Can My Deep Dermal Hyperpigmentation Be Removed?

I’m a 40-yr.-old white female with pale skin. At Age 4 I first noticed a permanent, see-thru blue/gray discoloration on my abdomen. There was no trauma as a child but I did have an umbilical hernia at birth–possibly related? At Age 20 I was hit with a ball to the thigh. What began as a red mark spread down my thigh & to my shin over a year's time, leaving behind the same permanent discoloration as described above (the front of my thigh occasionaly burns & tingles). 5 yrs. ago I took SubQ injections of Lupron in my abdomen. A few days after each shot the same type of discoloration appeared & stayed. Within the odd areas, there’s no change in skin texture & hair growth is normal but my veins seem to be larger and more visible than those in unaffected areas. Trauma only seems to affect the skin on the right side of my body; the left heals normally. At times it seems that my right side appears slightly darker OVERALL (more bluish) than the left. I DO tend to bruise easily & scar terribly but bleeding rate seems normal. I'm not diabetic. The discolorations make my skin look shadowy & I'd like to remove them but don’t know what course of action to take because doctors haven't been able to agree on a pathology. I always assumed Post Inflammatory Hyperpigmentation, but I’ve also heard Copper toxicity, Hemosiderin, Morphea, impaired circulation, muscle/ tissue/nerve damage & light reflection. I want to avoid doing a biopsy due to the possibility of trauma reactivating the process. Might you have an opinion concerning the cause of these discolorations & do you think anything can restore my natural skin color? The self-esteem issues & depression caused by this disorder have taken a terrible toll! I’d be willing to try lasers, UV therapy, medications, ointments, diet – whatever it takes. Just not sure which modalities will reach the deep dermis or veins, if that’s where the problem lies. Thanks so much for your time & thoughts!

Yours very sincerely,
A.L.
Cleveland, OH

[Alan Rockoff, MD]

It's hard to tell without seeing you, but postinflammatory pigmentation would seem most likely.  You can't really know where the pigment is within the skin without a biopsy.  A biopsy would indeed probably produce more pigment, but this would be confined to a 4-millimeter size spot, so it might be worth considering.  Having said all this, treatment success for increased pigment is generally poor.  Testing small areas with lasers might be worth considering.  Such lasers are generally harmless and non-invasive.  At the end of the day, however, after all these years of having this problem, I believe that you should consider counseling to come to terms with your body.  Many people have blemishes and other skin irregularities that simply can't be removed, and have to find some way to accept them and thus accept themselves.

Good luck.

Dr. Rockoff

[scarface457]

Dear Dr. Rockoff,
As a person living with a facial scar, I felt compelled to comment on your suggestion that pumpkinlover 08 find a way to accept herself through counseling. People with scars don't have trouble accepting themselves. They have trouble accepting the response of others to their scars. The response of others does lead to loss of quality of life and lost opportunities that are not all in their heads. The fact that the beauty industry and including the plastic surgery industry are booming, despite difficult financial times, speak to this.
You may have more accurately suggested that she get counseling to help her cope with her loss instead of problematizing her. If you have ever performed any sort of scar removal in your practice, your attitude towards this individual's pain seems hypocritical and lacking in empathy. That said, I don't know what your practice comprises of. Your suggestion that she needs an attitude change is a matter of blaming the victim which is an added insult to the injury of her scars. What is needed but not realistically forthcoming is a world that doesn't care about physical appearance. Therefore what she needs is medical help as to the cause of her scarring and until then, some sympathy, understanding and ways to compensate for her losses
Let the psycholigist decide what she needs help with.
Just sign me,
A person who cares and understands her pain