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Having white patches on cheeks. Is there anything to restore pigment to charred white skin?

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General & Family Physician
Practicing since : 2005
Answered : 2570 Questions
I have white patches on my cheeks due to CO2 laser resurfacing that was not successful. This was 8 years ago, and the skin colour has never returned. The pigment has gone completely. Is there anything to restore pigment to charred white skin? I am currently trying pigmento cream and tablets, but I'm not sure if it is suitable for the problem I have. I use camoflauge make-up to hide the patches but I want to know if any colour will ever return or if there is a procedure to restore pigment? Thank You.
Posted Sat, 11 Aug 2012 in Pigmentation Problems
Answered by Dr. Prasad 6 hours later

Thanks for your query.

I understand your concern and I wish you had tried some treatment for this laser induced hypopigmentation (white patch) earlier.

Laser resurfacing is well tolerated by many individuals however a small percentage individual like you develop white patches. This occurs due to loss of melanocyte. These patches usually fade away with time. Those which do not fade away may be treated with steroid containing products. But since it has been 8 long years and you haven't seen much difference I doubt the results of medical creams / products. In such instances the options are:

1. Photochemotherapy - Ultraviolet rays (UVA and UVB) have been tried since long time to correct hypopigmentations. They have been successful many a time. However since it's been there for more than 3 years, you may need repeated trial for months to see any improvement. We can combine this with 8-methoxypsoralen (8-MOP) for better results.

2. Excimer Laser treatment - Excimer laser have been tried in the treatment of vitiligo. I guess this can also be an option in your case.

3. Melanocyte transplantation - Melanocyte from unaffected skin may be transplanted surgically to the affected area. This is known to produce good results. However this may be the costliest of all. I wouldn't know the cost of this procedure at your region.

I would suggest you to discuss about these options with a nearby dermatologist / cosmetic surgeon. In the meanwhile continue with the skin camouflage make ups.

Hope this helps. Let me know if you have any other enquiries.
If all your queries are answered, please close this discussion.

Best Regards
Above answer was peer-reviewed by
Follow-up: Having white patches on cheeks. Is there anything to restore pigment to charred white skin? 6 hours later

Thank you for your reply.

Do you have a name for any steroid containing products that I could use? I have been to see my GP but he says it is not the kind of thing the NHS would prescribe. Could I buy a steroid containing product or the 8-MOP without prescription?

How does excimer laser work and what is the recovery time period?

Many thanks

Answered by Dr. Prasad 20 hours later

Thanks again for following up,

I apologize for the delayed response. I was out of station and had no internet access, hence the delay.

Off those options which I mentioned the other day, I personally feel photochemotherapy or melanocyte transplantation would be the good options for you.

Coming back to your new queries about steroid cream, 8 MOP and Excimer Laser,

1. Many brands of steroids are available over the counter, if I had to suggest one to my patient it would be 1% hydrocortisone cream as it is mild and we need a milder on the face. However like I mentioned 8 years is a very long time and I am not sure if these would help in your case. If you wish to try it, please try them under the guidance of a physician. Steroids can produce harsh effects on face when used inappropriately.

2. 8-MOP is not available over the counter. Moreover this is just an adjuvant to phototherapy - increasing the effectiveness of phototherapy.

3. 308 nm Excimer is a laser surgery similar to patches. A small study (consisting of 21 patients with facial white spots) done in the past was treated with this form of laser; the study revealed 71% achieved more than 75% improvement.
This improvement may take 3-4 months time to occur.
That being said, some dermatologists believe that correcting a laser affected area again with laser would not be a good option.

Fix an appointment with a competent dermatologist experienced in treating hypopigmented patches / vitiligo and consider aforementioned treating options.

Hope this information suffices your needs. I will be glad to help in you need more medical information. Do close this discussion if all your queries are answered.

Wish you good luck!

Dr. Prasad
Above answer was peer-reviewed by
Follow-up: Having white patches on cheeks. Is there anything to restore pigment to charred white skin? 2 hours later

Many many thanks for your reply. You have been most helpful. I feel very self-conscious with the problem being on my face, so I will try your suggestions with the hydrocortisone cream first.

Another question if I am allowed. As there are no melanocytes in the hypopigmented area, would that make the area more susceptible to skin cancer? On the one hand I thought the sun may help with spontaneous re-pigmentation (wishful thinking!). Or would it be wise to use a high factor sunscreen? The camoflauge make-up has a high spf but I wonderered if I should expose my face to the sun more?

Many many thanks again for your help. It is very very much appreciated.

Answered by Dr. Prasad 50 minutes later
Dear XXXXXX thanks again;

If you are planning to start with hydrocortisone and if there is no improvement, my advice is not to try it for more than a month. Long duration steroid application on the face can cause thinning and injury prone skin. Even if you find it useful, I recommend you to take the advice of your local dermatologist and continue it.

Dermabrasion is another form of skin resurfacing therapy which is useful if the spot is not large.

As far as risks of cancer is concerned, there are no evidences to suggests significant risk from small non vitiligo hypopigmented patch (presuming there is no family history of cancer). You need not cover the area with sunscreen all the time.

Hope this suffices. Let me know if you have any more queries.
If all your queries are answered, do close this discussion.

Best Regards
Dr. Prasad
Above answer was peer-reviewed by
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