Hyperpigmentation post Eczema

By Dr Vanita RattanFrom The Hyperpigmentation Clinic

What is Eczema?

• Eczema is a form of inflammation.• Symptoms include dry, red, itchy skin

sometimes with swelling. Flare ups happen intermittently. Therefore it has a chronic, relapsing natural course. However burnt out eczema often presents as dark patches of thickened skin which has had the abuse of topical steroids & chronic scratching.

• Most cases of eczema that develop Hyperpigmentation (Melanosis) occur early in childhood.

The current treatment advice is to:

1. Avoid irritants2. Moisturise 3. Apply short sharp bursts of mild topical

steroids

Typical cases

• At The Hyperpigmentation Clinic®, I typically see clients with Hyperpigmentation on the arms and legs after the acute eczema has burnt out. Predominantly in the flexural folds e.g. elbows & behind the knee.

• The pigmentation is generally widespread with no clear margins. In addition it has a grey-blue colour. Both these findings indicate that the location of this melanin is deep in the dermis.

• Clients tend to worry more about lower arms and lower legs as these are exposed and therefore more visible.

The Pathology

• The pathology is called Post Inflammatory Hyperpigmentation(PIH) or Melanosis.

• During a flare up, inflammatory mediators are released e.g. prostanoids and cytokines. These chemicals excite the Melanocytes (cells that produce the pigment melanin). This therefore increases the production of pigmentation.

The Pathology

• In addition the histamine released cause intense itching making the patient enter the itch –scratch vicious circle that leads to thickening (lichenification) & further darkening the skin. This is the reason for the bumpy dark blue grey skin seen on the arms & legs of long term sufferers.

• Pigmentation after Eczema is much more common in those with darker skins as the Melanocytes are larger & easily triggered. In white skins, erythema (redness) is more likely to be seen.

Treatment of Hyperpigmentation after Eczema

• Avoid the sun. In my experience those with Hyperpigmentation post eczema tend to wear long sleeve tops and trousers, so avoid the sun exacerbating Hyperpigmentation.

• Do not use steroid creams if possible. Steroid creams should be limited to one week use only as they thin the skin & promote long term Hyperpigmentation. Intense regular moisturising is the cornerstone of long term eczema management.

• The Hyperpigmentation Clinic® specialises in treating Hyperpigmentation in darker skin.

Our protocol for treating Hyperpigmentation post eczema in darker skin is as follows

A. Prime the skin .This strengthens the skin and gives it a uniform thickness. This avoids areas of thick skin interspersed with thin damaged skin caused by steroid abuse. The priming serum is a rich combination of Vitamins A, C, B3 (Niacinamide), E with plant based anti-oxidants Ferrulic acid, Rutin & green tea extract with a small amount of salicylic acid. This preparing of the skin is crucial in allowing uniform penetration of the Mask which is applied on treatment day.

B. Load the skin with vitamins to promote rapid post peel healing.

C. Lightenex Max Peel® is applied. This allows Tyrosinase inhibitors present to penetrate the skin and calm down the overactive Melanocytes. In addition the Mandelic acid & Salicylic acid cause the removal of these dark pigment loaded cells.

D. Post treatment creams are used to continue to calm down the Melanocytes & promote shedding of these dead cells.

E. Skin protection is provided to protect the new, young, healthy skin cells to grow.

Treatments to avoid in darker skins are:

1. Laser2. Glycolic peels3. TCA peels

• This is because the Melanocytes in dark skin are large & these treatments often lead to “hot spots” which later darken & manifest as Post Inflammatory Hyperpigmentation(PIH).

• For more information on Hyperpigmentation treatments in darker skin please visit TheHyperpigmentationClinic.com

• For more information on Hyperpigmentation treatments in darker skin please visit TheHyperpigmentationClinic.com

• We look forward to seeing you in the Clinic soon!