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Welcome to Skinside Out, where science meets beauty! In this episode, Dr. Zain is joined by Heather, Courtney, and Crystal to discuss hyperpigmentation—how to prevent it and the various treatment options available. Learn about the importance of sunscreen, the effectiveness of physical and chemical sunscreens, and sun-protective clothing. Discover the benefits of supplements like Heliocare and glutathione, topicals such as hydroquinone and vitamin C, and energy-based devices for treating hyperpigmentation. Tune in as the team provides insights into identifying the types of pigmentation, the role of combination therapy, and the importance of seeking professional dermatological advice. Don't miss this comprehensive guide to managing hyperpigmentation and achieving healthier, radiant skin!
00:00 Introduction to Hyperpigmentation
00:59 Importance of Sunscreen
03:24 Sun Protective Clothing and Supplements
08:11 Hormonal Therapy and Hyperpigmentation
10:50 Topical Treatments for Hyperpigmentation
16:33 Chemical Peels for Hyperpigmentation
18:20 The Importance of Conservative Treatment
20:40 Risks of Inexperienced Treatment
29:10 The Dangers of At-Home Treatments
30:58 Supplements and Final Thoughts
Creators and Guests
Host
Host
What is Skinside Out?
Welcome to Skinside Out, where science meets beauty, the ultimate dermatology podcast! Dive deep into the fascinating world of skin health with expert insights, evidence-based discussions, and myth-busting truths. Each episode explores the medical, cosmetic, and surgical aspects of dermatology, while keeping you informed about trending skincare topics. Whether you’re a skincare enthusiast, medical professional, or just curious about how to achieve your best skin, Skinside Out is your go-to resource for staying informed and inspired.
020 Skinside Out
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Dr. Zain Husain, MD: [00:00:00] Welcome to Skin Side Out Where Science Meets Beauty. I'm your host, Dr. Zane, with Heather, Courtney, and Crystal. So today we're gonna be discussing hyperpigmentation, the ways that we prevent it and treat it. . This is piggybacking on our last discussion on the causes of hyperpigmentation and how to identify them.
So let's dive right in. So [00:01:00] Heather, what can we do to prevent hyperpigmentation,
Heather Murray, PA-C: sunscreen? Um, I think sunscreen is the biggest thing that you can do to help protect your skin. Um, the higher the sunscreen, the better. I mean, you do want something SPF 30 or higher, but, um, to kind of give you an idea, so like a mineral-based sunscreen that's SPF 30, um, 97% of the UV rays are being blocked by that sunscreen.
Whereas if you're using PF 50, 99% of those UV rays are being blocked. So it does make a difference. The higher the better.
Dr. Zain Husain, MD: Yeah. And what about the thought that you know, since you're blocking 99% with S SPF 50, does it really matter to go to a higher SPF
Heather Murray, PA-C: higher than
Dr. Zain Husain, MD: 50 than SPF 50?
Heather Murray, PA-C: I don't know. I mean, is a block with a hundred that I don't know.
Dr. Zain Husain, MD: So the the interesting thing is, is that we have found in studies that people do not apply enough of the sunscreen. Yeah. Think that's the biggest [00:02:00] problem. I think get the actual SPF protection. Like if people actually applied it the way that they're supposed to properly, you do get that, you know, SPF protection and
Heather Murray, PA-C: reapply.
Dr. Zain Husain, MD: Mm-hmm. But people are not doing that, so that's why I do think it's helpful to have a higher SPF. You have more of that physical barrier from that zinc oxide, but you know, because in real life application, people are not applying enough of it. So maybe you are applying an SPF 100, you're still applying it pretty poorly.
Yeah. But you're still getting a little bit more protection than applying a poorly. Um, the using an a poorly applied like SPF 50.
Crystal: Yeah. I read somewhere that they recommended a shot glass. For the body. For the body.
riverside_episode_1_raw-synced-video-cfr_skinside_out_0020: I don't,
Crystal: two finger
riverside_episode_1_raw-synced-video-cfr_skinside_out_0020: lengths for the
Heather Murray, PA-C: face.
Crystal: Yep. No, I'm like, I'm like a liquor bottle. Like I feel like I go to the pool, I'm like white.
Like I am Like covered. Covered. Well that one
Heather Murray, PA-C: time we did IPL and I started putting sunscreen on and you were like, why are you putting so much on? And I'm like, this is how much you need. You lied.
Courtney Carroll, LE: You're a liar. What about [00:03:00] the people that will put all the sunscreen on and they immediately like jump in the pool?
Oh yeah.
Dr. Zain Husain, MD: Yeah. So you do have to watch out for that. Um, because especially
Heather Murray, PA-C: chemical sunscreens, because they, because they take like 15 minutes to start working.
Dr. Zain Husain, MD: Yeah, that's right. So with physical sunscreens, those that contain zinc or titanium, they're immediately active. It's the chemical ones that you have to put on at least 15 minutes before for optimal, you know, prevention.
Crystal: I think Sun Protective clothing is definitely the way to go. I love it. So easy. You don't have to reapply. It's protective. I mean, you know, you have your SPF shirts, you can get, um, hats, um, all different kinds of garment. They make cute little, um, like coverups now. I mean, they, like, they have everything.
So I feel like the SPF clothing is much more easy to abide to.
Heather Murray, PA-C: I've been meaning to research this, but does anybody know if the UPF degrades with the number of washes that you. Wash that piece of clothing.
Dr. Zain Husain, MD: I've heard [00:04:00] that it retains its integrity over a long number of washes. Okay. So that's a good question.
But yeah, I've heard that they're pretty robust. Nice. Especially the higher quality. Yeah, I was gonna say in UPF clothing.
Crystal: Yeah, yeah, yeah. Um, so yeah, I think those are definitely, um. You should be doing that every day. But there are some supplements too that um, I think also are extremely helpful. Um, so, um, you might've heard of Heliocare, which is the Holly Podium, Lakos.
I always forget to put, I always just wanna. Jump into the nucleus. Yeah. Um, but these are actually supplements you can take. It's derived from a fern, so it is vegan, um, organic. Um, but they basically help, um, prevent, so you use them in conjunction with sunscreen, but you can take these daily, some people just take them when they know they're out at the beach or the pool or whatever, but um, it actually helps to kind of block that sun, um, damage from occurring and.
The studies [00:05:00] on it are really interesting and it shows really how effective it it is. Um, you know, so anyone that has any like photosensitivity or, you know, talking about this hyperpigmentation, I think it's extremely beneficial.
Dr. Zain Husain, MD: Yeah, I actually put most of my hyperpigmentation patients, especially my melasma patients on the supplement as part of their protocol.
Um, I do think that it adds additional protection. Um, and there. Aren't any real side effects with it. There's really no harm to it. So I've been pretty impressed with the results and patients do notice a difference. Mm-hmm. So it's a, it's a pretty cool supplement.
Crystal: Yeah. My patient came back, um, I had put her on it like last month, and she was like, I went to the beach and I didn't burn.
Like, I'm so, oh my God. What
Dr. Zain Husain, MD: a concept.
Crystal: I know. I was like, yeah, you shouldn't be burning.
Heather Murray, PA-C: Yeah. They can also pair it too with, um, niacinamide, which is a mm-hmm. A natural, um, skin protectant too. It's not gonna replace sunscreen by any means, but yeah.
Crystal: I think both of that, you know, being [00:06:00] said, I, you know, sometimes I do worry about like, um, specifically like my melasma patients.
I used to see this one woman at my previous practice who would come in for her appointments, um, with a huge sun hat. She'd be wearing gloves. She had like a, this is before Covid, like she'd have a mask on. I mean, she was like. Hmm, really, um, covered up because she did not want to risk it. And you know, at some point I'm like, I want you to go live your life Uhhuh.
Like, you know, I don't want you to be scared of the sun. I don't want you to like live in this like draping for your whole life. So it is kind of that delicate balance of like doing the best that you can, but also like being able to have fun and like. Do things too, you know? Have you seen, well, there,
Courtney Carroll, LE: oh, go ahead.
There's people that think that they don't need to put anything on 'cause they're, you know, there's a lot of patients that I've seen or come across where they come in and they're just like, oh no, I don't need any sunscreen. I don't go anywhere. Yeah. You know, but
Dr. Zain Husain, MD: I work from home. Yeah.
Heather Murray, PA-C: What are your thoughts on the.
UV visors. Have you guys seen those where you like pull 'em down on your face? They're really
Dr. Zain Husain, MD: big in [00:07:00] Asia. They are? Yeah. Yeah. I think they're kind of cool. Like a beekeeper?
Crystal: Yeah, yeah. Kind of.
Dr. Zain Husain, MD: Yeah. Oh, they're wild. It looks like
Heather Murray, PA-C: a hat, but it comes all the way down and blocks your entire, it's intense. Entire face.
It's intense. Yeah.
Dr. Zain Husain, MD: Oh, wow. They're kind of cool though. Yeah. Some of them are like reflective and they kind of look shiny and Yeah.
Crystal: We're gonna get one for Dr. Zane for his birthday.
Dr. Zain Husain, MD: I'm going to brand it with my,
Crystal: yeah,
Courtney Carroll, LE: it's, it needs to be gold.
Crystal: Yeah. It needs to reflect gold. Yeah. I think they're all, I, I definitely get the, um.
The emotion behind it, but I don't know. At some point it's like, can you breathe in that like, you know, like, well, yeah, I'm that open.
riverside_episode_1_raw-synced-video-cfr_skinside_out_0020: It's like mesh kind of, right? Yeah.
Dr. Zain Husain, MD: No, I think that's like, it's like
riverside_episode_1_raw-synced-video-cfr_skinside_out_0020: it's, it looks like a reflective like visor. Yeah. Feel like I'd get so hot. Humidity. Yeah. Like what about your like,
Courtney Carroll, LE: like hot breath, like about your hair, you know, like does it like get, you know, is like foggy in there?
I think
Dr. Zain Husain, MD: we're gonna have to do an experiment. We're gonna have to buy one and Yes, we're gonna have to try it out. Yeah. And then we'll video tape our experience.
riverside_episode_1_raw-synced-video-cfr_skinside_out_0020: I'm [00:08:00] gonna walk
Dr. Zain Husain, MD: around my office and,
um, so yes, sun protection. Is huge. Um, and we're big proponents of that in our office. Um, what about for our melasma patients who are on hormonal therapy like birth control or HRT? What can we do to help those patients? I mean, a lot of them are on them for, you know, medical reasons.
Heather Murray, PA-C: I think some of the treatments that we'll get into, especially like the oral ones.
Mm-hmm. Um, like I'll just mention, tranexamic acid I think works really well, but I think just knowing that sometimes those. Hormonal components do play a role, and especially like if you're planning on getting off of birth control soon. Mm-hmm. It could flare because your body is used to that exogenous or that kind of outside hormone being used.
Um, so I think just, I think prepping the patient too is very important.
Dr. Zain Husain, MD: Mm-hmm. [00:09:00] And then combination therapy, we're gonna get into that. Um, topicals, orals, and, you know, even devices and lasers. So. Um, those can kind of help those tricky patients who are on these medications for medical indications and that can't necessarily come off of them.
And unfortunately they're kind of in a bind. 'cause a lot of what we want to offer is just not compatible with, you know, their other medical therapy.
Courtney Carroll, LE: A lot of times they don't know. They just think there's like just a one and done type of treatment and they need more than that.
Dr. Zain Husain, MD: Yeah, me's very tricky.
Heather Murray, PA-C: I think too, especially because the, the pigment is deep within the skin, it's gonna take time for that to mm-hmm.
Kind of be resurfaced, I guess.
Dr. Zain Husain, MD: Yeah. And it may require long-term therapy. It's not like, oh, we gotta clear and then it's done. Mm-hmm. You know, oftentimes it requires months and months of therapy and, you know, it may [00:10:00] even be years. So it's just very case by case. Every patient's different. So that's why partnering with, you know, your dermatologist and their team, um, is very helpful.
Crystal: Yeah. And seeing someone that knows, you know, about the different conditions, I think to the untrained eye pigmentation just looks like pigmentation. Um, so it's important to kind of have someone that knows. What specific type of pigmentation you're dealing with, and then what the best way to treat that is, because you know as we'll go into with some of the energy based devices.
Mm-hmm. Mm-hmm. There are some forms of hyperpigmentation that yes, are safe to use a laser on, but then there are some like melasma that okay, now you have to be more careful about what you're using. So being able to differentiate is really important. Mm-hmm.
Dr. Zain Husain, MD: All right, so let's dive into the different types of treatments for me, asthma and other forms of hyperpigmentation.
So I always like starting off with conservative therapy, so the topicals. So what are some of our favorite topicals to kind of use for these hyperpigmentation patients? I. [00:11:00]
Heather Murray, PA-C: Hydroquinone is probably the gold standard hq. Yes, HQ for sure. Um, and how does
Dr. Zain Husain, MD: it work?
Heather Murray, PA-C: So it's actually like a bleaching agent. It targets that excess pigment, um, likely kind of mentioned previously.
It's not something that you wanna do forever. Um, it, you do have to take a break from it. Um, and the nice thing though is while you're taking a break from hydroquinone, there are other things that you can do during that time, or you can even do things in conjunction with hydroquinone. So there are other kind of brightening agents that we use topically.
So there's ascorbic acid or vitamin C, there's koic acid, arbutin, um, licorice, root extract, lactic acid, a lot of different things. And I think they all work very differently. Um, so doing a mix of these can really be beneficial.
Dr. Zain Husain, MD: Yeah. Um, it's interesting, a lot of these different, um, molecules inhibit the [00:12:00] pigment production pathway by blocking, um, some of the key enzymes, tyrosinase being one of them.
So like HQ for instance, blocks that, um, it blocks the precursors from turning into melanin, which is needed for that pigment. So, um, and there's different path there's different steps to that pathway. Different molecules kind of interact with, so that's why combination therapy is sometimes very helpful because it's kind of hitting that pathway in multiple ways.
Heather Murray, PA-C: Yeah. Going back to vitamin C two. Mm-hmm. I think it really depends on what vitamin C you're using. Mm-hmm. Because vitamin C is very unstable, so you, depending on what product you're using, if it's got like a. Clear glass bottle. If it's getting sun exposure to that liquid or that vitamin C serum, um, you can degrade or oxidize that vitamin C very quickly.
So you want to use [00:13:00] something ideally that's in like an airless pump or something that is a little bit more shelf stable, but a lot of the more stable ones could be irritating. So yeah. Um. There's, I think at least three types of vitamin C. Mm-hmm. And each has their pros and cons.
Dr. Zain Husain, MD: I mean, for the aestheticians here, what are your thoughts on, you know, the quality of the vitamin C serum and are you paying for what you get for
Crystal: Oh, absolutely.
Yeah. I think, um, you know, going off what Heather said, there are a lot of vitamin Cs that are unstable. I mean, even, um. You know, not to hate on specific brands, um, but there are some that you can even see the color change, like while you're using it. Mm-hmm. You know, you get it and maybe it's that kind of clearish liquid a month down the road, it's turning into that orange, uh mm-hmm.
Coloration. So I think even, you know, with that being said, um. My favorite brand personally, is the skin better? Um, Alto, I think it's a very stable, and [00:14:00] in fact they actually use THD, which is, um, a vitamin C derived from a plant in Australia. Mm-hmm. And so it's a lot more stable than the ascorbic acid. But I think a lot of times, you know, even over the counter, vitamin Cs are so expensive.
So I tell my patients, if you are gonna splurge on a product, like I'll cheapen out on a mo. I love a LAROCHE Poe moisturizer. Okay. I love a laroche cleanser. There are things that yeah, we can get away with, but a vitamin CI tell them, I think, think, yeah,
Dr. Zain Husain, MD: you don't, you don't skimp on that. You don't skip on your retinol.
Yeah. Yeah. And you don't skimp on sunscreen sun.
Courtney Carroll, LE: Yeah. What are your thoughts on those that have an allergy to vitamin C, such as myself?
Dr. Zain Husain, MD: So you have a true allergy. I don't know what happens.
Courtney Carroll, LE: I always break. Maybe oranges.
Dr. Zain Husain, MD: You break, so
Courtney Carroll, LE: you break out. Acne is in these little tiny bumps. Is it vitamin E?
Heather Murray, PA-C: Do you pair it with vitamin E?
No.
Dr. Zain Husain, MD: Which vitamin C was it?
Courtney Carroll, LE: Um, the vitamin C from skin Better. Oh, it was alto. Yeah.
Crystal: They do have, I think, 18 other antioxidants. So it could be
Courtney Carroll, LE: something. I just get all these little tiny baby [00:15:00] bumps.
Crystal: Some people do have sensitivity. If I used to work with a provider,
Dr. Zain Husain, MD: it could happen. It could happen with any product.
So there might be a small subset of patients who, you know, develop an allergy to any given product. Um, but in general, the molecules that are stabilized with other antioxidants, you also have to be careful about which ones you use for which skin types. Mm-hmm. Like some that have a vitamin E in it tend to be a lot more oily, can break people out.
Eye breakout from SkinCeutical ce, like mm-hmm. Crazy. Like I start getting acting like the next day to the clouds. My pos, I'm gonna
Courtney Carroll, LE: try nors, vitamin C and I'll get back to you. Good stuff.
Crystal: I love, um, retinoids too for, um, our patients with hyperpigmentation. I mean retinoids, I feel like across the anything Yeah.
Use a retinoid liquid gold. Yeah. Like good gold. Um, but yeah, I mean you're, you're using these other ingredients. I think the retinoid number one helps the ingredients penetrate better. Um, and then it's helping to increase that cellular turnover. So I think [00:16:00] really. It should be used in conjunction with a lot of these other topicals.
Heather Murray, PA-C: Yeah. Um, another one, tranexamic acid, which I briefly mentioned, but it does come in a topical form too. Mm-hmm. Um, I think works really well just in partnership with a lot of these other ones. And you can take that one orally as well. Yeah.
Dr. Zain Husain, MD: I love the alpha and beta hydroxy acids. Um, they help to brighten the skin, help exfoliation as well to help our melasma patients.
Crystal: Those are gonna be, yeah, your glycolic acid, your salicylic acid, um, lactic acid. Mm-hmm. Those effect.
Dr. Zain Husain, MD: Yeah. Mm-hmm. And similarly, like, you know, we use a lot of those acids for chemical peels. Mm-hmm. So I know you guys perform a lot of chemical peels. What are your favorites for, you know, hyperpigmentation?
Crystal: I love T-C-A-T-C-A growing. Everybody seems to love TCA pills, Chlor acetic acid. They're calling for those. Yeah. Yeah. People love the, love the TCA pills, they, they work really well. Um, you know, I think going back to what Dr. Zane had mentioned earlier, it's um. Unfortunately it's [00:17:00] not one peel and done. I mean, these, you've, you know, you gotta think you're taking sometimes months or years of accumulated inflammation and sun damage and, you know, so it is gonna take time to correct that.
But that being said, I do think, um, you know, patients start noticing results, um, sometimes as quickly as the first peel. Mm-hmm. Um, I tend to notice the second peel, I think does a little bit better. Once we've gotten some of that like surface pigment, we're really able to like get into the skin and kind of bring that out and.
Um, get it cleared. So typically we recommend anywhere from three to six for chemical peels, um, for, you know, glycolic peels or salicylic acid, which are gonna be more of your superficial peels. I tend to use those more as like maintenance. Mm-hmm. So when I've kind of cleared someone up with our, our TCA peels and maybe throughout the summer we're just doing a mild superficial peel to keep things at bay.
Um, but I think glycolics are great, but for my more moderate to severe, um, hyperpigmentation patients, I don't tend to start there.
Courtney Carroll, LE: And it does still work even if you don't peel. Yes, I know that. I get it [00:18:00] drives me crazy. They'll get phone calls and they're like, I'm not peeling. I, I, I don't, I don't think it's working.
I'm like, it is. It does. It's working. I know. I almost don't
Crystal: call. Yeah. I almost don't even call salicylic and glycolic peels, like peels anymore. I almost say like chemical treatments because. The perception is that I will be peeling and if I'm not peeling, it's not working. Exactly. Exactly. They tend not to peel.
Mm-hmm. And then
Dr. Zain Husain, MD: we always start off conservative, especially for new patients, new appeals. You don't wanna start off with a very high potency concentrated chemical peel because we don't know how your skin's gonna react, right? Mm-hmm. So we wanna take measured steps that are safe. And effective, because the worst thing that can happen is you have a bad reaction with the peels.
Too strong leads to more hyperpigmentation. Right. And then you're in a worse position than when you're, when you first came,
Heather Murray, PA-C: especially first skin of color. We often pretreat with hydroquinone. Yeah. Just help minimize that risk.
Dr. Zain Husain, MD: Definitely. But
Courtney Carroll, LE: there's a lot of people that are of color that don't think they can get chemical peels and they can.
Mm-hmm. Mm-hmm. Yeah. Yeah.
Dr. Zain Husain, MD: I love chemical peels. Um, I think they work really well. [00:19:00] I will admit that, you know, when I was a medical student, I would order them on Amazon. Oh my
Crystal: God. He's no better than the people. Well,
Dr. Zain Husain, MD: well, I mean, I saw what my dermatologist did for me. I looked at the bottle and I just ordered Amazon.
Yeah, you looked at bottle
Crystal: the seller like who's selling it? Like
Dr. Zain Husain, MD: who knows? But I, I've learned my, I learned from those days. But yeah, skin of color can definitely benefit. All skin types can benefit. Mm-hmm. From chemical peels, just with the right counseling and the right, you know, precautions, um, you can get beautiful results with it.
Crystal: Yeah. And I like pairing, um, chemical peels. I like alternating treatments. I have found that alternating treatments has been. One of the best things that people can do in regards to treatment? I think just having, like you said, different mechanisms of action working like synergistically to mm-hmm. Create the best outcome.
I just find, um, you know, like for example, the LA md, which is a laser that we offer for our melasma patients, [00:20:00] which you might be thinking, wait a minute, you don't treat me plasma with a laser. But, you know, but that's why you, you do have. Specific lasers, um, like the Laser MD that doesn't have the same heat that some other lasers have that is safe for all skin types.
And again, we do start conservatively, um, you know, with the amount of JUULs or the power that we're using on the laser and kind of increase each time. But I find that, um, alternating with the chemical peels has been really effective. Yeah.
Heather Murray, PA-C: I think in our last episode too, we kind of talked about the different types of hyperpigmentation.
Um, specifically, um, what I'm trying to get at is like sunspots versus melasma, and yes, you can have both. Mm-hmm. And I think that's super important. You know, you do wanna make sure you're going to somebody who, um, knows the difference because if there is a great treatment for sunspots called IPL. It will worsen your melasma.
So if you do have both, you wanna make sure that you're getting the right treatment.
Dr. Zain Husain, MD: Yeah. And you know, also pigmented spots, they may be [00:21:00] more than that. They might be skin cancer. Oh yeah. Mm-hmm. And there have been multiple times I've heard of, oh, I went to this med spot and they were treating me with this laser, and it just won't get better.
And it keeps getting bigger. And they've been treating like a melanoma.
Crystal: Yeah. Yeah. With
Dr. Zain Husain, MD: laser. For years. Yeah. And yeah, I actually had a patient, like, who had literally a melanoma on her cheek. She's like, oh yeah, I went to the, you know, the, the dermatologist, um, or like the spa. And I was getting it treated with a laser.
Um, and yeah, it ended up being a melanoma and huge case to reconstruct her entire phase at a giant flap. And you know, it goes to show you like, you know, she was being seen in a med spa and you know, it was treated inappropriately with a laser. So you have to be able to distinguish between. Different types of lesions on the skin and you know, it can have fatal consequences.
Heather Murray, PA-C: Yeah. Melanoma in situ, um, used to be called lentigo malignant. [00:22:00] And so to kind of break that down, sunspots, the medical term is lenti. One single leny is called a lentigo. So if you have lentigo malign, lentigo malignant, that is. Pretty much melanoma. And so having that kind of spectrum of hyperpigmented spots or lesions really makes it very, um, risky to go somewhere that may not know the difference.
Crystal: And we've seen, like, man, we have seen those spots that like. You ask yourself, you ask the what made you biopsy, that it literally looks like a freckle, like a smeared freckle, like something that is not very, um, you know, we always talk about the ugly duckling mole, but something that's very like incognito.
So yeah, just to speak to that. I mean, it's not, your melanoma is not always gonna be this classic black and red bra, you know? It's, yeah. It's very scary. Some of the scarier ones are very discreet.
Dr. Zain Husain, MD: [00:23:00] Yeah. But even some of the obvious ones, just in inexperienced hands, like mm-hmm. Like it's screaming melanoma and badness.
Mm-hmm. Skin cancer. Mm-hmm. And they're still treating it. Oh, ladi da. I'm like, because they don't
Courtney Carroll, LE: know. They have no idea. I
Dr. Zain Husain, MD: mean, you used to be a manager of the med spa, like how much formal training did some of these staff have? She said, don't
Courtney Carroll, LE: get me started. I know. I mean, I'm like, don't get me started because I, again, they're just the, in a med spot, the focus really isn't.
Skincare, if I'm being honest, the focus is all just making money and selling. Um, so I mean. Again, from a manager's perspective, I know firsthand that there's people that have come in and they're supposed to get training and they haven't got training, and I haven't been able to get the approval for somebody come in for training and they don't have that much knowledge.
Um, but we're just winging it, you know? Yeah. And that's scary. It's like the,
Dr. Zain Husain, MD: yeah. How often do you [00:24:00] hear of, um, you know, those providers referring out to a dermatologist that ever happen?
Courtney Carroll, LE: I have seen it. You know, there are those people that are good about saying that, but then there are those people that are just like, no, no, yeah, we're just gonna try this for fun and see what happens.
You know, and then it goes left. Yeah. I think
Heather Murray, PA-C: there's, especially in dermatology, there is, um, not a fine line between medical and cosmetic for some places, and so, mm-hmm. I think a lot of med spas see skin as. Camping and cosmetic. Yes. And it's not unfortunately.
Dr. Zain Husain, MD: Yeah. And unfortunately it has consequences.
Heather Murray, PA-C: Yeah.
Dr. Zain Husain, MD: And patients can get harmed and you know, it makes me so angry when I hear about these kind of cases that patients were mismanaged. Um,
Courtney Carroll, LE: I think that. Just over time I've learned, or my advice would be if you think that something is [00:25:00] off. Mm-hmm. I wouldn't go directly to a med spa. I would definitely strongly consider going to a dermatologist.
'cause you're gonna get, I. Checked out
Crystal: better. You should be getting your skin checks anyways yearly. Um, and yeah, if there's something concerning,
Courtney Carroll, LE: I didn't even know. I didn't even know anything about a skin check until I started getting into dermatology, you know? So
Dr. Zain Husain, MD: yeah, it's a different focus. It's, yeah.
Crystal: So, um, other, just to kind of piggyback on that too, um, with spots. That are being treated that sometimes can look like other spots. So, um, we do offer IPLI know at our office too for some of that like post-inflammatory hyperpigmentation. Um, specific, specifically recently I've been using it for my lighter skin types.
Of course. Um, you have more of like the post-inflammatory erythema. Mm-hmm. For like acne. It looks really well. For acne. It's been working really well. Um, again, that's where you wanna differentiate, you know, the, you know, skin type. Mm-hmm. Um, what type of pigment you're, you're treating. Um, but the IPL can [00:26:00] treat the sunspots really well.
Yeah. Um, and it can also help treat some of the post-inflammatory erythema.
Dr. Zain Husain, MD: Yeah. But you have to be very careful with IPL and any of these laser technologies. They have heat and light, which are both potential triggers for melasma and hyperpigmentation. Mm-hmm. So you just have to be very mindful of that.
Many of the lasers I do not recommend for my melasma patients. Um, and some of my hyperpigmentation patients, it's just not appropriate based on their skin type and their condition. However, there are some technologies that are safe, but they have to be used in a safe manner. So that is also operator dependent.
Mm-hmm. Knowing what energy settings to use. Mm-hmm. How many passes, how aggressive to go, how slowly to increment, um, you know, the treatment options. So, you know, I really do love the 1927 nanometer DUM lasers, the fractional non-ablative lasers to gently kind of break up that pigment. Try to help improve the hyperpigmentation, either from melasma or [00:27:00] other sources, and it works nicely, but you have to be patient.
It takes longer because you don't want to crank it up. Because you can actually worsen that melasma or hyperpigmentation. Mm-hmm.
Crystal: That's what I was gonna say. You know, you really wanna trust your provider. Like I know for a lot of these patients, it's incredibly frustrating. Um, you know, they want it gone like tomorrow.
Mm-hmm.
riverside_episode_1_raw-synced-video-cfr_skinside_out_0020: And
Crystal: you know, a lot of the times I'll have patients come to me that wanna start it like a deeper peel. Um, you know, I've never seen their skin, or maybe they're not pre-treating or things like that. And. You really do wanna do it the safe way because again, you're gonna limit your, um, the money being spent in the long run.
Um, you wanna make sure that, you know, you're not getting burnt or having any of these other complications that can happen. And so, I know sometimes people tend to get, you know, ready to go. Mm-hmm. They're like, well, I want this, gimme the strongest setting, or gimme the strongest peel. And I'm like, whoa, whoa, whoa, buddy.
Hold your horses. Let's do it the safe way. Um, and that's where I think also like. Um, just getting into kind of like the aftercare, like taking pictures, um, is really important because [00:28:00] sometimes you're not able to really track that progress when, you know, when you're seeing yourself in the mirror every single day.
It's hard to say, oh, I see a drastic difference, but pictures can really be very telling, um, and show you how much progress you've made.
Dr. Zain Husain, MD: Yeah. And it may take a long time mm-hmm. To see that progress and you shouldn't be upset with. You're treating provider for taking it slow. They're doing it for your safety.
I am conservative and I like being conservative because I don't get into trouble that way, and I know how my patient's skin is reacting and we're not causing more problems. My first. My first priority is patient safety, do no harm. So that's really important.
Courtney Carroll, LE: I'd rather go to a provider that's gonna tell me no, like, I don't recommend that and I'm not gonna do that.
'cause they actually care. I mean, it's, it's pretty similar to, you know, going to a hair salon and being like, well, hey, my hair is black, but I wanna be platinum blonde overnight. Yeah. My hair's gonna fall off if somebody tries to do that. Yeah. [00:29:00] You know, and having that person be like, no, we're gonna take our time.
Yeah. To get there. It's insane. Yeah.
Dr. Zain Husain, MD: Slow and steady. Mm-hmm. Yeah.
Crystal: Also, um, you know, just. Avoiding some of these at home treatments. Yeah. Um, if I hear, I had a patient ask me recently and like I, this is not the first time I've, um, heard this, but about like the lemon, like using lemons at home.
Courtney Carroll, LE: I've
riverside_episode_1_raw-synced-video-cfr_skinside_out_0020: seen that people use
Heather Murray, PA-C: in their hair to get like natural highlights. Highlights. I've never, I have not seen anybody use it on their face, but, oh, I had a, well, I think they
Dr. Zain Husain, MD: have vitamin C, right?
Heather Murray, PA-C: Yeah, I guess so.
Crystal: Yeah. Well, I had a patient, pure vitamin C, a Hispanic lady, and she was asking for her mom. She said, oh my, well, she said her mom had used that. Like and still uses it. And I said, tell your mom to stop that and get her some vitamin C for mother's day.
Dr. Zain Husain, MD: Well, there is a patient that I had who was doing this and they went out in the sun.
Crystal: Oh yeah.
Dr. Zain Husain, MD: And there is a rash called Phyto photodermatitis where you're getting like these [00:30:00] blistering, streaky, um, you know, bouts of hyperpigmentation, um, from a reaction due to one of the chemicals in citrus. So not cute. It's such an
Heather Murray, PA-C: interesting. Condition, and I would never wish it on anybody, but it's very fascinating to see.
Like, I've even seen somebody went to Mexico and had a lot of, um, margaritas with limes. Mm-hmm. And they had like fingerprints on their legs from where they wiped off their fingers with that vitamin C. So it can make, I
Dr. Zain Husain, MD: love making that diagnosis because to me it's like super, nobody expects it. They're like, wait a minute, on vacation, did you go on a, a cruise?
Why
Crystal: Yeah. It's like the light bulb goes off and they're like, oh my, they think you're like the greatest person on earth.
Yeah.
Dr. Zain Husain, MD: Yeah. So we've talked about topical treatments, we've talked about the oral tranexamic acid. We talked about energy based devices and lasers. What other options do we have?
Heather Murray, PA-C: I think [00:31:00] supplements, like, um, there's some multivitamins that can help improve the, um. Or even out the skin tone. I think glutathione is a, a huge one.
So glutathione, we might have mentioned this before, but it's an, an antioxidant produced by your liver and that helps to even out the skin tone. But as you get older, your liver produces less of it. So having that, whether it's, you know, an injection of glutathione or, or. In an iv, um, can make a big difference.
It doesn't really get absorbed very well if you take it orally. Um, but I have heard that it, it, some people do.
Crystal: Maybe that's why they call them liver spots. I. Yeah, maybe.
Dr. Zain Husain, MD: Alright, Courtney, on that note. Um, so we talked a lot about the types of hyperpigmentation and their causes. In this episode, we focused on prevention and treatment.
I think [00:32:00] that the biggest take home points are, you know, first sun protection. I think that's huge, preventing the problem. And then also when you do have the hyperpigmentation, protecting your skin is huge. Um, there are a variety of treatment options available. Topical, um, you know, you have your oral and your energy based devices, um, and you even have supplements to help out.
And sometimes requires combination therapy, and that's what I found the most success with. It's not one treatment that typically gets the best result. It is using multiple treatments together to really optimize a treatment. And it sometimes takes a long time. So I know that hyperpigmentation is frustrating, but seeing your board certified dermatologist and their team is really important so you can identify the cause and then the proper treatment so that you can get better soon.
Okay, well hopefully you guys enjoyed this episode. Please like and subscribe and until next time, skin side out.
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