Does anyone have any suggestions regarding how to handle post-laser hypopigmenation (other than wait and see)? Pt had some unfortunate blistering on lower leg with 810 diode for hair removal (chill tip was defective). I fear she will have significant hypopigmentation. Any suggestions to reduce this would be greatly appreciated?

Which Fitz skin type is she??

She is "borderline" type 3. She has tanned extensively and never really "lightens up" in the winter. She is currently not tanning now. She is also type 1 diabetic.
Thanks for any suggestions.

Use Biafine (Ortho-McNeil) for the Burn healing; if there is decreased pigmentation a "off-label" use for elidel is for vitiligo..supposed to help stimulate migration of pigmentation from hair follicles (hope you didn't zap-em all).. good luck

DermaRogue,
When do you start the Elidel? She is completely healed just has the post inflammatory changes now.
dc

The safe way to go is to do IPL on her to see if you can get her melanocytes going. Start with light setting and gradually going up and watch for her response

First: I first use a glycolic at 15-25% to treat the PIPA; after the superficial dyschromia is gone then its OK to add the elidel.

Question: I did an IPL ona type 3 patient who developed red areas in the shape of the ipl head with darkening on the pigmented areas. Will this heal with hypo or hyperpigmentation? Is there anything I can do to correct this? I just got my IPL and was very careful with my settings. The epithelium is intact so I,m not sure these are burns. Thanks csc3744

I was taught not to do laser vein therapy on type I diabetics, due to lower extremity healing problems. Anyone care to comment?

I think it depends. I would treat the 30yo without any other diabetic complications and have good control of DM. I would not treat any with neuropathy peripheral vascular disease etc.

pmdoc,
I have had her use Elidel for one month now. She has definite hypopigmentation with surrounding darker skin (residually tanned skin).She looks like she has poka dots on her lower leg My question is this, will the IPL help to lighten the darker skin without jepardizing the hypo areas? She also wants to tan soon (April). Would just the act of tanning help to repigment this?
Thanks so much for input.
dc

DC:
Would the act of tanning help to repigment this: the answer is a big NO NO. Melanocytes in a sense don't not work in sync with each other. So when there are uneven level of expression by them and your pt exposes herself to the sun, it for sure will make it much worse.
Reassurance is probably your best advise to her. It can take up to 2 years to recalibrate. When using low level IPL, you treat all area with a 90 angle to the "striping lines" If you have a question about this, let me know. TIME ans PATIENCE are what you need to council her on. It will be back to normal eventually

Q: I have recently undergone 3 ipl treatments. After the first treatment, my skin really looked improved. Over the next two treatments, the setting on the laser was intensified. Now, two weeks after the third treatment, my skin looks terrible. I have dark spots where there were none. My skin looks blotchy everywhere. I'm very upset. What now? Looking for advice.

OMG cjs, I am in the same exact situation. I've had 2 ipls for rosacea and sun damage, and it is a month after the second one, and I am still pink and blotchy all over my face. The first week or so after the treatment it looked OK, but as time goes by it is getting blotchier and pinker. It looks awful. There are a couple of lighter spots on my nose, but I think they are actually the undamaged areas, because they match around my eyes where I wore the goggles. And where I had my sun damage is all inflamed and swollen, like the tecture has become more damaged than it was before. I am very upset by the whole thing, and the derm where I had it done (he did not perform the procedure, an aesthetician did) is saying that he doesn't think it is from the ipl as they use it to treat rosacea all of the time. He is recommending that I continue with a third treatment, which seems crazy to me! I am going for a second opinion with a very reputable derm in NYC but the waiting period to see her is a month. In the meantime, I am afraid that I have damaged myself for life, and I'm really freaked out by the whole experience. It seemed like such a safe thing to do, especially since I had very successful laser hair removal at the same facility.

Does anyone know why this reaction would take place, even though this skin does not appear to be burned on the surface? Will the pink blotches go away?

I wish you a lot of luck cjs. I hope this works out OK for both of us.

Dear Alyssa:

Went to a dermatologist yesterday for some advice. I'm feeling like he wouldn't dish on the doc who performed the procedure - so no commentary there. He's telling me crap like it's probably melasma (the dreaded pregnancy mask) or something related to my hormones. I'm 45 yrs. old. Not pregnant and not in menopause. I also live a very cold climate and did not go out sun bathing afterwards. He also commented that I'm one of those people that hyperpigmentation can happen to after a procedure like this. I'm back to using Tri-Luma. A hydroquinone composite used to fade these spots. I am disappointed that a test spot wasn't done first to find out if this would have been my reaction to ipl. I'm a middle American white chick. The perfect candidate? I am making another appointment with one more dermatologist to get a second opinion. So far both doctors are telling me it's just stubborn, but not permanent. Swell. I'd leave the laser alone for now. I'll keep you posted. Thanks for the kind words. Let me know how it goes.

Thanks for the info cjs. I visited my regular derm who prescribed me Elidel, but at $300 a tube, I am waiting for prior authorization from my health insurance before I fill it. I too am light skinned and was a good candidate for this procedure. At this point, I just want my old skin back. I am hoping that the derm I see in May, who is at a laser institute where I previously had a port wine stain successfully treated, will have a solution. I think the worst part of the whole experience is I feel very ashamed, as I feel as if I brought this on myself by having a cosmetic procedure performed in the first place. But in reality, I did a lot of research on IPL, and all the sites I looked at said it is a very safe procedure. In fact "no downtime" was listed as a benefit of the treatment.

In addition, I have broken out with cystic acne since the procedure (hasn't happened since my 20s), and none of the marks are going away like they used to, so now I have red spots all around my nose to boot. It is as if my skin just isn't healing itself. The depression I'm feeling about this whole experience is affecting me worse than anything else. I'm having a hard time getting out of bed in the morning, and when I look in the mirror,I just want to crawl back into bed. I'm just trying to keep the faith that 3 months or so from now this could all be over. Fingers crossed!

I'd love to hear how everything works out for you.

To PMDOC

Two months ago, I treated a male's back for laser hair removal with an alexandrite 755nm wavelength laser. He has developed hypopigmented spots on most of his back of the size of the laser handpiece. He is spanish origin with a skin type III medium skin tone. He can tan easily. I found your comments very useful when you advised dc, however I would like to know, shall I continue treating him with the same laser (Alexandrite) but using lower levels or shall I not?.

Also, you mentioned the IPL, I can offer him this treatment but which wavelength of IPL will be more beneficial for him?

I would like to know whether this condition would ever heal? How long will it take and whether there are any topical creams or other remedies to improve the hypopigmentation.

Thank you for your comments and if any other practitioner could advise me on this and write your own experiences it would be much appreciated.

Thank you

IMS

Dear IMS:
Sorry I have not been to this blog often lately. Your patient sounds like a Fitz type IV. You probably were a bit aggressive in using a larger spot size with the same Joules. The best advice I can give you is TIME and PATIENCE. Some of his melanocytes were "burned out", losing their melanins. IT will now take a long time for them to "regrow" and "recalibrate" with the rest of the body. It is a MUST to tell him to stay completely off the sun during the time. Exposing his skin to the sun for the next 1-2 year is absolutely contraindicated.

I had some laser done above my lip a few years ago, along with some fat added, in order to lessen the lines that have developed there. I have a white line above my lip now, almost like a milk lip that you see in advertisements. My dermatologist said it's sun damage but I'm beginning to think it happened with the laser.

I'd like to try Elidel off-label for hypopigmentation but have no idea how long I should give it to see results? Does anyone know?

IMS,

Christine Lee in California has used long pulsed Nd-Yag for repigmentation after laser procedure. I am not sure the parameters she was using. For your patient, you might have been more aggressive than you should have been. I think a Yag laser would be a safer way to go for your next treatment. Be more conservative for the first few treatments. However, the Nd-Yag is not as effective as the Alex for fine hair in fairer skin type.

BLJ: I have used elidel off-label for hypo pigmentation (and vitiligo); you need to give it 3 mos to see if you should continue.

Hello

I had a TCA peeling 6 months ago. Though I have applied daily sunscreen over the past 6 months, I am now seeing hypopigmentation develop in the areas where the burn was severe. Please what should I do? Is there any mean to fight this phenomenon, either topical ointment or repigmentation procedure?
I am growing desperate.

Thank you very much. Any advice appreciated.

I have had a lot of ipl treatments on my neck & chest for rejuvenation & to decrease the redness. I am a 42 year old english white woman. I do not think I have had great results & also have 2 patches of hypo-pigmentation - one on my neck being the size of the laser head. That has probably been there for nearly 18 months. The skin on my chest looks really blotchy to me & I feel really conscious...often wering shirts with high collars etc. I look enviously at people with "normal" skin on these areas. I think I have gone over the top with the ammount of treatments - hoping that the skin tone would even out etc. I have spent probably over £2000!
Just want some reassurance that it may rectify itself - I struggle to look in the mirror at the moment!

About a month ago I had laser hair removal done on my arms. I am not sure of the settings but I know it was a Candela GentleLase (sp?).

After my treatment I developed dark hyperpigmented circles the exact size of the laser head. The dark circles have since flaked off and I am left with white circles. Is this the same as hypopigmentation? I would like my skin to be back to normal soon so if it is just virgin skin (and not hypopigmentation) I was wondering if I could go out in the sun a few times to even out the circles.

Your advice and opinion are greatly appreciated.

I just treated a patient's full leg and bikini skin type 3 with the Gentlelase using a very low setting,using spot size 18 with 9 j.and she hyperpigmented on her thighs. I have five years of experience with the cuttera coolglide and have never seen a hyperpigmentation before. How long do they usually last and is there anything that she can use to speed up the recovery?

I just treated a patient's full leg and bikini skin type 3 with the Gentlelase using a very low setting,using spot size 18 with 9 j.and she hyperpigmented on her thighs. I have five years of experience with the cuttera coolglide and have never seen a hyperpigmentation before. How long do they usually last and is there anything that she can use to speed up the recovery?

try using Tri-luma cream, usually take 2-3 mos to fade

Sara: Sounds like a tanner to me. This time of year was always brutal for my clinic with tan skin-- even residual tans as well as people who lied about recent tanning. Test spots are more important than ever during the summer!!!

Bridget -
The same exact thing happened to me after a treatment with GentleLase. Have you tried tanning to even out the color? I'm nervous that tanning will make it worse but I want the white circles to even out!!

DC are you a chiro practicing medicine without a license?

Sara:
Do not use any spot size above 12 mm. Start with longer pulse width (30-40ms) then decrease it on subsequent treatments. To decrease risk of hyperpigmentation, aplly cortisone cream for 15 mins BEFORE the treatment and right after.

Danielle and Anne:
The answer is NO NO NO!!!. The worse thing you could do now is to expose the area to the sun. Stay OFF it. It can take up to 2 years to resolve the problem. TIME and PATIENCE.

Hi cjs/ Alyssa. How are you doing now? Unfortunately I developed hyperpigmentation after a fractional laser. I am glad I found your email thread. Wondering whether it has cleared up. Would really appreciate any feedback you may have. Thanks.

Great forum!!
My question is: what is the best way to treat IPL striping? I am a type 3 with incidental sun exposure that I should have treated at type 4. I used a 590nm and only was able to do one pass.I have striping now at 3 weeks post treatment, and possinle hypopigmentation (verus clearing of sundamage) the shape of the IPL head. Do I treat it perpendicular with the 590nm and lower joules? Do I use hydroquinone to decrease the inbetween pigment or will that jeopardized the lightened areas. THANKS!

to pmdoc and Dermarogue:

looks like I"m in the same boat as a lot of other people. I had laser hair removal done 6 weeks ago. My legs have hypopigmented the size of the laser head, in dime sized circles. I understand from reading that time and patience is the key to see if the pigment comes back. Is there anything topical or orally I can take that you would recommend? i've looked up some websites on stuff they offer to people with vitiligo. Do you consider those good options, or do you recommend I just wait and do nothing for the next year. The laser was a Cynosure Elite that combined a 755nm Alexandrite and a 1064 nm Nd:Yag.

thanks

BKesth

I have used Fraxel re:store on hypopigmented lesions. I tried this because I have seen literature that suggested the actions of the laser causes melanocyte migration. Meaning it makes cells that produce pigment gather to the area. I have used this method on a handful of patients, it is not perfect but it does cause some pigmentation and 'normalcy" to the affected areas. This process takes 3-6 weeks to see results after one treatment but it does work

thanks for your input, how many Fraxel treatments does it take how far apart, and what is usually the cost?
also - does anyone know anything about V-tar that is used topically. Also, something known as needling? I've heard they both can bring back hypopigmented areas from doing some internet research... just curious what's the best way to go. i don't have a ton of money to spend.

Hello...this is years later....I just had a laser hair removal producde done last tuesday and American Laser Centers and they went a lot more aggresive on me then they typically do....no burning...but I'm noticed VERY light spots on my face. I am a light skinned Indian..so you can't really see them...but I'm wondering do they get light with time? I am very good about staying out of the sun but wasn't sure if I can expect them to get lighter and lighter. Also, I'm still feeling a strang sensation in my face...like swelling in certain area's of my face ( but it's not actually swollen)...I'm worried that tissues are damaged or something but my DR won't refer me to a dermatologist ( argh kaiser)...they said to take advil and I'll be fine. Very confused about this as I don't hear about this long term facial discomfort after a laser procedure.

I'm also VERY worried about hypopigmentation. If any one has any comments to what I wrote...let me know.

One more thing...american laser centers uses IPL laser...theirs is called Ameri-Light. Anyway, they went to a level 28 with me and said my skin heat headings were fine....but not sure why I'm having this effect......any info would be appreciated!

Oh yeah, I'm never going back there again!

Had ipl 1 treatment for sun damaged skin on shoulders.i was told no tanning 5 weeks before and after.One shoulder came out not so bad but other shoulder has hypopigmented squares over entire area.I always work out and run with tank top or no shirt.Looks like those days are over for long time with summer coming in newjersey.My skin was not bad to begin with.I should of left it alone.English-german blood #3 skin type.Can i go into sun with sunblock and enjoy my life?Will it really take 2 years to go back to normal?UPDATE had 2nd treatment done on bad area in between hypo squares at lower setting then 2nd treatment healed but hypo from first treatment remains same 3 months later.2nd treatment did not help blend skin together at all.thanks

two weeks ago i was using neostrata 10 aha, i notice white spot in my forehead more light than the rest of my forehead, i was using it morning and night,
iam morrocan woman, iam 26 years old,
can you tell me what to do regarding this matter, thank you,
meryem

I had several Ipl treatments on my face last year. I had excellent results. I decided in january to do my chest, back and arms also. I had burns on just my back and arms. I ended up with hypopigmentation stripes on my back and arms as well. I put neosporen on my burns from the day they happened until about 3 weeks afte. It is now the end of june and I have been getting sun on those areas and the color is leveling out. I had read on a post somewhere to not let the sun touch the areas for at least 6 months and I was very strict about it. My arms get slightly more sun and no one even knows unless I point out where the spots were. Hope this helps someone

I was burned with the laser hair removal on the back of my legs they crusted and are now peeling leaving white moons all over my tanned legs. What can I do to help this it has been two weeks and I am stressing because I don't know if I will ever be able to wear shorts again. I also still have dark areas too. Please let me know what I should do any help would be greatly appreciated

I have hypopigmented patches all over my tan arms from laser hair removal a month ago. Go see a dermatologist before you tan or use any tanning lotions. I used a tanning lotion out of despair and it just irritated my skin even more. Before seeing my dermatologist, I did tan my arms a bit, which probably wasn't the best idea but did promote some pink coloration. My dermatologist told me to wear sunblock of spf 50 or higher or avoid sun completely for at least a month.

I just had Cryotherapy on several moles on my face and neck and its a month hence or more, and I have hypopigmented in each area of removal, it is so distressing. I'm African American/Flipina descent, I was told to use Retina A to speed cell regrowth, but wouldn't that make me extra sensitive to the sun? Any advice out there?

It has been a month since I had laser hair removal and now I have hypopigmentation on the back of my legs and a little in the front. I cant wear capri, shorts or even skirts. I dont't know if I could avoid the sun and do nothing for two years. Has anyone did anything and saw improvement like sun, vtar, or laser? I would really appreciate any advice because I am so depressed and sad that I even did this.

Brigette. I also had problems on my legs when I had laser hair removal done last Oct. It's been almost a year, and it has significantly gotten better. I was left with multiple dime-sized hypopigmentation circles all down the front and back of my lower legs after one treatment, where the tech obviously had the laser up too high. I've never cried so much b/c I thought I would never see my legs get better. I followed the advice of one of the docs who left a post above that said to stay away from tanning beds and any sun exposure, and that it may take up to 2 yrs. for the pigment to return and recalibrate on it's own. I haven't done anything to improve them, but have avoided all sun and UV exposure. It is getting better but it just takes a lot of patience! I can still notice it still slightly in some areas, but it has drastically improved! I also read somewhere that a 1.5mm dermaroller will help. It's a form of selfneedling that can help stimulate pigment to return. (You can buy them off of ebay or amazon.) I bought one, but haven't used it yet...so don't know how well it works. Hope this helps, good luck. I know it's devestating to go through.

PS....and Mystic spray tanning and self tanning lotions helped me keep color during the past year.

Bkesth do you have pictures? Also thanks for the info

In terms of Hypopigmentation, we have been successful in regenerating pigment with the Palomar 1540 Fractional Laser Resurfacing Handpiece. On average it takes 3-4 treatments to stimulate new melanocytes. Our center has been successful for hypopigmentation on patients caused by ablative CO2, sun damage, and acne scarring.