A mottled complexion can be one of the first signs of aging, a manifestation of years of "skin abuse," whether extrinsic—sun exposure, smoking, diet, acne scarring—or intrinsic causes determined by your genes and hormones. Whatever the cause, take heart that there is something you can do about them. There are hundreds of products and procedures available now to you, but your approach must be customized to your skin type & needs, and all require time, patience, diligence.It's easiest to think of all your options falling into just 3 categories, with broad descriptions of your many options following each one:
1. Exfoliation: mechanical or chemical removal of dead skin cells. This removes superficial epidermal pigmentation and pore blocking debris, reveals a more youthful cast to the skin surface, allows better penetration fo rejuvenating topical agents, and produces mild irritation of the dermis to induce new collagen deposition in the superficial dermis (that's a good thing!)
Your Options: products with any type of scrubbing "beads;" hydroxy acids (AHA or BHA such as glycolic, lactic, or salicylic); any number of in-office peel procedures using chemical solutions, (micro)dermabrasion, or lasers for deeper peels and more significant results.
2. Stimulate New Collagen Formation/Regulate New Skin Cell Production: loss of dermal collagen is a major factor in aging. So dermal thickening in this sense reduces depth & number of wrinkles, and provides nutritional support for the overlying epidermis, making it appear healthier, fresher, and more elastic (with 'snap' instead of crêpe-like 'sag.'). Because many prescription products & services that stimulate collagen formation also have a similar action on new skin cell production, we often lump them together. This normalization of skin cell production ensures normal functioning (including coloration) of skin cells, and can be a powerful ally in the battle against sun-damaged and aged skin.
Your Options: prescription retinoids (commerical names like Retin-A, Renova, Tazorac, Differin); over the counter retinols; non-ablative lasers/lights to heat & stimulate dermal tissue (like Aramis, IPL, or radiofrequency); ablative lasers that aggressively exfoliate to the point of inducing collagen rebuilding in the dermis.
3. Remove Abnormal Pigment and Blood Vessels: wait, you're probably thinking, "isn't this the whole point of the article, and why is this listed last?" This last step can only be effective and successful after first addressing the previous issues. Lightening excess pigment can be done very gradually with melanin suppressing topical products, or significantly accelerated through the synergistic effect of these topicals with laser/light therapy.
Your Options: Topicals with active ingredients such as hydroquinone 2%-4% (non-prescription is available only up to 2%); arbutin; kojic acid; azeleic acid; vitamin C; licorice extract.
In office procedures (this list will look very familiar): exfoliating peels, IPL which is absorbed into and destroys excess brown and red pigment; ablative lasers to physically remove superficially discolored layer of skin cells.
Generally, the deeper and more instant the procedure, the greater the risk of injury and post inflammatory hyper- or hypopigmentation, so discuss your options at length with your skin care provider.
And the most guaranteed, inexpensive, and surefire way to avoid this 1st sign of aging and prevent it from worsening? Full-spectrum UV sunscreen and minimizing excess sun exposure.
If you're lucky enough to have minimal aging changes so far, starting these preliminary steps early is the best way to avoid the expensive and labor-intensive effort required to resolve these pigmentation issues when they get intensify.
References:
Begoun, Paula. http://www.cosmeticscop.com/skin-care-facts-skin-lightening-brown-ashen-pigmentation-freckling-discoloration.aspx.
Kunin, Audry, M.D. The DermaDoctor Skinstruction Manual, 2005. Simon & Schuster, NY.
Seckel, Brooke, M.D. Save Your Face, 2nd Ed, 2006. Peach Publications, Concord, MA.
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