By Dr Neil Persadsingh,
Skin Specialist
The dark spots and the scars which are left on a patient's legs after she has suffered from mosquito bites and the resulting popular urticaria can be treated.
Nowadays we can treat these spots, and in the majority of cases, we can get them to disappear or at least to improve.
These spots are often embarrassing, and have given a lot of our young women a feeling of hopelessness. These girls will go from doctor to doctor looking for some type of help. And when this help is not forthcoming they become very frustrated. A sense of hopelessness sets in, as they are repeatedly told that there is no help.
Times have changed
The doctor will examine the spots with a Wood's Light. This is a special black light. If the spots are going to improve they will look worse when examined under the Wood's Light. The pigment causing the dark spots is concentrated in the epidermis -- that is the uppermost layers of the skin -- and this pigment will come off with treatment.
The doctor will then give you Retin-A or one of its analogies, such as Stevia-A to use at night on the spots. This functions as a mild exfoliant (removing the toppermost layer of the skin) and prepares the skin for further treatment. Retin-A comes in three strengths: 0.025 per cent, 0.05 per cent, and 0.1 per cent. The first strength, 0.025 per cent, is very weak and is probably the best concentration to start with on black skin. After two weeks the doctor may want to increase the strength of the Retin-A to 0.05 per cent, or he may want to go to 0.1 per cent. Retin-A can sometimes cause a lot of irritation, and this can lead to further darkening of the skin. Therefore, you must be careful and follow your doctor's advice, as he will put you onto the right strength of the Retin-A that you may use.
You must use a sunblock, however. My favourite is Piz Buin No 25. This contains titanium dioxide and cincinamates, and, as we have shown in a previous article, this combination gives the most complete protection from the sun. Other than this I use Johnson's Sensitive Skin and Chemical Free sun block. The patient should use the sunblocks three times a day: in the morning; at about lunch time; and about 4:00 pm in the afternoon. If possible, the patient should try and wear pants all the time. This is rarely a problem because usually these girls have been wearing pants to hide these spots all along.
After using these medications for at least a month, a chemical peel can be performed. My favourite is Jessener's Solution. This is applied to the dark spots, and it usually causes a frost to appear. After application, the area is examined with a Wood's Light, and the areas that will do well will fluoresce (shine).
In some cases I might combine the Jessener's Peel with a TCA peel. We use a TCA peel in concentrations of 10 per cent and we may go up to 50 per cent. The use of the TCA peel in combination with the Jessener's Peel allows us to go deeper into the skin, and, in effect, give a medium to a deep peel. This helps us to further clear up those spots on the legs.
The Jessener's Peel may be used cold. In this process a piece of solid carbon dioxide (dry ice) is applied to the spots after the peel has been performed. This again allows us to go deeper into the skin.
Some dermatologists use glycolic acid peels on the limbs. I have never had good results with this peel in this location, but some dermatologists swear by it. Here are some other options:
* B-hydroxide peel, a new peel using a salicylic acid preparation which can be used on the limbs. This peel is fast becoming my favourite, as it removes a lot of the pigment. Unfortunately it is more expensive.
* The old Phenol peel, which is a very deep peel, and should not be used on black skin, as they can cause the skin to turn white.
* Laser surgery can be used to remove blemishes on the legs. This method is expensive and in black skin there is always the possibility of the skin turning white, that is: hypo-pigmentation.
* Some patients may need plastic surgery, where the blemishes are cut out. This is a last resort and usually we will not have to do this type of surgery.
* Micro-dermabrasion, the so-called Power Peel, is the newest tool that we have for treating black spots on the legs. Unfortunately we do not have such a machine in Jamaica as yet, but the results would seem to be fantastic with this type of treatment. It is my intention to purchase one of these machines shortly.
After the chemical peel the patient has to use a another chemical. This may be Kligman's Cocktail, Azealic acid, or Kojoic acid, which your dermatologist will provide for you.
You will have to wear a sunblock for at least three months, and maybe as long as six months.
More than one peel may be necessary, but these can only be done at monthly intervals, as the skin needs time to recover between peels.
So ladies, if you have these dark spots on your legs -- do not despair, but instead visit your favourite dermatologist and he will help you to remove them permanently.