Erasing Skin Marks with Lasers : Bleaching Cream Backfires, Tattoos Skidoo

by Food and Drug Administration (FDA)

(Page 2 of 3)

Too much sun is linked to a number of types of skin lesions. "Exposure to the sun thins the skin, making it more transparent. It also causes enlargement of the blood vessels on the skin's surface, which in turn makes these vessels more visible. Plastic surgeons refer to these red, unsightly vessels as telangiectasias, or 'spiders'," says Joel M. Noe, M.D., assistant professor of plastic and reconstructive surgery at Harvard Medical School.

Often, spiders are caused by chronic overexposure to the sun, but they may also result from liver disease or occur in pregnancy due to a change in the way the body processes estrogen. In addition, they can be a side effect of oral contraceptives or prolonged use of topical corticosteroid drugs. They may also occur with a little-understood condition called rosacea, in which the middle third of the face is affected.

"These conditions responsible for red blood vessels on the face are incredibly common in our society, especially among the fair-skinned who have had lots of sun exposure," Noe adds.

He uses argon or pulsed dye lasers to treat spiders. "It can be done in the doctor's office using local anesthesia. The treatment produces a mild sensation of heat and a feeling like pinpoints lightly touching the skin," he says. Usually one or two treatments are needed.

Ultraviolet exposure from excessive sunning can wreak havoc on recovery from plastic surgery on the nose, producing redness called "post-rhinoplasty red nose" as new blood vessels appear on the bridge of the nose. This is part of the healing process and is preventable by minimizing sun exposure. It can be covered with make-up, or treated with an argon laser, says Noe.

Bleaching Cream Backfires

A 53-year-old black woman had used an over-the-counter "skin whitener cream" to even out her complexion for three months when she noticed just the opposite effect — a sooty, bluish-black raised area on her face. Her doctors first tried to lighten the area by treatments with the acne drug Retin-A, cryosurgery with liquid nitrogen, and finally by peeling off the skin pigment with trichloroacetic acid. These dermabrasion procedures worked on parts of her face, but not on the thin-skinned areas near her eyes and nose. She consulted Edgar Smith, M.D., and his colleagues at the University of Texas Medical Branch in Galveston, who had reported success with a carbon dioxide laser.

Sooty marks resulting from lightening creams are due to the ingredient hydroquinone, which can cause pigmented fibers to be gradually laid down in the dermis (the underlying skin layer). In the mid 1970s, doctors in South Africa began reporting the mysterious dark spots on the faces of black people who had used products containing 6 to 8 percent hydroquinone, and, as a result, the amount was limited in many countries, including the United States, to 2 percent. Still, in the 1980s, cases were reported among U.S. blacks.

So far only blacks have been reported to be affected, and their skin responses range from redness and mild pigmentation, to dark coloration, to the appearance of nodules. Although the CO2 laser is now the only one used on these blemishes, Smith suggests that a ruby laser may work even better, considering the recently reported success of this type of laser in removing tattoos.

Tattoos Skidoo

Since 6000 B.C., people have had their skin tattooed — and then later regretted it. Unfortunately, treatments to remove the marks often marred the skin further. Ronald Wheeland and co-workers of the University of California at Davis reported in the December 1990 Journal of Dermatological and Surgical Oncology that a preliminary study indicated treatment with a ruby laser to remove tattoos is "vastly superior" to standard methods, such as dermabrasion and surgical removal.

The ruby laser works much the way the pigmented lesion laser does, and also feels like a rubber band snap. The laser light is absorbed by melanin and the carbon-based pigments used in tattoos. The skin initially turns white for 10 to 20 minutes, then swells and turns red, feeling like a sunburn. Although the skin stays red for one to three weeks, healing takes 10 to 14 days, and fading continues for months. There are no open wounds. The researchers treated 163 tattoos on 80 patients and found that black and blue tattoos more than 10 years old responded best to the treatment.

The success of laser surgery in treating benign skin lesions has encouraged many people to seek help who would otherwise have relied on disguising or hiding their blemishes. Lasers have also helped thousands of others who were unhappy with the results of more traditional treatments. In the future, this kind of laser surgery may become more common for an increasing number of people with problems that are more than skin deep.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.