Dealing with black spots on the face
MANY young women are horrified when they find dark spots on their face. The spots are usually due to acne. What happens is that in people of colour, when they get acne it causes an inflammatory reaction in the skin, this in turn stimulates the pigment cells, the melanocytes, to manufacture excess pigment. The pigment is picked up by macrophages scavenger cells, which migrate into the dermis, the deeper layer of the skin.
The dark spots on the face can lead to emotional disturbance, with feelings of frustration as the patient tries over the counter creams with no success. They often get depressed. A lack of self-esteem and self-worth is common, in fact a lot of black women will attempt to bleach their skin to get rid of these dark spots.
Pickers – those are people who love to pick their skin – will tend to have more dark spots than others. The first order of business if you are a picker is to cut your nails short.
When the patient with dark spots on their face comes to the dermatologist, we will at first carefully examine the face using a regular light and a black light called a woods light.
If the black spots look worse under the black light the pigment is mostly in the epidermis and will be removed easily. If the dark spot looks better under the woods light, the pigment is deep in the dermis and will be more difficult to remove.
To treat the dark spots the skin has to be prepared. Usually we would use Retin A as a night-time medicine. This thins the epidermis – the outermost layer of the skin – and helps us with our procedures. During the day the patient must use a sunblock. I use Clasifel or Hydrafil or Spectroban 55.
These sunblocks protect the skin from the sun and the effects of the sun on the skin which stimulates the production of melanin. Clasifel, in addition to being a sun block, also contains some Hydroxyquinone and this will tone down the pigment cells so that we do not get a rebound effect after we do our procedure.
After a month of preparing the skin, we then bring the patient in and perform a microdermabrasion or we may do a chemical peel. The dermatologist will decide whether to do a Glycolic acid peel, a Trichloroacetic acid peel, a Salicylic acid peel and in several cases he may do a combination of Glycolic and Salicylic or a combination of Trichloroacetic and Glycolic. The patient is advised to stay out of the sun for that day and to use a sunblock during the following two weeks.
After the procedure, be it micordermabrasion or chemical peel or a combination of both, the patient is put on a cream that will assist in getting rid of the dark spots. Usually this will be the Klingman’s cocktail or a cream called Triluma.
It is important for the doctor to explain to the patient that the acne caused the spots and that just removing the spots and not treating the acne will lead to more acne and more spots.
In most cases we would recommend a course of accutane to stop the acne. The medicine must be taken for six months and the patient must not get pregnant while she is taking this medicine. We will also need to do a blood test to check the state of the patient’s liver and the fats in the patient’s blood (cholesterol, triglycerides).
It is important for the patient to understand that they will need monitoring for a while. They must see the dermatologist afterwards to maintain their skin’s condition.
Dr Neil Persadsingh is the author of Acne in Black Women and The Hair in Black Women. Please check his website acneinblackwomen.com for a free download of cosmetics and moisturisers for the acne patient.
