Question: My chest does not match my face. It’s discolored with brown, white and red patches. I’ve tried moisturizers with vitamin C, skin brighteners with Kojic acid and even broke down and bought hydroquinone to lighten the skin. Nothing worked. Do you have any suggestions?
Answer: I have received several very similar questions and I finally have a good answer. The Woman’s Dermatology Society arranged for me to interview Dr Tina Alster, the internationally acknowledged expert in laser dermatology to discuss the best way to deal with a discolored chest or decollete. According to Dr Alster, the technical term for the problem is poiklioderma. Caused by unprotected sun exposure, its a mash-up of hyperpigmentation ( brown spots), hypopigmentation ( white areas), swollen blood vessels ( reddened skin tones), and damaged collagen ( wrinkles). The UV rays can lead to this permanent bronzing.While a standard vacation suntan usually fades by the time you have unpacked, thus type of hyperpigmentation stays darkened throughout the year.
If the discolorations are fairly mild ( often seen under age 30), they may respond to a series of office based glycolic peels. This is not the milder 10% peels that you can buy at the cosmetics counter. These are the 50- 70% peels that are available in a doctor’s office. They are adminstered by a nurse and physician. This strong glycolic solution is dabbed on the chest and allowed to reamin for 5-10 minute. Then a neutralizer is applied to restore normal PH to the skin.
Lasers to the Rescue
More pronounced poiklioderma mottling responds beautifully to a series of Fraxel or IPL laser treatments. Because chest bronzing is made up of four different problems, Dr Alster uses the Fraxel Dual in two different wavelengths to treat both white and dark patches as well as encourage new collagen growth. To deal with the redness, Dr Alster may also use pulsed dye laser or IPL. Fraxel will leave the skin bright red and a little sore for 48 hours. Use a mild cleanser like Cetaphil and moisturizer like CeraVe to reduce discomfort and peeling. If the skin seems super dry you can dab on a light layer of Aquaphor. If the sorenss persists for more than 2 days, Alster may recommend a mild steroid cream to reduce inflammation. Whatever therapy is used, it must be accompanied by an iron bound committment to use a 50SPF sunscreen such as SkinCeuticals Physical Defense SPF50 for both the chest and neck. Freckles and dark spots have a powerful memory and unprotected sun exposure will trigger their return.