Medical facts vs myths
What stance must a dermatologist take on a complex issue that involves social/peer/ family pressure, ethics and safety of treatment?
Patients seeking advice for ‘fairness’ treatment fall into two categories:
■ Those seeking to lighten their innate complexion (i.e., the one they were born with)
■ Those seeking to lighten acquired pigmentation – this would include:
■ Specific ‘islands’ of excess pigmentation: These stand out from surrounding skin, such as melasma (the cheekbone pigmentation that commonly appears on the face of women during or after pregnancy), and post-inflammatory hyperpigmentation (wounds, scars and other lesions that heal with excess pigmentation).
■ Diffuse pigmentation of large areas of skin (tanning): Due to long hours outdoors without sun protection.
For those in category A, the simple truth is — if any product claims to be able to [lighten skin], at best it is more likely to simply lighten tans and even out the tone and complexion, with less likelihood of actual lightening of basic complexion; and at worst, it possibly contains ingredients that are in higher-than-allowed percentages, or that are outright banned (the so-called ‘industrial-strength bleaches’).
Those in category B do have genuine concerns.
As regards specific treatments, most dermatologists would commence treatment with simple topicals such as a low percentage hydroquinone or kojic acid, either solo or in combination with alpha hydroxy acids or tretinoin creams to effect some peeling and exfoliation to hasten the process.
The more stubborn the lesion and the deeper the pigmentation, the more aggressive the treatment such as microdermabrasion or even regular dermabrasion that can produce aesthetically pleasing results provided they are done correctly.
A more specific algorithmic approach that suits all cases will take up many more column inches. For now, what needs to be highlighted is: doctors can try and help reduce or even eliminate acquired pigmentation but not lighten an innately dark skin.
■ Dr Chandrashekhar has had over three decades of experience as a specialist dermatologist in Dubai.