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When a topical treatment is not enough to eliminate spots

When a topical treatment is not enough to eliminate spots

Deemed unattractive, pigmentation spots can appear on the hands, face, or décolletage. Fortunately, they can be diminished or removed with suitable topical treatments. The question that arises is, what to do when a topical treatment is not enough to eliminate hyperpigmentation spots? The answer is provided in this article.

Published February 22, 2024, by Manon, Scientific Editor — 4 min read

The essential knowledge about pigmented spots.

The pigment spots are the result of a change in the normal color of the skin. They are due to a disruption in the pigmentation process (melanogenesis). They result either from the excessive accumulation of melanin on the skin's surface, in which case we speak of hyperpigmentation, or from a lack of melanin, then we refer to hypopigmentation. Generally, pigment spots appear around the age of forty. There are three types of pigment spots:

  • The melasma or pregnancy mask:

    It appears as a result of hormonal fluctuations, manifesting as brown spots most commonly distributed on the forehead, cheeks, or lips. These typically form during pregnancy, or when taking a medication that impacts the hormonal system.

  • Lentigo :

    Also known as age spots or sun spots, these brown spots appear on the areas most exposed to the sun's UV rays, namely the back of the hands, the face, the neckline, and the back. They are the result of photo-aging of the skin.

  • Post-inflammatory hyperpigmentation:

    These spots occur following inflammation. Generally, they are red or even rosy in color, but they can also be brown.

What other options are there when topical treatments are insufficient?

Pigment spots can generally be treated with topical treatments designed with depigmenting agents. When these topical treatments for pigment spots are not sufficient to eliminate them, the dermatologist may propose the following alternative solutions:

  • Oral Treatment

    Oral treatments are another method for addressing hyperpigmentation, and tranexamic acid is among them. Indeed, it is believed to decrease the activity of tyrosinase by inhibiting the UV-induced plasmin activity, which in turn leads to a reduction in arachidonic acid and prostaglandins, affecting tyrosinase.

    Oral intake of glutathione has been shown to have a skin-lightening activity through various mechanisms such as the inhibition of the tyrosinase enzyme and the ability to shift the production of eumelanin to pheomelanin, although its mechanism is not known.

  • The Chemical Peel

    This technique works by inducing the exfoliation of the upper part of the stratum corneum to remove dead cells.

    It promotes the growth of new skin cells to make way for new skin. TCA peeling and AHA peeling are the two most commonly used methods when it comes to dermatological peeling.

  • Pigmentary Laser Treatment

    This type of dermatological treatment allows for precise targeting of pigmented spots. The heat generated by the laser manages to eliminate these spots within five to six days after the session. A commonly used laser is the xenon chloride lamp, which emits broad-spectrum light and is frequently used against melasma. Pulsed dye lasers may also help reduce pigmented spots by reducing the stimulation of melanocytes, although their mode of action is not entirely clear.

  • Microneedling

    This refers to the name of a technique during which a tool dotted with microneedles is rolled over the skin to penetrate the epidermis and reach the upper dermis to induce a healing response. This technique is primarily used to enhance the transepidermal delivery of various agents for the treatment of hyperpigmentation disorders. A clinical study showed that the treatment with micro-injections of tranexamic acid combined with microneedling resulted in a greater improvement in hyperpigmentation in patients with melasma than the control group.


NAUTIYAL A. & al. Management of hyperpigmentation: Current treatments and emerging therapies. The official journal of INTERNATIONAL FEDERATION OF PIGMENT CELL SOCIETIES · SOCIETY FOR MELANOMA RESEARCH (2021).


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