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White Spots Hypopigmentation

White Spots Hypopigmentation Causes & Treatments

White Spots Hypopigmentation

Patient Y: Dr Sin, I noticed these white spots on my face after lasers from my previous doctor. What can I do about them?

Hypopigmentation spots, also known as white spots can occur usually months to years after excessively strong laser treatments. These white spot are where the melanocytes have been excessively damaged without a chance for them to heal up. Commonly, this can occur with the use of Q Switched Nd YAG lasers and also Pico Second lasers, those that mainly target melanin as a main chromophore target.

Common Causes of White Hypopigmentation Spots

  • Excessively frequent pigment toning lasers use
  • Overtly high powers used during pigment toning
  • If it occurs in conjunction with other body areas, sometimes it is part of a disease spectrum of vitiligo.
  • Alternatively, if it’s a relatively new and big white spot area without any history of other treatments, it may be important to have it looked at under a skin scope, to make sure it is not something had. Amelanotic melanoma can present as such.

These white spots of hyperpigmentation typically take between months to years before they start to show! Many times, they surface after 1-2 years of overtly frequent laser toning treatments!

Steps to Treating Hypopigmentation Spots

Step 1: Prevention is Key
Prevention of further damage to melanocytes (pigment-producing cells)
Avoidance of excessive pigment lasers on your skin.
Most of the time, the initial damage was done in trying to treat a particular region of pigmentation – common cases include that of melasma, solar lentigos. In a bid of achieving temporary clearance, high powers and overtly frequent treatment regimes are prescribed.
The key is to stop further damage as it can affect and worsen the region that has already been affected by hypopigmentation.

Step 2Various Therapies
Various therapies have been proposed for improvement. They can reap some improvement but only to a limited extent.
These therapies include the following:

  • RF Microneedling
  • Ablative CO2 Lasers
  • Excimer Laser
  • Phototherapy
  • Melanocytes transfer/ grafting

Step 3Expert Treatment
The importance of seeing a doctor who knows your skin condition and selects the best treatment available. 
There remains a wide range of selection of alternative treatment therapies such as R2 Glow Laser other than pigment targeting lasers to treat long standing conditions such as melasma.

Establish a long-term treatment plan with your doctor to understand the pros and cons of each treatment before beginning on it. It is always most important to avoid complications that are generally an uphill task to reverse.

Last Words
Know your doctor early before going for any treatment. Always seek a possible second opinion if needed.  

*Dr Sin Yong is a strong proponent of using lasers other than pigment lasers to aid in maintenance, which has very minimal risks of damaging melanocytes (black pigment producing cells), and delivering clear glowy skin. Always enquire if your treating doctor has specialized lasers for your skin condition rather than using a suboptimal laser setting for your skin! Unfortunately with the current treatments, the rate of improvements even with the above treatments for Hypopigmentation Spots are not as ideal. It is hence of utmost importance when choosing lasers for maintenance, to choose something with way lesser risks of hypopigmentation spots development!

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