A Decollete to Die For

QandA3Question: 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.

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