Pigmentation spots & melasma

Pigmentation spots reflect a localised excess of melanin, and cover distinct situations that it is important not to confuse: lentigines related to cumulative sun exposure, marks left by an inflammation or an acne lesion, and lastly melasma, whose origin combines hormonal, genetic and sun-related factors. My approach aims to understand the mechanism involved, the depth of the pigment and the phototype before envisaging the slightest procedure, for similar appearances may stem from different mechanisms. The means to which I have recourse are tried and tested techniques, when they are indicated: lasers or light sources targeting the pigment, chemical peels intended to depigment, topical care for preparation and maintenance, at all times underpinned by photoprotection.

Convinced that the appropriateness of a course of care is decided first of all in the examination, I begin the process with an analysis of the skin intended to characterise the spots and to assess the phototype, the exposure habits, the current treatments and the medical history. These elements, considered together, determine the choice of technique, the pace of the sessions and any prior preparation of the skin. Depending on the case, several sessions may be proposed and the protocol adjusted over the course of the follow-up. The duration of a session, their number and their spacing are specified in consultation, and cannot be set in advance in a general manner.

The areas most often concerned are the face, forehead, cheekbones and upper lip, as well as the décolleté and the back of the hands. Certain situations lead me to postpone a procedure, or even not to proceed with it: pregnancy or breastfeeding, recent tanning or planned sun exposure, the taking of photosensitising medicines, a history of healing disorders, olive or dark phototypes for which the risk of a pigmentary reaction must be weighed. Melasma also remains a chronic and recurrent condition, which I manage gradually with the aim of reducing its appearance and of limiting its flare-ups, though a definitive disappearance cannot be expected.

After-effects may occur following a session, redness, a sensation of heat, oedema, peeling or fine crusts depending on the technique used. Pigmentary reactions remain possible, in the form of post-inflammatory hyperpigmentation or of localised lightening, in particular on olive or dark skin. Strict sun avoidance and daily photoprotection form an integral part of the course of care, both before and after the sessions, and the care to be applied is explained in consultation. A prior consultation is mandatory: it allows the skin to be examined, information to be given on the techniques that may be envisaged and on their risks, and the conclusion to be reached, where appropriate, that no procedure is indicated.