Pigmentation Treatment

Pigmentation treatment covers the medical measures and procedures used to reduce hyperpigmentation and even out skin tone. Pigmentation marks appear when melanin, the skin's natural pigment, builds up unevenly under the influence of sun, hormones, inflammation or ageing.

The most common types are sun spots, also called solar lentigines, melasma, often linked to hormones and sun, and marks left after acne or other skin inflammation. At Detalii Med in Baia Mare, assessment and treatment are carried out by Dr Alina Perța, senior consultant dermatologist, and Dr Greta Jurj, specialist dermatologist who also works in aesthetic dermatology.

Treatment is intended for people who have:

• brown marks on the face, décolletage, hands or other sun-exposed areas;
• melasma, as symmetrical patches on the cheeks, forehead or upper lip, often appearing during pregnancy or hormonal treatment;
• marks left after acne, irritation or other inflammatory lesions;
• uneven skin tone, with darker areas.

Any new mark, or one that changes, has irregular borders or several colours, must be assessed by a doctor before any aesthetic treatment. Not all dark marks are benign.

Sun spots usually respond well to treatment and can fade significantly. Marks left after inflammation fade over time, and treatment can speed up this process. Skin tone can become more even and texture smoother.

Melasma is harder to treat: it can be improved and controlled, but tends to return, especially after exposure to sun or heat and with hormonal changes. In general, marks can reappear if the skin is not protected from the sun. Treatment does not change the skin's natural tone and is not a skin-lightening method.

The doctor talks with the patient about when the marks appeared, how they have developed, sun exposure, hormonal treatments, pregnancies and the products applied to the skin. It is also important to know whether the patient has previously developed marks after irritation or procedures, as this influences the choice of treatment.

The examination includes dermatoscopy, to determine the type and depth of the pigment and to rule out lesions that need a different approach. If a mark looks suspicious, the doctor recommends a biopsy and histopathological examination before any treatment.

Treatment is chosen according to the type of mark, the depth of the pigment and the skin type. It may include, alone or in combination:

• rigorous daily sun protection, in every season, which underpins any treatment;
• creams with depigmenting ingredients, prescribed and monitored by the doctor;
• chemical peels, over several sessions;
• energy-based procedures for certain types of marks, especially sun spots.

The type of technology is chosen at the consultation, according to the indication. For melasma, the approach is usually more cautious, as overly aggressive procedures can make the marks worse. The number of sessions and the interval between them are set individually.

Depigmenting creams and superficial peels do not usually require anaesthesia; during a peel the patient may feel a brief stinging or warm sensation. For some energy-based procedures, the doctor may first apply an anaesthetic cream to the area being treated. The sensation felt varies from person to person.

After peels or procedures, the skin may be red, sensitive or flaky for a few days. Treated marks may temporarily darken or form small crusts, which fall off on their own, usually within one to two weeks. The crusts should not be picked off.

Strict sun protection is essential after treatment. The doctor recommends a gentle skin care routine and when active products can be reintroduced.

Depigmenting creams can cause irritation, redness or dryness. Peels and energy-based procedures can cause prolonged redness, crusting, infection or, rarely, scarring.

An important risk is the appearance of new marks after treatment, either darker or lighter than the surrounding skin. The risk is higher in darker skin, in tanned skin and in melasma. For this reason, procedures are usually planned in the months with less sun exposure, and the settings are adapted to each skin type.

Results appear gradually. With topical treatments, improvement is usually seen after several weeks or months of consistent use. With peels and energy-based procedures, several sessions are usually needed, and sun spots may respond faster than melasma.

How long the effect lasts depends largely on sun protection. Marks can reappear over time, especially in melasma, so maintenance treatment may be needed.

Pigmentation marks have different causes, and effective treatment starts with a correct diagnosis. Before any procedure, the mark must be assessed by a dermatologist to rule out a suspicious lesion. Daily sun protection is an essential part of treatment, and the right plan is decided individually, at the consultation.