Facial spots refer to various irregular spots that appear on the face, such as freckles, chloasma, coffee spots, malar nevus and post-inflammatory pigmentation. These spots not only destroy the uniformity of skin color, but may also affect the patient's self-confidence. This article will introduce the clinical manifestations and treatment strategies of common facial spots in detail.
FRECKLES
Freckles
Freckles are a common autosomal dominant hereditary pigmentation disease, which is more common in women and mainly distributed on the nose and cheeks of the face. It manifests as light brown to dark brown spots with a pinhead to rice grain size. Sun exposure will aggravate the symptoms, while they will be relieved in winter.
Treatment methods
Local treatment: Depigmentation preparations: such as 3% hydrogen peroxide, 10% white mercuric ointment or 3% hydroquinone cream, applied externally 1-2 times a day, can temporarily improve symptoms. 5% salicylic acid ointment, 0.1% retinoic acid cream, etc. can accelerate the exfoliation of pigmented skin. However, it should be noted that methods such as 25% phenol ether, 30%-50% trichloroacetic acid or liquid nitrogen spray should be used with caution to avoid post-inflammatory pigmentation or scarring.
Physical therapy: The current mainstream physical therapy methods include intense pulsed light, traditional Q-switched laser and picosecond laser. These technologies achieve therapeutic effects by precisely acting on pigment particles.
CHOLELMA
Melasma
Melasma is a facial pigmentation disease that appears as light yellow-brown to dark coffee-colored spots with varying shades and shapes. The rash is often seen on the protruding parts of the zygomatic bone, forehead, brow arch, eyelids, nasal dorsum, nose wings, upper lip and mandible. Among middle-aged Asian women, the incidence rate is as high as 30%.
Treatment methods
Systemic treatment:
- Tranexamic acid: oral 250-500mg/time.
- Glycyrrhizic acid: intravenous drip 40-80mg/time.
- Vitamin C: 0.2g/time, 3 times a day.
- Vitamin E: 0.1g/time, once a day.
- Glutathione: used for anti-oxidation and adjuvant therapy.
Local treatment:
- Hydroquinone and its derivatives: commonly used concentration 2%-5%, once a night, 2-4 weeks of treatment can be effective, 6-10 weeks of best effect.
- Retinoic acid: commonly used concentration 0.05%-0.1%, once a night, the course of treatment is about 6 months.
- Azelaic acid: 15% gel or 20% cream, twice a day, the course of treatment is about 6 months.
- Tranexamic acid: 2%-5% cream, twice a day, the course of treatment is about 4 weeks.
- Arbutin: 3%-5% concentration, once a night.
Treatment with Chinese medicine:
Oral administration: Select prescriptions according to syndrome type:
- Liver depression and qi stagnation syndrome: Xiaoyao powder with modifications, commonly used Bupleurum, Angelica, Poria, etc.
- Qi stagnation and blood stasis syndrome: Taohong Siwu decoction with modifications, commonly used Angelica, safflower, etc.
- Spleen deficiency and dampness obstruction syndrome: Shenling Baizhu powder with modifications.
- Liver and kidney yin deficiency syndrome: Liuwei Dihuang pills with modifications.
External treatment:
- Chinese medicine wet compress: Use pearl powder, rhodiola rosea and other drugs, wet compress or mix into paste for external use.
- Acupuncture therapy: Choose straight or circumferential puncture according to the size of the plaque, and cooperate with acupoints of different syndrome types.
- Acupoint injection: use angelica injection or compound danshen liquid and inject it into specific acupoints.
- Moxibustion: use warm acupuncture or warming moxibustion device to stimulate specific acupoints.
- Other therapies: such as thread embedding, cupping, scraping, fumigation, massage, etc.
CAFE-AU-LAIT-SPOTS
Café au lait spots
Café au lait spots, also known as milk coffee spots, are a common skin lesion, manifested as light brown or coffee-colored patches of varying shapes and sizes, with a smooth surface and uniform color. Its incidence rate is about 10%-20%. Some patches are regular in shape and smooth in edges, while others are irregular in shape and have map-like edges.
Treatment methods
Early treatments include surgical excision, carbon dioxide laser, freezing, etc., but scars and severe pigmentation are prone to occur. The emergence of selective lasers provides a safer treatment option. According to the pulse width, Q-switched lasers or picosecond lasers can be selected; according to the wavelength, 532nm, 694nm, 755nm, 1064nm lasers can be selected; according to the excitation medium, (frequency-doubled) Nd:YAG, ruby, alexandrite lasers, etc. can be selected. Although these lasers have certain therapeutic effects, no absolutely superior treatment method has been found so far, and trial treatment is usually required to select the best option.
BROWNISH CYAN NEVUS
BROWNISH CYAN NEVUS
BROWNISH CYAN NEVUS, also known as acquired bilateral nevus of Ota-like spots, is a special type of pigmented lesion, which is more common in young Asian women. Its clinical manifestations are bilateral brown oval or irregular polygonal spots on the zygomatic region, usually without obvious subjective symptoms.
Treatment methods
There is currently no special treatment method, mainly relying on laser treatment. The pigment particles are broken up through photothermal or photomechanical effects, so that they are absorbed through metabolism while protecting the surrounding normal tissues. Commonly used lasers include Q-switched lasers and picosecond lasers. Treatment usually requires multiple sessions, with an interval of 3-6 months between each session. Ice compresses should be applied after surgery to avoid infection. In addition, the study found that the combined treatment of tranexamic acid and hyaluronic acid can significantly improve the efficacy, reduce pigmentation and adverse reactions. Tranexamic acid reduces melanin production by reducing the activity of plasmin, interfering with the interaction between keratinocytes and melanocytes; hyaluronic acid has moisturizing and anti-aging effects.
BROWNISH CYAN NEVUS
Post-inflammatory pigmentation
Post-inflammatory pigmentation is a secondary symptom caused by skin inflammation, allergic reaction, mechanical injury, drug reaction or treatment measures. It is characterized by increased pigmentation after skin inflammation.
Treatment methods
Local treatment is the main treatment method. Commonly used drugs include hydroquinone, tretinoin, 0.1% tazarotene cream, 0.1% retinal combined with 6% glycolic acid (GA) preparations, azelaic acid, kojic acid and licorice extract. Chemical peels and laser treatment can be used as second-line treatments, such as epidermal chemical peels containing 35% GA or salicylic acid (SA), 20% salicylic acid + 10% mandelic acid composite peels, 595nm long-pulse dye lasers or low-energy, large-spot QS
1064nm Nd:YAG lasers. It should be noted that there is great controversy over non-ablative fractional lasers (NAFR) and ablative fractional lasers (AFR). Many studies have shown that they may aggravate post-inflammatory pigmentation after treatment, so they are not recommended for such treatments.
References
[1] Chinese Journal of Clinical Dermatology, 2nd Edition.
[2] Zhao Junying, Zhao Guang. Expert consensus on the diagnosis and treatment of melasma with integrated traditional Chinese and Western medicine[J]. Chinese Journal of Medical Aesthetics and Cosmetology. 2021.27(6):455-458.
[3] Long Liyun, Zhou Xiaoliang. Effect of tranexamic acid combined with hyaluronic acid intradermal injection in the treatment of zygomatic brown-blue nevus[J]. Contemporary Chinese Medicine. 30(17):69-72.
[4] Pigment Disease Group of the Dermatology and Venereology Committee of the Chinese Society of Integrated Traditional Chinese and Western Medicine. Expert consensus on the diagnosis and treatment of melasma in China (2021 edition) [J]. Chinese Journal of Dermatology. 2021.54(2):110-115.
[5] Expert consensus on the treatment of melasma with traditional Chinese medicine [J]. Chinese Journal of Integrated Traditional Chinese and Western Medicine Dermatology and Venereology, 2019,18(04):372-374.
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