Hyperpigmentaion Protocol

The Obagi Nu-Derm system (7 products) and Skin Medica Hyperpigmentation System (4 products) are equally effective in reducing hyperpigmentation. Both systems will improve complexion, color and youthfullness and reduce:

  • Photodamage
  • Pigmentation
  • Sallowness
  • Erythema (redness)

Skin Medica produces quicker results within 4 weeks, but both the Obagi Nu-Derm and Skin Medica Hyperpigmentation system produce statistically similar results by 12 weeks. The four product Skin Medica System is less costly than Obagi Nu-Derm (7 products) and can be customized for patient moisture level and wrinkling.

Skin Medica Hyperpigmentation Protocol. (Asterix indicates mandatory regimen of 4 products, which will give the same results as the seven product Obagi Nu Derm system*)

  1. Choice of One Cleanser. Over-the-counter (OTC) cleansers are either petrolatum-based or are based on soap products-both of which are suboptimal for damaged or hyperpigmented skin. Also OTC cleansers are not tailored to the moisture level of the patient’s skin. Dr. Katsaros likes:
    • For normal moisture level skin: Botanical based cleansers (that avoid petrolatum) are best. Skin Medica facial clenaser twice per day.
    • Oily Skin: Foaming cleansers from either Skin Medica.
    • Dry or sensitive skin responds to Skin Medica sensitive cleansers.
  2. Toners are used to restore the pH to normal. This toner step is mandatory with Obagi NuDerm, but is optional with the Skin Medica Hyperpigmentation protocol. Cleansers tend to reduce the skin pH that occurs after the cleansing process. Foaming cleansers (used for oily skin) are acidic and reduce the pH more than other clensers.
    • For the Skin Medica hyperpigmentation protocol, IF the Skin Medica Rejuvenation (botanical) cleansers is used (like in most cases), then steps 3-4 below will be enough to neutralize it and no toner is needed (majority of cases).
    • If a foaming (acidic) cleanser is used , a toner needs to be added.
    • Hyperpigmentation patients that are treated with Intense Pulse Light (IPL) will require the Skin Medica restorative toner for dry post-procedure skin.
  3. EpiQuin Micro 4% hydroquinone, twice per day. If there is no wrinkling or sagginess of the skin, steps 5 may be skipped. If the skin has normal moisture or is oily, step 6 (moisturizer) may be skipped.
  4. Tri-Retinol Complex ES, twice per day.
  5. Tissue Nutrients System (TNS) provide growth factors for aged and wrinkled skin. If there is hyperpigmentation only-without wrinkling or sagging, this step is not needed. If there is wrinkling or saggyness in addition to hyperpigmentstion, TNS should be added. TNS growth factors are not part of the Obagi Nu Derm system. TNS provides growth factors that are needed by the dermal matrix to be healthy. The growth factors are actually taken from human fibroblast cultures. After 3 months of treatment with TNS, fine wrinkles are reduced because the thickness of the collagen matrix (that supports the skin) becomes thicker and tighter.Recommended products:
    • TNS Essential Serum is for normal skin.
    • TNS Recovery Complex is for dry or very sensitive skin.

    Not all growth factor systemsare created equal. OTC products sometimes are labeled as having nutrients or growth factors-but the growth factor concentration used in OTC products is less than 10%, which is useless. Prescription grade TNS systems have growth factors in concentrations of 40-50%.

  6. Facial Moisturizers need to be tailored to the patient. For a Skin Medica patient on a pure hyperpigmentation protocol, this step is not necessary. Patients who are on TNS, should apply a moisturizer.
    • Oily skin: Ultrasheer moisurizers are best for oily or acne proned skin.
    • Normal skin moisture, not damaged: Microsplit Vitamin C/E anti-oxidant preperations are acceptable.
    • Wrinkled and/or thin skin: High level anti-oxidants.
    • Thin Skin: Add estradiol if skin is thin.
    • Very Dry Skin: Requires tissue growth factors, ceramide. May add estradiol or anti-oxidants later.
  7. Sun Screens are a MUST for all patients treated with retinol, retinoids, vitamin A products, tretinoin. Not all sunscreens are created equal. The SP rating is the least important factor in sun protection. A sun screen with high SP rating that easily dissolves in water (or sweat) will not protect the skin very long-regardless of SP rating. A sun screen that is part of a heavy cream, will stay on, but may plug the pores and cause acne. A mineral based SP30 sun screen that is highly water resistant strikes good balance between sun protection-without smothering the pores.
    • Skin Medica SP30 or Obagi SP30 sun screen is adequate