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Pigmentation Problems (Hypo- and Hyper-)

Q: Please advise if Obagi's Nu Derm system is the best product to treat hyperpigmentation.

Esthetician: We do not carry Obagi at the moment. However, there's no such thing call BEST products because it's toally depends on each individualperson. The product that works for your friend may not work for you! You may consult with your skincare professional for the products that are best for you.

Q: Dear Dr. Berger,
I'm 22 and black boy with a problematic uneven skintone. I have hyperpigmentations on my elbows, knees, ankles (hands & feeds) and on my cheek bone area and especially on my butt.
I just don't know what to do, because I tried everything out. I was using "clear essence" (skin lightening/whitening) products which wasn't really that helpfull. They only helped me to get rid of some dark spots but they wasn't helpfull for all the other body parts. An asian friend of mine told me to try to take some Gluthathione pills, which was really helpfull for him, but not really for me.
The only solution is to ask you, because all the other doctors can't really help me or have no idea how to deal with my uneven skintone problems.
Can you help me? If yes what kind of product should I start using to get a clear and even skintone from head to toe? Is there a posibillity to buy those kind of products for cheap prizes as well or are the expensive products the helpfull and better ones?
Pleas help me Dr. Berger to feel more comfortable and cofident in my own skin.

Esthetician: Dermalogica's Chroma White line is made for uneven skin tones. Over time you will see results. Also do not get discouraged if this product turns out to not work, we have many different brands made for people with uneven skin tone. You will find something for you on our web site.

Q: I am 38yr old black dark skin woman, I have every morning and everyday, throughout the a new break out of acne just on my rght cheek, the rest of my face is clear, and with every break out it leaves hyperpigmentation, some have told me its because thats the side I hold my phone on, I mean when run or workout and even sweat they will appear, so what product would help me? Something I can use for awhile and wont stop working.

Esthetician: For your skin type I would suggest Dermalogica's Chroma White line.

Q: I am wondering what priori products i should use. I am 37, fair skin with freckles. I always wear a suncream. I have fine lines and some pigmentation

Esthetician: Priori has a line called CoffeeBerry Natureceuticals and coffee berry is a new form of antioxidant that will help with fine lines and pigmentation.

Q: Hello, Dr. Berger!
I have a combination skin, I was suffering in my teen years with spots. Now I'm 26 and yes, in some periods I have spots, but only a couple or so. But I noticed that with time I get a kind of pegmentation after the spots are gone. And if some years ago this pegmentation could easily and faster dissapear from my face, nowadays I see that it can not go away that easily from my face. That makes my face different colored a bit, I don't use foundation or consillers to cover this discoloration as I don't like using those make-up products. So, as far as I know, the only one way to make my face skin be the same colored in it's every part is -- using AHA peelings. Could you tell me, please, is this really the only one way? Or as I heard it's also possible to use vitamin A (an oil) for pigmentated skin. Is this true? I need your professional advice about what I could use as my home skin care to get rid from pigmented parts after spots.
Thanks, kind regards, Yuliya

Esthetician: Well in not sure what you mean by "spots" but you can use PCA pigment gell to get rid of discoloration or if these spots are raised and the pigmentation its leaves after is scaring you can use scarguard.

Q: can you advice best treatment for pigmentationon my side face. coulsd you recomend cream that will eliminate the layer of skin to bring out brighter complexion

Esthetician: You should try June Jacobs Brightening serum.

Q: I have a question about acne scars. When I get acne scars (hyperpigmentation), they stay on my face for 5 to 6 months. What product would you recommend for lightening the scars?

Esthetician: The best thing to use for acne scars from our website would be Scarlight.

Q: my face has alot of white and brown discoloration.i had 3 fraxil treatments,but it didn't work.what would work on me?creams make my face break out.

Esthetician: What you should do is go to our website and under Conditons and Concerns choose Hyperpigmentation and Uneven Skintone and you will find all the different products you can use to fix your problem, like Exuviance Vespera Bionic Serum or Dermalogica's Daily Microfoliant.

Q: I'm 63 yrs old. And I tried all the remedies to lighten or get reed of my liver spot on my cheeks. I tried laser, lancome(Blanc expert) Avon (Luminosity) & more other product. But nothing could solve my problem. I had been using Demablend for 16 years but if I could get rid the age spot on my face, that would be fantastic. Could you please advice me what's the bets rememdy to lighten or get rid of my age spot? Thank you.

Esthetician: We have many products for you to choose from including Murad's Age Spot & Pigment Lightening Gel or Nuxe's Nuxuriance Anti-Aging Re-Densifying Concentrated Serum.

Q: Hi Dr.Berger iam trying to find out which line would be the best for my skin at age of 47!I have used jane irredale but i found out that it did not give me the best coverage for out this way and found it very drying to the skin!I know it has to do with more than the top layer it goes to more under the dermis that could cause of my dryness!and too under the eyes it looks cakey and not young looking!I sometimes do break out with my hormones too in which i find too when a woman has her periods!i do have a little pigmentation to showing up from years of laying in the sun!I want to look fresh and healthy and young looking!I dont know if what i said has helped in the asking part!Could you please tell me which one or is there one better than these two available!marsha

Esthetician: You should try G.M. Collin's Anti-aging duo, it helps with both aging and dry skin.

Q: The skin above my lip has darkened recently. I wonder if it could be age spots. I am only 35; and it has left me looking like I have a mustache.

Esthetician: If you go to our website under the condtions and concers section you will see one that says "dark spots and age spots," browse the products in that section, they will help you with your problem.

Q: After hip surgery and then physical therapy, I ended up with stretch marks on my upper thighs. What might help hide these marks or make them go away?

Esthetician: Browse through the products from Mama Mio, they have many stretch mark oils and creams to help you.

Q: My question is regarding Vitaligo. My face has a couple of brown areas left extending a little into the neck area.
Dermatologists are not optimistic regarding depigmentation procedures.
I would love to greet spring and/or summer without facial coverup. What about the permenent procedure Micheal Jackson went
through? My natural color is light brown (Latina). I would appreciate any referrals or information.

Esthetician: Under the conditions and concerns section on our website and go to the age spots and brown spots subsection you will find products that will help you.

Q: I have a pervasive case of Vitiligo which has bleached my neck and throat (also up and down my arms and legs.) To top it all off, I have hyperpigmentation on my face as well. Do you have any suggestions on what I should do? I use SPF40 daily on my face; spf 50 daily everywhere else. But this does not take care of the makeup.

Esthetician: Under the conditions and concerns section on our website and go to the hyperpigmentation subsection you will find products that will help you.

Q: Dear Dr. Berger,
I have acne scars on my face. I had a peel a few years ago thinking it might help the scar become less noticeable. After I had the peel I started to have pigmentation which makes my face dirtier looking.
I have tried all the products on the market. Mederma, Retin A, etc. but the scars and the pigmentation did not fade at all. So I decide to have a Medlite laser for 5 session. The scar did not go away and neither did the pigmentation.
I heard about the Fraxel. How effective is the Fraxel for removing the scar and pigmentation, and how much approximately is the cost? I am a keloid former. Can I have a Fraxel treatment even if I have a very sensitive skin?

Dr. Berger: Let’s start at the beginning. First, though some Caucasians form keloids, I assume you’re African-American. There are just some lasers that shouldn’t be used on people of color and, especially keloid formers.
I’d try physician prescribed Hydroquinone, maybe, in experiences hands, Laser Genesis (CUTERA) at high settings to break up the pigmentation... but do not venture into the Fraxel/Pearl/resurfacing world. Even the peel sounds like it was a bit too invasive for your skin-type.
The results could be worse than the initial problem.

Q: What is good for spider veins on face and brown marks?

Dr. Berger: Spider veins on the face can be removed with a 1064 YAG laser like the CUTERA CoolGlide. Pre-treatment topical anesthetic cream helps a lot and it takes 3 sessions to completely destroy the veins in most cases.
For brown marks I recommend photo facials or, if they’re more severe, Photo Dynamic Therapy. Consult your local Cutera Laser specialist. www.cutera.com

Q: I have reddish pigmentation that does not go away with time above my upper lip that results in almost looking like I have a moustache, because I have shaved my upper lip for years. I have used OTC hydroquinone and Renova, but do not see much improvement. What do you recommend would be effective to have the normal color of skin once again? I am tired of using cover-up to continually hide that pigment. What have you seen that works for that particular thing?

Dr. Berger: Do you still have upper lip hair?
That’s a good place to start… laser removal. Then, when you’re not irritating it over and over, try stronger hydroquinone from your dermatologist and, possibly a LimeLight#8482; photo facial (IPL) to remove the redness.

Q: Dr Berger,
I’m 38 and have permanent redness on and around my nose. Could you please advise a cream? Thanks for your time! Ian UK

Dr. Berger: Well, Ian, it depends on what sort of redness. Does it get worse in the heat? Under stress? It might be Rosacea, which is difficult to treat, but is controlled well with laser treatments.
It may just be venous formations, and a 1064 YAG laser could get rid of it permanently.
There are no effective creams for diffuse redness such as you describe.

Q: Dear Dr Berger,
Could you recommend a skin care regime for me? I am 60 years old with a lot of brown spots and discoloration, but do not want to do laser or anything else that would be invasive. Thank you, Carol Weisbrot

Dr. Berger: Well, Carol, I’d love to have a magic potion to clear discoloration. Have you tried Hydroquinones? They are sometimes effective.
At 60, do you get monthly facials… use great skincare products, LOADS of SPF 45 sunscreen daily and moisturize twice a day?
This is a difficult problem and, frankly, non-invasive laser treatments such as the IPL or LimeLight are the best solution. They’re not actually lasers… they’re Intense Pulsed light of broad spectrum, and effectively and SELECTIVELY destroy pigmentation.
Just be certain a physician is handling the machine and you’ll be fine.

Q: What can I use for the black spot on my face after being in the sun. Just 30 min. in the sun, but using sunblock still does not help me at all. I used all different type of products nothing seem to work for me. Please help.

Dr. Berger: Dear Joy,
have you tried ProCytes SPF60? It’s great. Get a floppy hat, too. As I repeat til I’m hoarse: "The Ozone Layer is GONE! Protect yourself!" I feel sort of like Chicken Little. LOL Anyway, I digress.
The spots should be IPL treated (Photo Facials) and don’t do that til winter.

Q: I have melasma and its not going away. I have tried everything. Is self-tanner safe for melasma? Will it cause it to get worse? I am trying to get an even tone.

Dr. Berger: That’s a VERY interesting question. Self Tanner should not effect Melasma, but I’ve never heard of using it to even tone. You’ll probably have to use a lot! There’s a product called Cosmolon for treating Melasma which has gotten very good feedback from physicians I know. Ask your specialist.

Q: Hi Dr. Berger.
What products can I use to lighten my skin permanently? Is there such a thing? Is Dr. Murad (nano DNA) any good?
I want even toned skin. Please recommend a good dermatologist in Beverly Hills, California.

Dr. Berger: Gee, Shireen, Beverly Hills has great dermatologists on every corner!
I don't think any product will permanently lighten skin. Expect repeat treatments as often as you produce more pigment. If you want even tone, and you're light skinned, IPLs will do the trick (I like LimeLight)… but if you're a person of color, that's not an option. See a specialist in Beverly Hills for a real evaluation of your options, since each skin type is different.

Q: I am a 35 yr. old white female with olive skin and I have been battling melasma for 3 years.
I have tried Triluma and had 10 IPL treatments. The melasma has improved. I am considering having the pearl laser treatment in two weeks. Can this work better than the IPL treatments? Is there any risk that this treatment can make the melasma worse? I have melasma on my cheeks, upper lip and chin.

Dr. Berger: Melasma is sooo difficult to treat. Some physicians seem to get pretty good results with Genesis (CUTERA) at high settings with anesthetic cream beforehand.
Some use the pearl, though it's new and not specifically designed for that problem… but it does remove surface pigmentation so...
Others, still, use a great product called Cosmalon™ that is a combined office treatment with self applied home-care after. IPLs are not a great option, in my opinion. I might be tempted to try (with your complete understanding that this is speculative and new) the Pearl.

Q: Dear Dr Berger,
I'm 31 yrs old and I have a few brown spots on my cheeks. I believe that the sun caused them. I'm wondering what kind of treatment would be suitable for me and, if it's a laser, how soon will I see the result?
How many treatments? I live in NJ and I can travel to your office in NY City. However, I'd like to get some ideas please.

Dr. Berger: Dear Alison,
for severe sun damage IPL Laser treatment with Levulin are the answer. Milder sun damage responds well to a series of IPLs, alone. I'd be delighted to evaluate you, check the damage level with a VISIA facial analysis and even recommend the right skin products to avoid future problems.

Q: Dear Dr. Berger,
Is there any way that laser can reduce the appearance of the scars (color-wise)?

Dr. Berger: Dear Jenna,
Genesis™ laser treatments about every 2 weeks over the scar area will reduce the color, in my experience. I use this treatment frequently for red, irritated "facelift scars" in front of the ears. A series of about 10 treatments usually work well.

Q: Dear Dr. Berger,
What is your opinion about Hydroquinone?

Dr. Berger: Where, and for what purpose? Hydroquinone is a great skin bleaching agent, somewhat irritant (more so at higher strengths) and effective occasionally for melasma, irregular skin tone and acne scar hyper-pigmentation. Does that help?

Q: I'm 30 year old African American woman and I had some kind of allergic reaction on my lips and the doctor gave me some triamcinolone acetonide. Which worked very well but it left my bottom lip discolored.(real dark brown) Is there something I can get or put on my lip to get my natural color back?

Dr. Berger: To be quite frank, I have never encountered this problem, but I was surprised to find that the internet is full of blogs and discussion groups about it. I searched the literature and found no products for decreasing color on the lips, and I believe that Hydroquinone is just too irritating for use on the lip.

Q: I am 36 years old woman and suffer from dark circles under my eye but no puffiness or wrinkle. The skin around my eyes is very thin and I have purplish brown shades under my eyes. Which eye cream is the best for my problem.

Dr. Berger: If you're a smoker... quit. Try to eat a balanced diet and take a multi-vitamin. Home remedies include tea bags and cucumber slices, but a good quality nighttime eye cream with Vitamin K is the best treatment. I recommend PETER THOMAS ROTH - Ceramide Eye Complex. It's not a perfect solution, but it's definitely the best out there.

Q: Dear Dr. Berger, I recently had a rhinoplasty. It looks great, but some of the discoloration under my right eye still hasn't faded. It's been about 3 months now and I'm starting to worry. Do you have any suggestions? Is this something a laser could correct? Thanks for your time.

Dr. Berger: Have you spoken to your surgeon? I bet he's seen this alot. Usually, post rhinoplasty discoloration will fade after 5-6 months… that's a longer than expected time, but it happens.
If not, ask him for his advice. That's why he makes the big bucks. ;-)
He might recommend a fading cream... maybe a Rx formulation with 7% Hydroquinone.

Q: Hi Doctor, I am a 43 year old, white, blonde female and have hyper-pigmentation all over my face. This started about 5 years ago with small spots. Now it looks like I am wearing a mask. I have worn highly protective sun screen, but it just gets worse. What can I do about this so I don't feel so self-conscious all the time?

Dr. Berger: Dear Trish, fear not!
Find a laser specialist with a Cutera LimeLight laser.
He might pre-condition your skin with Hydroquinone and, after several weeks off of that product to decrease irritation, will probably begin a series of IPL treatments designed to eliminate the spots.
Let me know what happens.

Q: What is a good coverage for Vitiligo on the corners of my lips?

Dr. Berger: I like Dermablend products, because of the range of tones available. The results are uniformly smooth and you can certainly match your tone.
Let me know what happens.

Q: I have a very rosy complexion. Too rosy. Otherwise it looks great. What do I do about the red? Thanks.

Dr. Berger: Dear Deborah,
Find a physician with a Cutera LimeLight. It treats redness and sun damage and spots… not just spots. That is far and away your best choice.

Q: Dr Berger,
Is it safe to use 7% hydroquinone along with 2% Vc-ip and Arbutin 3%?.

Dr. Berger: Dear Victoria,
So that's Victoria's secret! Too many creams. Actually, 7% Hydroquinone is very strong and I would recommend using those products serially, rather than simultaneously. It's better to err on the side of caution… always.

Q: Can Solage be used around the eyes to lighten? It is a prescription only produce.

Dr. Berger: Frankly, Alice, I have no experience with Solage. I read up on it and it seems fine, but I tend to favor the old standards like Hydroquinone.
If it works for you… It is, after all, a lightening cream, though it's specifically recommended for sun spots and age spots. May work, probably can't hurt.

Q: I am 43, and was in the sun a lot as a teen.  I have brown spots all over my face I want to get rid of.

Dr. Berger: Dear Rhonda,
The treatment of choice is 4 sessions of IPL pulsed light or, in advanced cases (like you seem to describe) PDT with Levulin™. That will certainly do the trick.

Q: Dear Dr.Berger
I am a Latina women and I seem to have real dark circles in my eyes. I am 43 years old, weigh 100 lbs, pretty face yet without concealer my eyes look bad. I need advice please write.

Dr. Berger: Dear Nina,
As I wrote to Marcie, There are many good bleaching creams with Hydroquinone available, but be VERY careful not to get then into the eye, itself. Also, use it sparingly or you might get the reverse effect and be too light around the eyes.

Q: I have adult acne. I am 31 years and never had acne growing up. It's on my neck area, and it has left dark spots where my acne was. What can I do to help the dark spots? Please write back if you have any ideas.

Dr. Berger: Dear Skyla (GREAT name… lovely!),
Try hydroquinones under dermatologist supervision and, if that doesn't do the trick, consider IPL treatments.

Q: Dear Dr.Berger, I heard that hydroquinone can cause many side effects including a gradual blue-black darkening of the skin (ochronosis) as a serious allergic reaction. As this drug is being banned by FDA in the close future, Is it true that it is one of the cause of cancer? (I'm currently under treatment of hydroquinone). Thank you very much for your help.

Dr. Berger: Yes, there are problems with Hydroquinones. If you have had any Basal Cell activity or significant Actinic Keratosis it is probably best to avoid the higher percentage products. Stick with 2%... or better still, if the spots are generalized, consider IPL laser treatments under the care of a physician.
Usually 4 treatments, spaced a month apart, with a CUTERA 560 will resolve most hyper-pigmentation.

Q: Discolorations, what is the best product to even your skin out. I also use microderm from rx clinic, spf everyday and organic skincare.

Dr. Berger: There are a wealth of products which treat specific spots (many with various amounts of hydroquinone), and even more "cover-up" products to evenly cover complexion irregularities. But to really TREAT uneven skin tone, there's nothing that comes close to IPL(Intense Pulsed Light) Laser treatments.
Usually a series of four treatments, spaced 4 weeks apart, will erase the unevenness and leave a smooth, even skin tone.
This works best for patients with light to medium complexions, and the results can be dramatic..

Q: I have melasma since 2 years ago. I had try everything...hidroquinone and vitamic c, but nothing works, I also have a really sensitive skin. What product can I try that will help me?

Dr. Berger: Melasma is a very difficult problem... especially when you've unsuccessfully exhausted the topical formulations.
I'd like to know what percentages of hydroquinone you've tried, and how long you used each type.
Treatment today is generally a combination of preparing the skin with progressively stronger amounts of hydroquinone and then attacking the problem with CUTERA Genesis AND IPL lasers.
Let me stress the word "treatment". There is no actual "cure" for Melasma.
Treatment will be ongoing, and it is essential that you avoid sun exposure... use 45-60 SPF even to walk the dog... even when it's cloudy and raining.
If you are in the NY Metro area, I'd be delighted to discuss this problem in person. I understand how frustrating it can be.

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