Skincare Case 108

This is a case of a 29-year-old female with Fitzpatrick skin type III and normal skin type, presenting with dark spots on her face. Upon examination, there are scattered hyperpigmentations on her cheeks with a few pimples present. There are no signs of pustules or cysts at the moment. Her history includes acne since her teenage years and considerable personal emotional and work-related stress. Her menstrual cycle is normal. She has tried various homemade and over-the-counter treatments, and has a history of using prescription medicine. Her current home care routine involves using a gel cleanser and sunscreen in the morning and a gel cleanser every day and adapalene twice a week in the evening.

Causes

The main cause for her hyperpigmentation (dark spots) is post-inflammatory hyperpigmentation (PIH), a common aftermath of acne. PIH is a result of an overproduction of melanin or an irregular dispersion of pigment following skin inflammation or injury.

The presence of acne is likely due to a combination of factors including hormonal changes (which can still be present even with a normal menstrual cycle), excess sebum production, inflammation, and Propionibacterium acnes bacteria. Stress can also exacerbate acne, and it appears that she has significant personal and work-related stress.

What is Done Wrong

1. Lack of targeted treatment for hyperpigmentation: While her skincare routine includes a gel cleanser and sunscreen, and adapalene (a retinoid that can help with acne), there’s no specific product aimed at reducing hyperpigmentation.
2. Inadequate stress management: Given that stress can exacerbate skin conditions such as acne, it seems that there may be inadequate management of stress in her case.
3. Possibly inconsistent or incorrect use of treatments: The patient has a history of using various homemade, over-the-counter, and prescription treatments. However, it’s unclear how consistently or correctly these were used, which could affect their efficacy.

Office and Home Treatment Options

Office treatments:

1. Chemical peels: Lighter peels like glycolic or salicylic acid can help with acne and hyperpigmentation.
2. Laser therapy: Laser treatments can be effective in reducing hyperpigmentation.
3. Microdermabrasion or Microneedling: These treatments can help reduce the appearance of dark spots.

Home treatments:

1. Topical retinoids: Continue use of adapalene, which can help with acne and mildly with hyperpigmentation.
2. Topical vitamin C: This antioxidant can help lighten dark spots and even out skin tone.
3. Topical hydroquinone: This ingredient is commonly used for lightening hyperpigmentation.
4. Niacinamide: This is useful for both acne and hyperpigmentation.
5. Sunscreen: Continue use of sunscreen to prevent further darkening of spots.

Preventions

1. Sun protection: Regular and proper use of a broad-spectrum sunscreen.
2. Stress management: Incorporate stress management techniques such as meditation, yoga, regular exercise, and balanced diet.
3. Consistent skincare routine: Regular cleansing, moisturizing, and targeted treatments.
4. Avoid picking at spots: This can lead to further inflammation and potential scarring or hyperpigmentation.

Home Care Daily Routine

Morning:

1. Cleanse with a gentle gel cleanser.
2. Apply a vitamin C serum to the entire face.
3. Apply a broad-spectrum sunscreen (SPF 30 or higher).

Evening:

1. Cleanse with a gentle gel cleanser.
2. Apply niacinamide serum to the entire face.
3. On nights when not using adapalene, apply a moisturizer.
4. Twice a week, after cleansing, apply a thin layer of adapalene (retinoid) to the entire face. Avoid applying this on the same nights when you apply the niacinamide serum, as using them together can cause irritation.
5. If hyperpigmentation persists, consider incorporating a hydroquinone cream as directed by your healthcare provider.

 In addition to this routine, incorporate stress management techniques into your daily life. This can be as simple as setting aside 15-30 minutes a day for meditation or deep-breathing exercises, or finding activities that you enjoy and that help you relax, such as reading, walking, or yoga. Regular exercise and a balanced diet can also help manage stress and contribute to overall skin health.Remember, consistency is key when it comes to skincare. It can take several weeks to months to see improvement in your skin, so be patient and stick with your routine. It’s also important to consult with a dermatologist or a skincare specialist to ensure the routine is suitable for your skin type and concerns, and to make any necessary adjustments over time.