Hyperpigmentation -- melanin deposits such as brown spots, lesions and excessive freckling caused by too much sun -- is a significant sign of aging, along with wrinkles and greys, but remains largely hidden from view. Considering that modern UVA/UVB sunscreen was not around until the 1980s, anyone in their 30s and beyond (especially those "beyond") have soaked up a lot of harmful rays.
In effect, today the look of uneven, spotty and sun-damaged skin has become the new grey hair. And don't think the cosmetics industry hasn't noticed. Selling out as fast as wrinkle remedies, products and specialized procedures abound to promise even skin tones, lightened areas and radiant skin.
First of all, save the skin you're in
What's the best remedy? Dermatologist Dr. Benjamin Barankin, from Cosmetic Dermatology on Bloor (http://www.unlockyourbeauty.com/) in Toronto, says protecting your skin against the sun cannot be overemphasized "The proof of this is that even in elderly people, their buttocks have great skin tone and colour, so [uneven skin] is not as much an age problem as it is a sun exposure problem," he says. So be sure to keep sun exposure to a minimum (just enough to get your vitamin D) and to wear sunscreen and protective clothing if you're going to be outdoors for any length of time -- whether it's sunny out or not. Additionally, he stresses that smoking cigarettes will make skin sallow in colour while adding wrinkles.
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How to safely lighten your skin
If you wish to lighten areas of your skin there are lots of options, but some treatments can cause serious damage and sometimes permanent scarring. Dr. Barankin offers the following steps to safe skin lightening treatments:
1. Over-the-counter creams
Yes, you can brighten your skin without going to extremes. Dr. Barankin says over-the-counter skin-lightening creams that contain glycolic acid or alpha hydroxy acids have modest benefit, plus Retinol-containing products can also help. Read the product label to see if they contain these ingredients.
2. Prescribed skin-lightening products
If you're not happy with over-the-counter basics, your next step would be to try a prescription-strength cream containing vitamin-A acid. Products containing hydroquinone -- a pigment-inhibiting compound -- will also lighten skin. Dr. Barankin stresses sunscreen is an essential component of hydroquinone or other prescription therapy and must be reviewed with your doctor or dermatologist, "Especially the importance of using the proper sunscreen (not just a high SPF number!) in the proper way," he says.
However, be aware that hydroquinone use has been banned in France and is currently under review by the FDA for possible cancer-causing properties.
3. Dermatologist-prescribed formulas
For more rigorous products, speak directly to a dermatologist about Kligman's or modified-Kligman's formula, which combines hydroquinone, dexamethasone and tretinoin (a retinoid). In addition, Dr. Barankin recommends Solage for brown spots on the face.
4. Procedures for smooth, even skin tone
Physician-grade chemical peels can help to even out skin tone, or Dr. Barankin says microdermabrasion can also be of some benefit.
A stronger procedure uses lasers and/or intense pulsed light devices to remove layers of damaged or wrinkled skin at precise levels of penetration. This is also the treatment of choice to fix any redness or blood vessels of the cheeks due to sun damage or rosacea. "This should be performed or supervised by physicians, preferably a dermatologist," he says.
5. Specialized procedures
Liquid nitrogen cryotherapy: "This can be used by dermatologists to peel the flat brown lesions -- lentigo -- or the raised brown lesions -- seborrheic keratoses -- that can develop with aging," he says. Speak to a dermatologist to see if this procedure applies to you.
In Asian or African-American skin, Dr. Barankin says dark brown to black lesions called dermatosis papulosa nigra commonly develop around the eyes and are effectively treated with electrosurgery or an ablative laser by dermatologists.
6. Lightening large areas
Very rarely, some people need large areas of their bodies treated. "In patients with vitiligo (a skin disease with autoimmune destruction of pigment) that have extensive involvement (e.g., Michael Jackson), we on occasion use a monobenzyl ether of hydroquinone to bleach the remaining dark skin so that they have a uniform white skin," he says.
Things to avoid
• Your face is your most delicate canvas, so make sure you seek the advice of a qualified professional if you want to lighten your skin. "Not a week goes by where a patient has gone to a 'skin clinic' with no physicians on site and had their skin treated, resulting in ugly and sometimes permanent scars," says Dr. Barankin.
• He also warns against using creams or products not approved for sale in Canada. "The other common occurrence we see is patients from Africa who overuse bleaching creams (available widely over the counter in Africa) and develop paradoxical darkening of the skin (this is called exogenous ochronosis)," he says.
Whether you choose to lighten up or to embrace your skin's transitions, don't forget the basic rules of great skin apply regardless of age or skin type: restful sleep, lots of water, good nutrition, don't smoke and stay out of the sun.
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