This article is based on clinical experience.
Hello, I'm the face doctor.
The post on this blog is to give the right information about skin to a variety of people
I would like to inform you that it has been written based on numerous clinical experiences.
Today's post is about the differentiation and rough treatment guide for different types of pigmented lesions. Since pigmented lesions vary in treatment method and duration depending on their type and depth, determining the depth of the lesions and determining the treatment direction before treatment has a great impact on the prognosis. Here's an example.
In the case of freckles and melasma, the treatment method and duration are different. Freckles are pigments that are effective with just one treatment, and in the case of melasma, they need to be treated steadily at least 10 times to be treated without side effects. That is why it is very important to know exactly what lesions you have before starting treatment in setting treatment plans and directions.
Before we start talking about pigments, let's first talk about the biases that most people may have. People often think that dark pigments on the skin surface will be difficult to treat, but in most cases, dark pigments on the surface are easier to treat and faster than light deep pigments. It's often get much better even if you get just a treatment just once.
Let me give you an example to help you understand.
In the picture, the pigment itself looks severe on the girl on the above, but the pigments on the surface are easy to treat and work well so it can be brightened a lot with just one treatment.
(Young people before their 50s are more likely to relapse than those after their 50s.)
Rather, if you have a blurry, pale pigment like the woman in the picture below, or if you have a blurry pigment like you spilled coffee milk on your cheekbones, you should be treated slowly.
Deep layer pigments need various treatments combined, especially because it takes a long time to treat. First, you can think of taking medicine or regenerative injection treatments such as pdrn skin booster, which makes the skin layer stronger and makes pigment release smooth.
Now, let's talk about each lesion.
First, you can roughly divide the pigments into Melasma, feckles, blemishes, SK(seborrheic keratosis) , and Nevus of ota/ABNOM.
Melasma is pigmented lesion that is hazyly connected like clouds, and it takes a long time to treat, and it is not easy to treat, so various treatments may need to be performed at the same time. It usually occurs around the cheekbones. In addition, since it is affected by hormones and sunlight, spots tend to decrease when menopause occurs, but they can come back up as much as possible depending on sunlight or hormones.
Freckles (Ephelides) have a flat, uncluttered pattern and genetic characteristics that occur before elementary school. In the case of a biopsy of freckles, the number of melanin pigments itself is normal, but the production and delivery of melanin pigments are active due to high cell activity. Since the cause of freckles is epidermal melanocytic origin, the treatment method is "destruction", which can be very effective in a short number of times. However, you should know that freckle treatment is not a concept of rooting out, so it can recur as much as possible under the influence of sunlight.
Then, how can you distinguish between freckles and blemishes? Unlike freckles that appear from a young age, blemishes are caused by aging caused by DNA sun damage with age. Academically, blemishes are rare compared to freckles, which are relatively uniform and symmetrical, called solarentigo. The distinction between the naked eye is often ambiguous and the treatment method is almost similar to that of freckles, so I don't think the distinction is of much significance clinically.
In the case of seborrheic keratosis, there are cases where it is raised and observed flatly, but if it is raised, physical peeling treatment should be combined, such as CO2 treatment, and if it is not raised, it is difficult to distinguish it from the lentigo by the naked eye, and the treatment method is similar to that of the lentigo. Lastly, let me explain about Nevus of ota and ABNOM.
If you look at people with nevus of ota, you can see cases with bluish pigmented lesions, which often occur along the trigeminal nerve, so they usually appear on the cheekbones around the eyes and nose. Nevus of ota is characterized by being mostly innate and occurring on one side.
On the other hand, ABNOM is acquired and often bilateral, as indicated by ABNOM's full name, Acquired Bilateral Nevus of OTA-like Macule. Unlike Nevus of ota, which appears in a wide distribution pattern, ABNOM is round and rather difficult to distinguish from blemishes and freckles, so it may be considered that it can be easily treated like freckles. However since it is a spot with deeper melanocytes than blemishes and freckles, ABNOM should be treated separately from freckles and blemishes.
However, because various pigments are often mixed than if there is only one lesion, it is necessary to explain to the patient that the treatment method may vary depending on the depth of the pigments and select the type and intensity of the laser suitable for the type of the pigment.
Reference: 강원형 박사의 IPL 클리닉(강원형 저), 색소지도와 레이저치료 코스의 예측(김현근 저)