Anyone can get melanoma. Finding it early is the key to surviving this aggressive, potentially fatal cancer. People who are at the highest risk are Caucasians with fair skin (always sunburn) with red or blonde hair and blue or green eyes. The risk is also greater for people with a first degree relative (parent, sibling, or child) with melanoma and those who have a large number of moles (50 or more). Regularly checking your own moles helps, you know what they normally look like, and therefore will alert you to any new or changing ones.

An easy mnemonic to help you remember what to look for is ABCDE:

• A is for Asymmetry: look for moles where the shape of one half is different from the other.
• B is for Border: look for moles with irregular, scalloped, or jagged borders.
• C is for Color: look for moles with multiple colors or variation in color-especially shades of black, brown, blue, red, or white.
• D is for Diameter: melanomas are usually larger than 6 millimeters (the size of a pencil eraser) but they can be smaller too.
• E is for Evolution/Evolving: moles that are undergoing ANY kind of change, especially as outlined above, need to be evaluated by a medical professional.

Another good rule of thumb to follow is the “ugly duckling” sign. If you spot a mole that just doesn’t look like anything else you currently have or have seen before, then it needs to be checked.

Sometimes, melanomas can be painful, itch or bleed. Often times, however, they are asymptomatic. Many people also think that a melanoma has to be raised, but that is wrong. They can be flat and not even felt on the skins surface. This is the reason that you must LOOK at all of your moles, even in places that you don’t regularly see in the mirror (back, calves, bottoms of feet). It is also possible to develop melanoma of the nailbed. This type of melanoma is more common in darker skinned people (Hispanics and African Americans) and usually appears as a darkly pigmented streak down the nail.

When melanoma is found early, it is almost 100% curable. Having a full body exam is an easy process. A trained dermatology provider can perform a head to toe exam at a routine appointment. If an irregular mole is found, a simple biopsy can be performed that day with minimal discomfort and risk. Biopsy results are usually available within a week and treatment of melanoma is directed by how deep the cancer is in the skin. If found early, a larger surgical excision is usually sufficient treatment. Delaying a diagnosis allows the cancer to grow deeper and increases the risk of it spreading to the lymph nodes and/or other organs via the bloodstream. A deep melanoma will require evaluation and further testing by a surgical oncologist.

In addition to doing your own exams and having an annual full body exam, there are simple things you can do to reduce your risk of melanoma.

• Stop outdoor and indoor tanning. Research shows indoor tanning increases a person’s melanoma risk by 75%. Getting a base tan prior to a vacation does not protect you, it only increases the chance you’ll develop skin cancer.
• Use sunscreen every day. Look for an SPF of at least 30 as well as Zinc (no less than 6%) on the ingredient list. Apply 20 minutes before outdoor activity and reapply every 2 hours that you are outdoors and more often if you are sweating heavily or swimming. Even on cloudy, rainy, or snowy days you need to wear sunscreen if you are exposed to the sun.
• Limit your outdoor activity to early morning and later afternoon. UV radiation is most intense during the hours of 10 AM and 4 PM. Plan outdoor activities to minimize exposure.

 One person dies every minute from a melanoma. While a component of this cancer is genetic, there are still many steps you can take to reduce your chances of having it. This May, take time to educate yourself and the ones you love about preventing melanoma and have your annual full body exam if you haven’t already.

Source: www.aad.org/skin-conditions/dermatology-a-to-z/melanoma

Skincare and Your Eyes – Part 1 of 2
Skincare and Your Eyes – Part 2 of 2

Poison Ivy-vine

Getting out into the yard after a long winter can be exciting and invigorating but a lot of work. With a wet spring, weeds and vines have grown amuck, so clearing these areas is often a top priority. However, keep in mind that there may be poison ivy, poison oak or sumac lurking with the more benign shrubs. Poison ivy runs rampant in the eastern US. Poison oak is most often found in the south as well as rural west. Poison sumac, fortunately is rare, but can be just as troublesome. Annually, these plants account for 50 million cases of rash in the US alone.

The cause of the rashes associated with these plants is urishol, the oil on the plant itself. When this oil comes in contact with the skin, it binds to proteins on the skin cell surface causing them to change shape and appear “foreign” to the body’s immune system. This ignites a cascade of immune reaction leading to the red, blistery, itchy, and painful eruption of contact dermatitis. In approximately 15-30% of people, urishol does not elicit an immune response. However, at least 25% of the population has very strong reactions to it, usually leading to severe symptoms. Often a person must be “sensitized” to urishol. The first few times the skin comes in contact with the oil, little may happen, but subsequent exposures will lead to progressively stronger reactions. Thus, it is safe to say, one can definitely become allergic to these plants at any point in their lifetime.

Poison Sumac

Contact dermatitis will typically develop within 24 hours of contact with the plant. While we commonly think of these rashes as summer time phenomena, urishol is present in every part of the plant at ANY given time throughout the year. It also can remain active on non-living objects for years! So cleaning all clothing, shoes, socks, gardening tools, camping equipment, etc. that has been exposed is critical to preventing further exposure and subsequent rashes. Even pets need to be washed as urishol on their fur can be deposited on skin prompting an outbreak.

The typical eruption can last anywhere from 2-5 weeks. The majorities are, mild in nature and will resolve spontaneously in 14 days. However, infection can be a major complication as scratching brings bacteria to breed in broken, susceptible skin. This will usually require a prescription antibiotic to resolve. Treatment of contact dermatitis can be thought of in two phases: stopping the urishol contact with the skin and treating/reducing the pain and itching of the ensuing eruption.

To prevent urishol from binding, exposed skin must be washed with soap and cool water within minutes of exposure. Since it is an oil, soap is required. Commercial preparations are also available containing surfactants that bind to urishol solubilizing it and washing it away. The FDA has also approved an over the counter product that contains a clay like ingredient. When used before potential contact with urishol, it acts as a barrier to prevent binding to the skin.

Poison Oak

Once the rash is present, treatment consists of topical steroid creams and antihistamines to soothe redness and itching.  If a reaction is severe enough, a 2-3 week course of oral prednisone from your medical provider may be necessary.  The best treatment of all is prevention through avoidance of any suspicious plant or vine.

Remember urishol is what causes the rash, so once it is washed away from the skin; you cannot “give” poison ivy to someone else. Scratching the rash itself does not spread it, as the rash is being driven by your internal immune reaction.  Scratching can, however increase your chances of having a secondary infection, so seek treatments to help prevent continual scratching. Also, keep in mind that burning the vines and plants may aresolize the urishol which for those who are highly sensitive may result in contact with the oil from the smoke and possibly even inhalation leading to a greater systemic reaction.

As common as contact dermatitis is, it doesn’t have to keep you from the outdoor activities you love. Familiarize yourself with the appearance of these plants, avoid them even if you don’t think you’re allergic, and if you do have contact, try to wash the oil from your skin as soon as possible. If you do break out, seek treatment to prevent unnecessary infection and speed resolution.

 As cooler weather approaches, many of us experience the onset of dry skin.  Here are a few tips to help keep your skin looking and feeling its best this fall and winter.

First, cleanse properly!  While it’s tempting to exfoliate, or scrub aggressively, to remove dead, dry and flaky skin, resist the urge.  Doing this may only aggravate your dry, irritated skin.  Use a gentle, oil-free, non-soap cleanser with tepid water on your dry skin.

Second, moisturize wisely!  Consider a high quality moisturizer/sunscreen product designed specifically for facial skin.  Remember that although the temperature cools, UV radiation is present year round!  During the winter, the amount of UVB, the sun’s rays responsible for tanning/burning, significantly declines.  UVA radiation, however, remains constant.  UVA rays are responsible for aging your skin since they penetrate much deeper and damage the collagen structure.  Using a moisturizer rich in zinc, will not only soothe irritated skin, but it will also effectively block all UVA radiation, even those harmful rays we don’t take note of when we are in our cars and next to the office window.

For moisturizing dry areas from the neck down, look for ingredients such as ceramides, hyaluronic acid and petroleum.  Avoid products that consist of unnecessary fragrance and coloring.  Applying the product to damp skin, immediately after showering, helps to seal in moisture.  If you’re severely dry, consider applying a moisturizer twice a day or more!

Skin Solutions recommends and carries the following highly effective products to treat and protect dry skin: CeraVe hydrating cleanser, LaRoche-Posay Toleriane cleanser and moisturizer, Likewise facial moisturizer for normal to dry skin, CeraVe moisturizing cream and Elta Melting cream.  Please stop by our office, or Pena MD Studio, and we will be happy to give you further information and assist you in finding the most suitable products for you.

Following these guidelines will help you have the best skin year round and give your skin a healthy glow this fall and winter!

Brown recluse spiders are fairly easy to recognize.  They are usually small, approximately 1.5 cm in length, roughly the size of dime.  They range in color from yellow-tan to dark brown and have a characteristic “fiddle shape” on their cephalothorax (the part of the body to which the legs attach).  The base of the fiddle is at the spider’s head, while the neck points to the rear.

Brown recluse bites can be painless to mildly painful (like a bee sting), so it is often helpful to collect the spider (if possible) for identification if you believe you’ve been bitten.  The venom is extremely potent, but a single bite releases a very small amount into the skin.  Bite reactions can vary from mild , appearing like any other insect bite, to severe with systemic flu like symptoms.

A more severe bite reaction will become painful within the first 2-4 hours after the bite.  Redness and swelling develop within that time and there is often a pale, blister-like area in the center.  The venom contains powerful enzymes that destroy and breakdown the skin.  As the reaction continues, these blistered areas can grow quite large and often develop central ulcerations within a couple days.  A systemic reaction to the venom may cause nausea, vomitting, fever and chills, weakness and joint pain and occur in the first 24-48 after the bite.  It is best to seek medical care on the same day if you believe you’ve been bitten, and especially if you are having a severe bite reaction.

While there is no specific antidote, the sooner a diagnosis is made and treatment initiated, the better the outcome.  Treatment for mild bites includes rest, ice bags applied to the area and elevation if the bite is on an extremity.  Aspirin may be helpful in slowing the localized effect of the spider’s venom.  A tetnus shot should be given if not up to date.  For more severe bites, antibiotics, pain medication and other anti-inflamatory medications may be prescribed.

Thankfully, the majority of brown recluse spider bites fall into the mild reaction category.  However, severe reactions do occur and can occur more frequently in certain age groups such as the young and the elderly.  Collection of the spider and prompt medical attention can help differentiate the type of spider involved and aid in treatment of potentially severe bites.

The ticks spread the bacteria while feeding which is what occurs once a tick attaches to your skin.

 The most robust transmission occurs  at 48-72 hours after the tick attaches.

Removing the entire tick is recommended to discontinue feeding and the transmission of bacteria.

It is common to have mild skin irritation at the site of the tick bite, but one of the first signs of Lyme disease is a large circular red lesion at the bite site that appears 1-3 weeks after transmission.  It important to see a healthcare provider if you have redness near the bite site or unsure if the area looks normal.  Lyme disease can be diagnosed by blood work or clinical appearance.

 The most common treatment for Lyme Disease is antibiotics.

It is vital to treat Lyme Disease early to avoid heart, joint and nervous system complications.

Prevention is key in avoiding Lyme Disease and other tick borne illnesses.   The most effective and commonly used tick repellent is DEET.  Deet-based insect repellants in concentrations of 30% or less can be used on children as young as two months.   Using long-sleeved shirts and long pants in addition to DEET applied over the clothing can decrease the likelihood of getting bitten by a tick. Checking your body for ticks after being in a tick-infested area is suggested.

Source: Journal of AAD, April 2011, Lyme Disease,pg 619-654, Bhate and Schwartz; www.deet.com

UV RAYS

UV light is categorized as UVA, UVB, and UVC radiation. UVC radiation never reaches the earth’s surface. However, UVA and UVB radiation is the most concerning due to its role in skin disease. UVA makes up 96.5% of UV radiation and can penetrate glass as when driving in a car. UVB makes up the remaining 3.5 percent and contributes to DNA damage in the skin. Concurrently, both UV types affect the skin immediately as well as long-term. Within seconds, UV radiation can damage DNA and cause sunburn and immunosupression. Long-term effects of UV radiation on the skin include photoaging, skin thickening, skin cancers, and changes in pigment within the skin. When considering different vacationing spots throughout the year, UV ray exposure varies in certain parts of the country and overall throughout the world. The ozone plays a major role as a barrier in the atmosphere against sun’s damaging rays. It is thickest at the poles of the earth and thinnest near the equator. This is important when considering vacations to the Bahamas or Caribbean Islands. In addition, UV intensity increases about 10% with each 1,000 feet of elevation above sea level. Thus, UV rays are more intense in Denver, which is 5,280 feet above sea level versus New Orleans, which is at sea level. Furthermore, snow, ice, sand, glass, and metal can reflect UV rays. It’s surprising to know that sand reflects 25% of rays and snow reflects up to 80% of rays. It’s also important to remember that even a cloudy day can allow up to 70% of passage of the sun’s rays.

 EFFECTS ON AGING AND ANTIOXIDANTS

Photoaging, or aging due to sun exposure, differs from the intrinsic aging process and is characterized by skin roughening, dilated pores, diminished skin tone, skin laxity, blotchy skin color, brown spots, sallowness (unhealthy yellowing and paleness of the skin), broken blood vessels, fine lines, and wrinkles. Free radicals created from the UV rays cause the process of photoaging of the skin. These free radicals damage the DNA, proteins, and fats. They are also associated with an inflammatory response, such as occurring with a sunburn. Antioxidants neutralize these free radicals and are included in some sunscreens.

 SUNSCREEN

Today there are hundreds of sunscreens available on the shelves and it is difficult to choose the most appropriate sunscreen to protect you and your family. SPF indicates a sunscreen’s effectiveness to prevent sunburns related to time spent in the sun. Contrary to what one might think, it does not actually increase proportionately, especially once a SPF of 30 is reached. A SPF of 50 blocks 98% of the UVB rays while a SPF of 30 blocks 97% and a SPF of 15 blocks 93% (Table 1). Many scientists believe that the most appropriate SPF is 30 and that there is not significant gain in using an SPF higher than 30. A good sun protector should also contain zinc oxide or titanium dioxide, which block the sun’s rays. Zinc oxide is now formulated in micronized particles aiding in a better cosmetic appearance rather than looking like the skin is covered in a white paste. Bottom-line is that a sunscreen should contain a SPF of 30-50, contain micronized zinc oxide or titanium oxide, and should be used daily all year long.

Sources: The Dermatologist, April 2011 and Practical Dermatology, March 2011, Vol. 8, No. 3

 Our friends at Likewise Everyday Skincare have one that’s easy to keep:

wear sunscreen everyday.

Wearing sunscreen on exposed areas is the simplest and most important thing

you can do to take care of your skin.

To make it even easier, Likewise products are now available on Amazon.com!

 And to celebrate, they’re introducing new pricing on the

skin-loving facial moisturizers, now only $35.00

Need more encouragement?

Take a visit to Likewise on Facebook ( http://on.fb.me/emGDFZ) , your resource for the latest updates on skin health and other fun sun info.

And if you “like” Likewise, you’ll get an exclusive coupon redeemable on Amazon

or at one of our Skin Solutions Dermatology locations.

Best wishes for a Healthy and Happy New Year from Likewise.

It is important to know the difference between melanoma and a harmless mole. A normal mole is most often an evenly colored brown, tan, or black spot on the skin. It can be either flat or raised. It can be round or oval. Moles are usually less than 1/4 inch in diameter, or about the width of a pencil eraser. Moles can be present at birth or they can appear later. Several moles can appear at the same time.

Once a mole has developed, it will usually stay the same size, shape, and color for many years. Moles may fade away in older people.  Most people have moles, and almost all moles are harmless. But it is important to spot changes in a mole– such as its size, shape, or color– that may signal a developing melanoma.  You should see your doctor if you have a mole or growth that worries you.

The ABCD Rule can also help tell a normal mole from a melanoma:
A: Asymmetry – one half of the mole does not match the other half
B: Border irregularity – the edges of the mole are ragged or notched
C: Color – the color of the mole is not the same all over. There may be shades of tan, brown, or black, and sometimes patches of red, blue, or white
D: Diameter – the mole is wider than about 1/4 inch (although doctors are now finding more melanomas that are smaller)
Other important signs of melanoma include changes in size, shape, or color of a mole. Some melanomas do not fit the descriptions above, and it may be hard to tell if the mole is normal or not, so you should show your doctor anything that you are unsure of.
Skin cancers often don’t cause symptoms until they become quite large. Then they can bleed or even hurt.  Basal cell carcinomas often appear as flat, firm, pale areas or as small, raised, pink or red, translucent, shiny, waxy areas that may bleed after minor injury. You might see one or more irregular blood vessels, a depressed area in the center, or blue, brown, or black areas. Large ones may have oozing or crusted spots.  Squamous cell carcinoma may appear as growing lumps, often with a rough surface, or as flat, reddish patches that grow slowly.
Prevention
The best way to prevent skin cancer is to protect yourself from the sun. Also, protect children from an early age. Doctors suggest that people of all ages limit their time in the sun and avoid other sources of UV radiation:
•    It is best to stay out of the midday sun (from mid-morning to late afternoon) whenever you can. You also should protect yourself from UV radiation reflected by sand, water, snow and ice. UV radiation can go through light clothing, windshields, windows and clouds.
•    Wear long sleeves and long pants of tightly woven fabrics, a hat with a wide brim, and sunglasses that absorb UV. Use sunscreen lotions. Sunscreen may help prevent skin cancer, especially broad-spectrum sunscreen (to filter UVB and UVA rays) with a sun protection factor (SPF) of at least 15. But you still need to avoid the sun and wear clothing to protect your skin.
•    Stay away from sunlamps and tanning booths.

Do not use pictures of other moles to try to diagnose it yourself. Pictures are useful examples, but they cannot take the place of a doctor’s examination.
If you have a question or concern about something on your skin, we have two convenient locations, call and schedule your appointment today.

Franklin Office:   Call 615.771.7546    200 Cool Springs Blvd. Franklin, TN 37067

Columbia Office: Call 931.840.9991    1401 Hatcher Lane Columbia, TN 38401

www.ssdermandlaser.com

Types of Acne Scarring
There are different kinds of acne scarring: ice pick scarring, atrophic scarring, and hypertrophic scarring. Ice pick scars are deep pitted scars with steep edges. Atrophic scars are pitted but have smooth borders and are not as deep. Hypertrophic scar, more common on the back and chest, are thick lumpy scars that sit above the surface of the skin.

Color changes in acne in more common than scarring and can resolve but may take years to completely disappear.
Color changes come in three basic colors:
1. Pink and purple: patches at the site of acne lesions
2. Brown/black: hyperpigmentation
3. White: post inflammatory hypopigmentation

Post inflammatory hyperpigmentation is very common in those with darker skin tones or in those who tan easily and can significantly worsen the appearance of acne.

Treatment of Acne Scars
Acne scarring is permanent but can be treated. No treatment is 100% effective and the best result is improvement, not perfection. Treatment of scarring may require many different kinds of treatments, depending on the kind of scarring present. Treatment of acne scarring can be expensive and may not be covered by insurance. It is important that all the acne is clear before treating scarring. Otherwise, new scars form and the procedures are wasted. The most effective treatments are surgical and there are many types.
• Laser Resurfacing
Laser Resurfacing has been used for the treatment of acne scarring. All lasers use a high-energy beam of light that targets specific structures in the skin. The Erbium laser resurfacing is ablative meaning that it destroys the outer layers of the skin. Ablative techniques are more effective and depending on the level of treatment needed may require recovery time from 2 -5 days.

It is a great feeling to have a tan – but at what cost? When the risk outweighs the benefit, it is best to look elsewhere, and this is one of those situations. There are many options to seek out in looking for the perfect method for you. There are a number of other options to consider before putting yourself at risk for a tan. Seek out the advice of your doctor when in doubt, especially when it comes to altering your appearance.

Psoriasis

What Is Psoriasis?
Psoriasis is a non-contagious chronic skin condition which occurs as a result of abnormalities in the body’s immune system. In individuals with psoriasis, the immune system erroneously sends out signals that cause an increased production in the growth of skin cells. The condition appears as red, scaly patches, often with a whitish or slivery covering of dead skin cells. The condition can affect only a small area of the body, or can spread to cover the entire body in some individuals.

What Causes Psoriasis?
Psoriasis outbreaks can be precipitated by a number of factors, including stress, injury to the skin, and streptococcal infection. The condition is caused by a breakdown in the body’s immune system, and researchers believe stress triggers the immune response that causes the abnormal growth of skin cells that is the hallmark of psoriasis. Certain medications, including drugs to control blood pressure, can also cause a flare-up of psoriasis. Psoriasis also often occurs within families, leading researchers to believe a genetic component is involved.

What treatments are available for psoriasis?
Many types of treatments are available to control psoriasis symptoms and flare-ups, including topical agents, oral medications, and light therapy. Most treatments are directed at slowing the abnormal growth of skin cells that occurs in psoriasis. Topical treatment is usually the first line of treatment, and may include special shampoos, creams, ointments, and lotions, as well as controlled exposure to sunlight. Your physician may recommend beginning treatment with over-the-counter medications before moving to prescription topical agents. Some individuals can benefit from having the area wrapped in a dressing after the topical treatment is applied, in what is known as “occlusion therapy.” Some specialists may prescribe a rotting therapy of different topical medications to avoid developing a tolerance to a particular medication.

Phototherapy is another popular treatment option which may be used alone or in combination with other medications. Light therapy may involve either UVB or UVA radiation, and is carefully applied by a physicians trained in effective application of light. Most treatments are performed 2 to 3 times per week. In the case of UVA therapy, your doctor will probably prescribe use of a drug called psoralen, which helps sensitize your skin to the effects of the light.

Oral medications are usually reserved for individuals with moderate to severe cases of psoriasis, and may also be used for men and women for whom topical treatments and light therapy have failed to achieve satisfactory results. Popular oral medications used to treat psoriasis include methotrexate, retinoids, and cyclosporine. These drugs are carefully monitored by your physician, and may not be used in certain individuals with specific health problems. Most oral medications are used in conjunction with topical products, and may also be used with light therapy. In some rare cases, injections of medication may be used in small areas which are resistant to other forms of treatment.

In certain cases, the physician may decide to use biologics, a class of medicines which mimic the proteins made naturally by the body. These drugs block the immune system response that causes the overproduction of skin cells. Generally, biologics are thought to be less effective overall than other treatments, and are used in patients who cannot tolerate other forms of therapy.

Vitilgo

What is vitiligo?
Vitiligo is a non-contagious skin disorder that causes loss of color in the skin, and appears as white patches. Although it can occur on any area of the body, vitligo most commonly occurs on the face, lips, arms, hands, legs, and genital area. The condition is not uncommon, with about one to two percent of the world’s population suffering from vitiligo.

What are the causes of vitiligo?
The exact cause of vitligo is not known, but researchers believe the condition is caused by a combination of environmental, genetic, and autoimmune factors. The condition occurs when melanocytes, the cells which produce the skin’s color, die or lose their ability to produce pigment.

What are the risk factors of Vitiligo?
Vitiligo often runs in familes, with about 20 percent of all individuals who have vitiligo also having a family member with the condition. Most individuals who develop vitligo are in general good health, although some individuals with other autoimmune disorders also develop vitiligo. Since the cause is unknown, the only potential risk factors which have been tentatively identified are genetic predisposition and autoimmune disorders.

What are they symptoms of Vitiligo?
Vitiligo becomes apparent when one or more areas of the skin loses pigment for no apparent reason. In its usual course, vitiligo develops rapidly with loss of pigmentation occurring in one or more areas of the body. In most individuals, this condition occurs in cycles, with periods of pigment loss followed by periods when there is no change in pigment. In virtually all cases, skin pigmentation does not return on its own and there is no way to predict how much pigment will be lost in any given individual. Light-skinned individuals may not notice vitiligo until warmer months, when areas of the body fail to tan when exposed to the sun.

What types of treatment are available for vitiligo?
There is no cure for vitiligo, but the loss of skin color which is its symptom can be treated. In many fair-skinned individuals, the only necessary treatment is to avoid sun exposure, since lack of pigment is often not noticeable when there is no suntan. Those with darker skin may opt to use tinted makeup, special skin stains or self-tanning agents to achieve a temporary cover-up. Some individuals can benefit from micropigmentation tattooing.

When these temporary measures are not satisfactory, your specialist may advise a treatment to restore some pigmentation, or a series of procedures to remove the body’s pigment. In most cases, treatments aimed at returning pigment are temporary, although longer lasting than self-tanners and stains.

Light therapies and topical corticosteroids have been shown to be effective in returning pigmentation to many patients suffering from vitiligo. A new class of drugs called “immunomodulators” may also aid in vitiligo treatment, but are usually reserved for patients who do not respond to other treatments. Patients may also respond to excimer laser treatment.

For individuals who have lost most of their natural pigment, depigmentation therapy removes the remaining pigment, resulting in an even, white tone overall. This treatment takes about a year to complete and pigmentation removal is permanent.