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Hyperpigmentation, Decatur | Dermatology Specialists of AtlantaHyperpigmentation concerns bring many clients to the dermatologist’s office for treatment. This condition is sometimes resistant to treatment. It affects both sexes of all heredity groups, presenting local areas of darker skin. Many middle-aged or older patients present with the condition which results from the over activity of melanocytes, cells needed to produce melanin (known as the ‘melanoic’ type) or the overabundance of the cells (known as the ‘melanocytotic’ type).

The condition isn’t medically dangerous, but the presence of local skin darkening may be a symptom of serious disease. Of course, many patients are naturally concerned about the appearance of their skin. They may suffer anxiety or embarrassment about “age spots” or “liver spots” on the skin. Dermatology Specialists of Atlanta, a nationally board-certified dermatology practice, analyzes, diagnoses, and treats patients with concerns about this skin condition from all over the Atlanta area.


Several main types of the condition are often seen by dermatologists, including:

  • Lentigines, or age spots, occur most frequently on older patients’ skin. According to the National Institutes of Health (NIH), they’re common on individuals with light skin. More than ninety percent of patients with light hair and skin present with localized areas of darkened skin after age sixty. The spots aren’t the result of the aging process. Rather, damage from the sun’s UV rays is progressive and, over time, this damage appears on the surface of the skin.
  • Melasma,occurs as the result of fluctuating hormones. Pregnant patients, those who use hormone therapies (including birth control) or individuals with thyroid disorders may exhibit darkened spots or areas. About six million individuals in the U.S. suffer with the condition, according to Pandya and Guevara (American Journal of Clinical Dermatology).
  • Post-inflammatory PIH, results from skin injured by acne, burns, psoriasis, or even friction created by skin treatments. PIH may fade in the skin’s regenerative process, but can take many months or longer. This form is relatively easier to treat than others.


Dermatology Specialists of Atlanta first analyzes the patient’s skin to determine its cause. Dr. Kathleen J. Smith takes the patient’s history to evaluate genetic, lifestyle, or other reasons for the condition, including:

  • Previous sun exposure and damage. The patient’s level of UV exposure may be the primary cause of the condition. The dermatologist wants to know if the patient experiences sunburns from UV rays, uses sunscreens, or uses tanning booths.
  • Medical issues. Many diseases can contribute to the condition, including hypothyroid, Addison’s or Cushing’s diseases.
  • Hormones. If the patient is pregnant or recently pregnant, uses or used forms of birth control, or any type of hormonal replacement therapy, the patient may have melisma.
  • Medications. Some medicines, including those prescribed by a doctor or purchased over-the-counter, can cause the condition. The physician needs to know about any medicines or medications used over the past year, including antibiotics, anti-seizure medicines, or chemotherapy agents. Harvard University School of Medicine reports that some hyperpigmentation treatments, such as hydroquinone, may actually cause the condition in certain individuals.

It’s also important for the patient to share treatment information with others involved in his or her skin care. For these reasons and others, most patients battling the condition place aesthetic and medical treatment in the hands of a board-certified dermatologist such as Dermatology Specialists of Atlanta.


The dermatologist is likely to consider the following items before recommending treatment options:

Fitzpatrick type. The treatment options available to the client may depend on his or her skin tone and type. Lighter skin is easiest to treat. Those with darker skin tones may require gentle treatments to avoid hypopigmentation or skin damage. A Wood’s lamp helps the dermatologist to determine how severe the patient’s condition is. Some forms appear only on the epidermis, and others reflect damage to the underlying dermal layer. Topical medicines are usually not effective if the patient’s skin has damage to the dermal layer. Magnification is also useful to see the precise areas or patterns present in the patient’s skin.

New Treatment for Melasma

Dr. Kathleen Smith now is providing compounded topicals for even greater results for improving the brownish patches usually present in sun-exposed facial areas. Hydroquinone is the most popular and most effective topical hypo-pigmenting agent. By combining with other agents such as Alpha Hydroxy Acids and trentinion can enhance the lightening effect of hydroquinone. Each compounded prescription is done by customizing for the specific patient she is treating taking into consideration their skin type and condition.

Other Treatments for Hyperpigmentation

The number of treatments offered to patients with this condition have increased over the past fifteen years. These new therapies help even those with resistant areas of darkened skin to show improvement. Dr. Kathleen J. Smith may use topical medicines and other non-invasive therapies to treat the condition. Often, the dermatologist will recommend complementary therapies to be used in tandem.

Other treatments help to exfoliate the patient’s skin. Professional aesthetic treatments including alpha or beta hydroxyl acids and retinols may be recommended to improve the turnover rate of the patient’s cells. Other treatments may include active ingredients such as hydroquinone, azelaic acid, kojic acid, mandelic acid, or niacinamide (Vitamin B3). In addition, Dr. Kathleen J. Smith may recommend non-ablative procedures, including intense pulse light (IPL), chemical peel series, microdermabrasion or dermabrasion, or laser treatments to speed up the clearing of darkened skin.


Clear, healthy skin is important to most people, and there are many options available to those patients diagnosed with hyperpigmentation. Patients in search of a triple board-certified dermatologist in the greater Atlanta metropolitan area, including North Atlanta, North Decatur, and Druid Hills, should arrange an appointment with Dr. Kathleen J. Smith at 404-357-9648.

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