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Pigmented lesions and tattoos both represent unwanted colored material in your skin. Treatment is requires either removing the pigment directly (by removing the involved skin), or by damaging the pigment, allowing your body to remove the pigment. Treatment options (for damaging the pigment) are laser treatment and intense light treatment (Photoderm®). Each treatment choice has its advantages and disadvantages. More than one treatment is usually needed for any option selected. No treatment is without risk.

I have used two different lasers and the Photoderm®. In my experience, the Photoderm has been the most effective. The ruby laser and Photoderm treatment use light energy targeted at the pigment itself. The pigment absorbs the light energy, disrupting the pigment into smaller fragments. These smaller pigment fragments are then removed by your body’s white cells, similar to pac man. The full effect of any single treatment may take 4-6 weeks. Darker colors are the most sensitive to treatment.

The most common side effect is a burning feeling with some redness at the treatment site. Side effects involve some form of a burn, ranging from a light "sun burn" to a blister. Local color change is possible. To limit risk of injury, before starting treatment, a test area is performed. The test area is monitored from several days to 2 weeks. Occasionally, retesting may be necessary.

The main advantage of Photoderm® is the low risk of a burn. The main disadvantage is the need for 2-5 treatment visits 4-6 weeks apart.

The CO₂ laser destroys the skin down to the pigment layer, creating a second degree burn. The pigment is destroyed as the tissue holding the pigment is destroyed. Initially, you have a layer of laser "scab." The pigment is still present, and may even appear brighter. As the treated area heals, the pigment fades. Areas of pigment will likely persist. Pigment remaining 3-6 months after treatment will require additional treatment.

Skin color in treated areas may become either lighter or darker. Color change is usually temporary, but may be permanent. If the discoloration is present one year after treatment, it will be permanent. Areas to be treated should be protected from the sun for 3-4 weeks before starting treatment (including test treatment). Avoid sun exposure to treated areas for 2-4 months (longer, if you tan very easily)

After treatment, you can resume normal activity according to your comfort. Cool compresses help with initial discomfort. If any scabbing develops, keep the area lubricated with either antibiotic ointment or Vaseline.

Activity & wound care is the same as after any other burn: Keep the area clean & lubricated. Baby shampoo is recommended for washing. Depending on the area to be treated, specific lubricants will either be given to you at the time of treatment, or they will be suggested for you.

The main advantage of CO₂ laser treatment is that the vast majority of the pigmented lesion is destroyed at 1 time. The main risk is a scar similar to your vaccination mark.

Risks of treatment are the same as any other surgery. These include bleeding, infection, scarring, altered sensation, altered skin color (lighter or darker), possible need for additional treatment, altered skin texture, and failure for the pigmented area to improve.