"Dr. Ciraldo, one big challenge for me is treating people with hyperpigmentation. Some people come in after seeing many doctors and after years on protocols like Obagi or TCA peels, without ever clearing. Have you got advice on how to give confidence to clients that I can really help them?" JD, Miami, FL 
Dr. Ciraldo's Answer….Here you go! 
Tips for Hyperpigmentation Management 
1. FIND OUT WHY: Get a good history of ethnic background and any new products, medications, or procedures that the person uses or had been using during the onset of the hyperpigmentation or for the six months prior to onset. 
2. BRING IN “THE BAG”: Many times these patients have used many things that could be a problem and they don’t realize it. Ask them to bring in a bag filled with all the products they use on their face and neck…this should include depilatories, fragrance they may spray on their necks, hair spray. Look for certain fragrances, like musk, which is notorious for staining skin; sodium lauryl sulfate, which can inflame skin and then cause pigmentation; and other possible irritants which could cause inflammation and/or photosensitivity. 
3. EXAMINE THE SKIN: Along with the history, a good skin exam can help to finally resolve even longstanding hyperpigmentation. For instance, many people diagnosed with melasma really have post-inflammatory hyperpigmentation (PIH) instead. If the correct diagnosis is really PIH, you have to clear the inflammation before you can get rid of the hyperpigmentation. Examples would be people who are experiencing lingering stains after acne breakouts or laser hair removal that leaves hyperpigmentation on the face. If the diagnosis is really staining after acne, you have to give the client a good at-home acne management regimen before you can resolve the hyperpigmentation problem. If you have difficulty identifying the cause(s) of the problem you can take a photo and email it to us at info@cosmedicaltechnologies.com and we will help you!!
4. DAILY REPLENISHING SPF 36 IS A MUST: Daly Replenishing Sunblock SPF 36 (even if the person comes to you, as they often do, using SPF 80 or more!)…the Zinc in the formula will calm the skin which helps with management of hyperpigmentation. This is a product that all people with hyperpigmentations should use. 
5. MANAGE MELANOGENESIS: The process that creates melanin (or pigment) in the skin can be triggered by both inflammation and hormones. There are numerous substances that help to reduce pigmentation in the whole process. Some of these tyrosinase-inhibiting ingredients include antioxidants such as Vitamin C (Ascorbic Acid) and Resorcinol (found in J-Peel). Our Ultra Benefits Moisturizer has broad-spectrum protection. Other ingredients that prove beneficial are retinol and 2% hydroquinone. 
Case presentation 
This woman had a two year history of hyperpigmentation that was diagnosed as melasma. She also complained of clogged pores and breakouts. She hadn’t responded to traditional regimens. Her before and after photos were taken 12 weeks apart. 
Here’s how she improved with CosMedical Technology products and peels: She was placed on the following at-home regimen: 
1. Salicylic Face and Body Wash: (2% Salicylic Cleanser): since excess pigment gets stored for weeks in the dead cells of the stratum corneum, this helps to lessen hyperpigmentation - and you’ll note it helped her pore appearance as well (am/pm) 
2. Dual Action Toner: to micro-exfoliate (am/pm) 
3. Vita-Soothe: this anti-oxidant hydrating serum brightens skin as it moisturizes. Vita-Soothe recreates skin’s protective barrier function to protect against environmental insults and therefore aids in preventing new hyperpigmentation (am/pm) 
4. Ultra Benefits: This twice-daily moisturizer with our proprietary ABF™ complex provides the only broad spectrum anti-oxidant coverage on the market, soy for skin lightening and three skin firming peptides (am/pm) 
5. Daily Replenishing SPF 30+: This physical sunblock contains 7.5% Zinc Oxide and 2.4% Titanium Dioxide to not only effectively block pigment-producing UVA but also to calm skin (am only)
In-Office Peels: She had a series of 70% CosMedical Glycolic Washes weekly or biweekly, depending on scheduling issues, for a total of six CosMedical peels. 
Other Important Information: 
She stopped her laser hair removal treatments since we determined that her real diagnosis was not melisma but PIH after laser hair removal; her hyperpigmentation coincided with the areas of laser hair removal which had been performed approximately three months prior to the onset of the hyperpigmentation. She continues to do well after the peels and is scheduled to have a maintenance peel every three months.
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