or liver spots (lentigines) are small flat pigmented spots, similar to freckles, that are most often seen on sun exposed skin sometime after the age of 40.
These benign acquired melanocytic lesions are usually dark brown to black and do not change in color as freckles do upon sun exposure. Freckles are areas where the melanocytes (pigment-making cells) are more active and responsive to UV radiation than in neighboring skin.
Freckles (or ephelides) Pigmented Lesions:
Common in lighter skinned individuals, and pigmentation may be pronounced in freckles by UV exposure. Age spots may occur anywhere but usually appear on sun exposed skin (i.e., face, shoulders, neck, ears, back of hands) as a result of sun damage.
Lentigines may also occur in rare genetic disorders like LEOPARD, Peatz-Jeghers syndromes and xeroderma pigmentosum. Poor nutrition, abnormal liver function, and lack of exercise can also cause liver spots.
Multiple lentigines syndrome is inherited as an autosomal dominant trait. Affected people have large numbers of lentigines -- present from birth and somewhat darker than true freckles -- as the most obvious sign. These are located mostly on the trunk and neck. Affected people also have wide-set eyes (hypertelorism), prominent ears, nerve deafness (partial), and cafe-au-lait spots (light brown birthmarks.
Melasma
Melasma (also known as chloasma or the mask of pregnancy when present in pregnant women) is a tan or dark facial skin discoloration. Although it can affect anyone, melasma is particularly common in women, especially pregnant women and those who are taking oral contraceptives or hormone replacement therapy (HRT) medications.
Symptoms of melasma are dark, irregular patches commonly found on the upper cheek, nose, lips, upperlip, and forehead. These patches often develop gradually over time. Melasma does not cause any other symptoms beyond the cosmetic discoloration.
Genetic predisposition is also a major factor in determining whether someone will develop melasma.The incidence of melasma also increases in patients with thyroid disease. It is thought that the overproduction of melanocyte-stimulating hormone (MSH) brought on by stress can cause outbreaks of this condition. Other rare causes of melasma include allergic reaction to medications and cosmetics.
Poikiloderma of civatte
Poikiloderma of Civatte usually a reddish-brown discoloration on the lateral cheeks and neck characteristically spares the shaded area under the chin. The skin in the affected skin is red-brown with prominent hair follicles.
The term "poikiloderma" refers to a change in the skin where there is thinning, increased pigmentation and dilation of the fine blood vessels (telangiectasia).
The exact cause is unknown.
Contributing factors are:
- Fair skin
- Accumulated sun exposure
- Photosensitising components of cosmetics and toiletries especially perfumes
- Hormonal factors
Café au lait spot
Café au lait spots or cafe-au-lait spots (CAL) are pigmented birthmarks.
The name café au lait is French for "coffee with milk" and refers to their light-brown color.
While café au lait spots are usually not associated with any medical problems, having many (three or more) such spots is linked with neurofibromatosis and the rare McCune-Albright syndrome.
Also, having six or more of such spots greater than 5 mm in diameter prepubertal or greater than 15 mm in diameter postpubertal children is essentially diagnostic of Neurofibromatosis type I.
Becker naevus
A Becker naevus (Becker nevus) is a late-onset epidermal naevus or birthmark occurring mostly in males. It is also known as Becker melanosis. It is due to an overgrowth of the epidermis (upper layers of the skin), pigment cells (melanocytes) and hair follicles. It develops during childhood or adolescence on the shoulders or upper trunk, occasionally elsewhere.
It is thought that it is due to a gene defect, which has not yet been identified. It may be triggered to develop by circulating androgens (male hormones such as testosterone), which is why it appears in males at puberty
Ochronosis is a dermatological disorder that results in the adverse pigmentation of cartilage from a long term buildup of phenylalanine or tyrosine.
In this disorder, a pigment substance resulting from incomplete catabolism of tyrosine and phenylalanine is deposited, over the years, in cartilage, the eye, and to a lesser degree in the skin.
Hori's Nevus
Nevus of Ota
These are relatively uncommon dark discolorations occurring around the eye and shoulders. The course is usually benign but can be disfiguring and a cosmetic problem. Newer modalities such as lasers have produced excellent cosmetic results.
Campbell de Morgan
Campbell de Morgan spots are bright red spots usually a couple of millimetres across although they may grow to being half a centimetre. They are usually very bright red and have a very clear margin. They should not be confused with thread veins or spider veins which have red streaky veins radiating away from them.
They are not usually seen in children but usually develop on the skin as one gets older. They become more common and larger as you get older.
They are often found on the chest, abdomen or arms. They can also be found on the back or on the neck.
Campbell de Morgan spots are coils of abnormal blood vessels that come through the skin and are very close the surface hence their bright red colour.
Campbell de Morgan spots do not grow or develop into anything else. They cannot change into a malignant (Cancer) growth or anything else to worry. They are purely a cosmetic problem. Having them should not worry you.
Venous Lake
A venous lake is an asymptomatic, generally solitary, soft, compressible, dark blue to violaceous, 0.2- to 1-cm papule commonly found on sun-exposed surfaces of the vermilion border of the lip, face and ears. Lesions generally occur among the elderly. Though these lesions may resemble nodular melanoma, the lack of induration, slow growth, and lightening appearance upon diascopy suggest against it, and indicate a vascular lesion. Additionally, lack of pulsation distinguishes this lesion of the lower lip from a tortuous segment of the inferior labial artery .
Treatment is not necessary, and the lesion's non-malignant nature. However, if treatment is sought for cosmetic reasons, lesions can be treated with laser therapy.
Pigments
Melanins are synthesized in melanosomes from the amino acid tyrosine via dopa and dopaquinone. The enzyme tyrosinase is required in these early steps. After the tyrosinase steps, the pathways to produce black, brown and red pigments diverge and involve many other enzymes. MSH treatment accelerates melanin synthesis and causes the skin to visibly darken.
-Eumelanin is primarily responsible for the color seen in skin, hair and eyes. In general, eumelanin is genetically controlled. The exception to this genetic control is the tanning reaction that occurs with the exposure to UV light.
-Pheomelanin in fair skinned individuals often adds an orange or red hue to the hair. These people also often have green eyes and freckles.
Differences in skin color are due mainly to differences in the number of melanin granules in the keratinocytes.
Human complexions are generally classified into six skin types:
1) - light skinned, burns easily, never tans
2) - light skinned, burns easily, tans some
3) - light skinned, burns occasionally, tans well
4) - light skinned, tans well, rarely burns
5) - brown skinned (Asian, Indo-Asian, Chinese, Japanese), tans well, burns rarely, can sunburn after prolonged exposure to UVR
6) - black skinned (Afro-Caribbean), deeply pigmented, can burn after prolonged exposure to UVR.
General treatment
Age spots are harmless and require no treatment unless they are growing more than surrounding age spots, cause discomfort or take on an irregular appearance. If there is a concern about the nature of any skin lesion, consultation with a dermatologist is warranted. Some lentigines might be melanoma, a skin cancer.
Superficial Pigmentation
Superficial pigemtation is pigmentation that occurs in the epidermis. This pigmentation can be removed effectively by an Intense Pulsed Light or Q-switched laser system releasing light of yellow/green colour (550nm to 700nm).
Types of superficial pigmentation include:
- Lentigo (age spots, sun spots and freckles)
- Nevus of Ota/Ita
- Deep Pigmentation
Deep pigmentation
Describes an area of pigmentation that occurs in the dermis. Removal of dermal pigmentation requires destruction of melanocyte cells using a Q-switch laser. QSwitched lasers releasing infra-red/red or green light are typically used.
Types of deep dermal pigmentation include:
- Birth marks
- Café-au-lait macules
- Naevus spilus
Clinical Process
- Client's dermatologic history is evaluated.
- Clinet's skin type is considered
- Procedure explained in detail
- Potential side effects are discussed
- Including pigment changes
- Temporary or permanent textural changes
- Recurrence
- Consent form signed
- Pre- and post- treatment photos
- Follow up arranged
The removal of all types of pigmented lesions is by selective photothermolysis of melanosomes of pigment within the skin. In Intense Pulsed Light removal, the light emitted is absorbed by melanin in the epidermis, heating the cells to a point where they are destroyed.
The treated area will quickly turn a darker colour, indicating destruction of the cells. The epidermal cells renew over the following days/weeks, initially forming a micro-crust before revealing a new, non-pigmented epidermis underneath.
Typically 2 to 4 treatments are required for removal to be complete.
In Q-switched laser removal, the light emitted is absorbed by melanin in either the epidermis (with KTP) or the dermis (with Nd:YAG lasers), heating the melanosomes to a point where they are destroyed.
The treatment creates an immediate whitening of the pigmented area, due to expulsion of steam, and the area will swell for 24 hours due to the thermal effect within the area. The pigmented area fades over the following weeks.
Typically 2 to 4 treatments are required for removal to be complete, depending on the depth of the lesion. These treatments are tailored to your needs and are approved by the Laser Protection Supervisor
What will the treatment be like?
The procedure is as follows for all Pulsar IPL treatments:
- Dr Patel will always carry out the treatment.
- The area to be treated is prepared.
- A clear, hypo-allergenic gel is applied to cool the skin.
- The Lumina Q System Applicator is then applied directly to the skin and the selected area is treated via a series of intense bursts of light. Each burst of light represents a 5cm2 treated area.
St Mellion Cosmetic Clinic Branches in Manchester, Exeter and St Mellion near Plymouth