Ashy Dermatosis

Ashy dermatosis is a common cause of pigmentation in darker & ethnic skin types. This form of pigmentation lies deep in the surface of the skin hence creams are ineffective in most cases. The highest success is with medical therapy combined with pico laser resurfacing.

Recovery

2 minutes

Results

4+ months, variable

Treatment Time

2 minutes

Aftercare

SPF

Treatment science scoremelasma clinic

The science of Ashy Dermatosis Treatments

  • Ashy dermatosis is a common cause of pigmentation in ethnic skin types
  • Treatments are medically based, however lasers can be effective in some cases
  • Picosecond lasers provide the highest rate of clearance with no side effects
  • Even with the best technology success rate is only 40-50% 
  • It can take up to 4 months to notice improvements 
  • Joint management with a medical dermatologist is required in all cases

The picosecond laser can be effective in some cases of Ashy Dermatosis. Picosure Pro provides fast clearance without any downtime.

What is Ashy Dermatosis?

Ashy dermatosis is an acquired disorder of pigmentation that presents as dark flat patches that affects the face, neck, trunk & limbs. By definition, it is not itchy (no symptoms). Ashy runs a chronic course, often taking many years before improving (if at all).

What is the cause of Ashy dermatosis?

In short, the cause is unknown, however genetics, infection & inflammation may play a role in the development of pigmentation. Ashy is more commonly seen in dark ethnic skin, namely Asian & Central American patients.

What is the mainstay of treatment for Ashy dermatosis?

A medical dermatologist can guide you accordingly. The 4 main treatment arms are-

  1. Sun protection to reduce pigment due to Ashy. 
  2. Creams to help fade pigment. 
  3. Tablets.
  4. UVB.

*Note: Dr Davin Lim is a procedural dermatologist, namely his work focuses on lasers, deep peels & other physical treatments of pigmentation. He does not prescribe medications for Ashy dermatosis & will refer you to a colleague in Sydney for joint management. Cutis Dermatology Brisbane has medical dermatologists who can assist in the management of all forms of pigmentation.

Your clinician will guide you through your specific protocol & pigment corrector. This only applies to potentially irritating agents, it is not a blanket guide for all topicals/pigment correctors 
.
Still sensitive, even if short contact? 
.
1️⃣Use half the amount (dilute in moisturizer) 
.
2️⃣ moisturiser before & after
. 
3️⃣Titrate use, ie. skip a day….or three
.
4️⃣Test spot for allergy (very rare, skin irritation more common). Use a tiny amount, apply to the inner arm, photograph 📸the reaction taking note of the time it takes to develop irritation. Show this to your treating clinician to interpret & they will guide you. Irritation is different from allergic reactions💯
.
👉🙏🏼Addition of topicals will be guided by your treating clinician, based upon your skin sensitivity, current topical use & treatment (peels vs lasers). Timing is important 
.
The Melasma Clinic
Brisbane | Sydney🇦🇺
.
#themelasmaclinic #melasma #dermatologistsydney

Your clinician will guide you through your specific protocol & pigment corrector. This only applies to potentially irritating agents, it is not a blanket guide for all topicals/pigment correctors
.
Still sensitive, even if short contact?
.
1️⃣Use half the amount (dilute in moisturizer)
.
2️⃣ moisturiser before & after
.
3️⃣Titrate use, ie. skip a day….or three
.
4️⃣Test spot for allergy (very rare, skin irritation more common). Use a tiny amount, apply to the inner arm, photograph 📸the reaction taking note of the time it takes to develop irritation. Show this to your treating clinician to interpret & they will guide you. Irritation is different from allergic reactions💯
.
👉🙏🏼Addition of topicals will be guided by your treating clinician, based upon your skin sensitivity, current topical use & treatment (peels vs lasers). Timing is important
.
The Melasma Clinic
Brisbane | Sydney🇦🇺
.
#themelasmaclinic #melasma #dermatologistsydney
...

Dr Vee Mang is an Australian trained physician with extensive experience in skin, having worked in the field of dermatology. She’s a cosmetic physician who works with Dr Van Park & Dr Davin Lim in Woollahra, Sydney
.
👉Her interests: Pigmentation, neurotoxin, acne management, anti-aging
.
📖Bookings: Open for consultation, send your expression of interest at our website, melasmaclinic.com.au Yes, an expression of interest is required for the Sydney clinic. 
.
The Melasma Clinic
Brisbane | Sydney🇦🇺
.
#themelasmaclinic #melasma

Dr Vee Mang is an Australian trained physician with extensive experience in skin, having worked in the field of dermatology. She’s a cosmetic physician who works with Dr Van Park & Dr Davin Lim in Woollahra, Sydney
.
👉Her interests: Pigmentation, neurotoxin, acne management, anti-aging
.
📖Bookings: Open for consultation, send your expression of interest at our website, melasmaclinic.com.au Yes, an expression of interest is required for the Sydney clinic.
.
The Melasma Clinic
Brisbane | Sydney🇦🇺
.
#themelasmaclinic #melasma
...

Dr Van Park is the co-founder of The Melasma Clinic. She’s a key opinion leader in the field of aesthetic injectables with her innovative & novel injection techniques with neuromodulators & soft tissue injectables
.
👉Rumor has it that Davin Lim fixed her melasma & hence why she founded this clinic. 
.
📖Bookings: She’s closed her books, but occasional consults may arise 
.
The Melasma Clinic
Brisbane | Sydney🇦🇺
.
#themelasmaclinic #drvanpark #dvp #clinicdvp #cosmeticphysician

Dr Van Park is the co-founder of The Melasma Clinic. She’s a key opinion leader in the field of aesthetic injectables with her innovative & novel injection techniques with neuromodulators & soft tissue injectables
.
👉Rumor has it that Davin Lim fixed her melasma & hence why she founded this clinic.
.
📖Bookings: She’s closed her books, but occasional consults may arise
.
The Melasma Clinic
Brisbane | Sydney🇦🇺
.
#themelasmaclinic #drvanpark #dvp #clinicdvp #cosmeticphysician
...

Davin Lim is a technician & co-founder. He comes up with the diagnosis, management plan & settings, nothing more. He fixed Van’s melasma & the rest is history☄️
.
👉In store: working on AI for ‘virtual Davin’, namely programmed AI bot for Q and A, coupled with AI video & virtual voice. Bot Q & A will be released in the next few weeks, virtual video & voice within 6 months (hopefully)
.
📖Bookings: handful of appointments available in Sydney every month, expression of interest via melasmaclinic.com.au 
.
🏡The Melasma Clinic
Brisbane | Sydney🇦🇺
.
#davinlim #drdavinlim #themelasmaclinic #dermatologistsydney #dermatologyclinicsydney

Davin Lim is a technician & co-founder. He comes up with the diagnosis, management plan & settings, nothing more. He fixed Van’s melasma & the rest is history☄️
.
👉In store: working on AI for ‘virtual Davin’, namely programmed AI bot for Q and A, coupled with AI video & virtual voice. Bot Q & A will be released in the next few weeks, virtual video & voice within 6 months (hopefully)
.
📖Bookings: handful of appointments available in Sydney every month, expression of interest via melasmaclinic.com.au
.
🏡The Melasma Clinic
Brisbane | Sydney🇦🇺
.
#davinlim #drdavinlim #themelasmaclinic #dermatologistsydney #dermatologyclinicsydney
...

IPL is awesome for non-melasma pigmentation but is often a cause of flare ups for melasma pigment. The reason is the excessive heat that is often associated with IPL. Exception to this rule is the use of exact filters in correct pulse widths with co-prescription of pigment inhibitors- medical therapy. It can be done, but the threshold for error is very thin💯
.
👉This patient: treated with old fashioned dermal toning with nano-lasers, Spectra by Lutronic, in addition to medical therapy
.
📆👉Timeline: 10 weeks. Pico lasers offer faster resolution, if performed correctly. 
.
Dr Davin Lim
Dermatologist
Brisbane | Sydney🇦🇺
.
#drdavinlim #IPL #IPLtreatment #melasma #melasmacure #melasmasurvivor #melasmaskincare #themelasmaclinic #sydneydermatologist

IPL is awesome for non-melasma pigmentation but is often a cause of flare ups for melasma pigment. The reason is the excessive heat that is often associated with IPL. Exception to this rule is the use of exact filters in correct pulse widths with co-prescription of pigment inhibitors- medical therapy. It can be done, but the threshold for error is very thin💯
.
👉This patient: treated with old fashioned dermal toning with nano-lasers, Spectra by Lutronic, in addition to medical therapy
.
📆👉Timeline: 10 weeks. Pico lasers offer faster resolution, if performed correctly.
.
Dr Davin Lim
Dermatologist
Brisbane | Sydney🇦🇺
.
#drdavinlim #IPL #IPLtreatment #melasma #melasmacure #melasmasurvivor #melasmaskincare #themelasmaclinic #sydneydermatologist
...

Dermamelan & Cosmelan peels have arrived 💯
.
👉Novel peels: are a good option for primarily epidermal melasma and superficial pigmentation, albeit a downtime of 6-12 days 
.
👌🏻Employ peels based upon diagnostic features of pigment and allowed recovery of the patient 
.
🏡The Melasma Clinic Sydney-Brisbane 🇦🇺
#melasma #cosmelan2 #cosmelanmask #cosmelanpeel

Dermamelan & Cosmelan peels have arrived 💯
.
👉Novel peels: are a good option for primarily epidermal melasma and superficial pigmentation, albeit a downtime of 6-12 days
.
👌🏻Employ peels based upon diagnostic features of pigment and allowed recovery of the patient
.
🏡The Melasma Clinic Sydney-Brisbane 🇦🇺
#melasma #cosmelan2 #cosmelanmask #cosmelanpeel
...

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Can creams fade treat Ashy dermatosis?

Creams have a marginal effect on Ashy dermatosis, however can be useful in the active phase of this condition. Your dermatologist can guide you. Three types of creams can be used, depending on the phase of Ashy. 

  1. Calcineurin inhibitors such a tacrolimus or pimecrolimus (Protopic or Elidel). This group of creams do not have the long term side effects of steroids. 
  2. Pigment inhibitors are used when Ashy dermatosis is in the remission phases. They include hydroquinone, arbutin, azelaic acid, ascorbic acid & cysteamine. Creams are marginally effective & ideally should be combined with lasers & medical therapy. 
  3. Corticosteroids to reduce inflammation. Example; Advantan Fatty ointment. This is used in a pulse manner (your dermatologist will guide you). Steroid creams are only useful in the very early phase of Ashy, even then, their use is controversial as it is used more commonly in other skin conditions that may look like Ashy- eg. lichen planus pigmentosus.

The Melasma Clinic difference

Our specialist clinic is overseen by dermatologists who provide a comprehensive & bespoke approach to skin care. We take into account the complexity and individuality of your skin. Our pigment solutions include preventing future recurrences of melasma. Our ethos is to improve & maintain your skin’s health & vitality as an ongoing commitment to our patients.

What results can I expect from a Picosure laser?

To date, this is the most effective laser for Ashy Dermatosis. Even with the latest in technology, clearances are not predictable with an efficacy rate of less than 50%. It can take up to 3-4 months before results are seen. 

Lasers are always adjunctive to medical management of Ashy, namely lasers are combined with tablets & topical creams.

Dr Davin Lim

645K subscribers

How many sessions will I require to clear Ashy pigmentation?

A series of 4-8 sessions are required spaced 3-6 weeks apart. Results may take up to 3 months, a failure rate of 50% is not uncommon. 

*For deeper dermal pigmentation, more sessions are required, up to 16 sessions over 1.5 years.

What is the treatment like?

Treatments are comfortable & fast, taking less than 2 minutes to perform. On a pain scale of 1 to 10, it rates as a 1 to 2.

Are lasers guaranteed treatment for Ashy?

No, lasers are only successful in less than 50% of cases, even with the most technologically advanced picosecond lasers. It can take up to 4 months before results are seen, often requiring 3-4 sessions. Lasers are always combined with medical therapy.

Can our dermatologists diagnose & manage Ashy dermatosis?

Our dermatologist can diagnose Ashy (the diagnosis is not difficult), however our clinic will not manage Ashy dermatosis as this requires joint management with the medical team. This is primarily due to the fact that multiple follow up appointments are required for medical therapy, especially if tablets are required. 

*Our appointment times are limited, hence our dermatologists will refer you for medical management at the Skin Hospital, Darlinghurst, Sydney or Cutis Dermatology, Brisbane.

Peel type

Recovery

Number of sessions

Costs

Glycolic Nil 5 $
Cosmelan 7 days 1 $$$
Jessner TCA 8 days + 1 $$$$

Will Ashy dermatosis return after treatment?

Once cleared the chances of recurrence is low, however in some cases active inflammation may cause a rebound of Ashy. If this happens, your dermatologist will start you on medical therapy with tablets & prescription creams.

Our specialist clinic is overseen by dermatologists who have extensive experience in the treatment of all forms of pigmentation, including Ashy dermatosis.

What patient groups are predisposed to Ashy dermatosis?

Ashy dermatosis or erythema dyschromicum perstans is commonly seen in ethnic groups, including Asian (Indians, Sri Lankan) as well as Central – South Americans. It is more common in females than males, often in the ages of 20 to 60.

What are other conditions that may look like Ashy dermatosis?

This is where it gets really interesting, as there are many conditions that may look like Ashy. Your medical dermatologist can guide you. We consider other diagnosis such as-

*Dr Davin Lim will refer you for joint management by a medical dermatologist at the Skin Hospital in Sydney or medical dermatologists at Cutis Dermatology in Brisbane. 

How will my dermatologist know the difference between Ashy & other forms of pigmentation?

In some cases a biopsy is required to support the diagnosis of Ashy. This involves taking 2-3 mm of skin in affected areas. The skin is then analyzed under a microscope. 

Our dermatologist can provide you with a second opinion, however will NOT be involved in the medical management of Ashy dermatosis as this requires close follow up.

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How will my dermatologist know the difference between Ashy & other forms of pigmentation?

In some cases a biopsy is required to support the diagnosis of Ashy. This involves taking 2-3 mm of skin in affected areas. The skin is then analyzed under a microscope. 

Our dermatologist can provide you with a second opinion, however will NOT be involved in the medical management of Ashy dermatosis as this requires close follow up.

More of our mostFrequently asked questions

Can chemical peels be effective in treating erythema dyschromicum perstans - Ashy?

What is phototherapy & is it effective for Ashy dermatosis?

What is clofazimine & is it effective?

What is isotretinoin & is it effective in treating Ashy dermatosis?

What are other types of lasers that can treat Ashy dermatosis?

What natural remedies are there for Ashy dermatosis?

A SummaryTreating Ashy dermatosis

Dr Davin Lim | Dermatologist
The Melasma Clinic, Brisbane | Sydney

This is a common cause of acquired pigmentation seen by dermatologists. Our clinics in Brisbane & Sydney see 1-2 cases a week. In most cases a biopsy is required. If you have Ashy, we recommend joint management by a medical dermatologist & our clinicians. Why? Because in some cases tablets are required & frequent monitoring is required. Your treating dermatologist can refer you for consideration of laser treatment once a diagnosis has been ascertained. 

Lasers can be partially successful in fading some cases of Ashy. A failure rate of 50% is seen. There are no guarantees that even with the very latest pico lasers, your pigmentation will be treated. Test spots are sometimes required. 

Laser parameters are tiered towards the patient. 

  • Low level pico laser. This no downtime protocol takes 4-8 sessions to complete. Sessions spaced 3-8 weeks apart. Risk of PIH is very low (almost never seen). 
  • Mixed laser settings with two wavelengths- 1064-755; novel laser settings to address pigment in different depths.