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Melasma is skin discoloration (tan, brown, blue, or black) found most commonly on
sun-exposed areas of the face. Usually mistaken for a tan, Melasma appears around the
cheeks, forehead, upper lip, nose, chin, and jaw line. It also may appear on the
forearms but this is quite rare. Women with darker skin tones
(especially Hispanic, Asian, Indian, and Middle Eastern) are at greatest risk although
you don’t have to be women to be afflicted as up to 10% of cases are shown in dark
skinned men.
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Melasma is a common skin disorder. Melasma can be associated with the female hormones
estrogen and progesterone and is especially common in pregnant women, women who are
taking oral contraceptives, and women taking hormone replacement therapy during
menopause. The use of cosmetics is associated with melasma but the relationship
between the two is not clearly understood. Sun exposure is strongly associated with
melasma
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Melasma has no associated symptoms.
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Melasma causes irregular tan, brown, or even blue/black patches on parts of the face
including cheeks, forehead, nose, chin, jaw line, and upper lip. It is most often
evenly matched on both sides of the face.
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Your physician can usually diagnose melasma, using a Wood’s lamp, based upon the
appearance of your skin.
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The best treatment for melasma is prevention. The key to preventing melasma is sun
avoidance and daily sunscreen use. However, for most of us, since it is too late
for prevention there are a number of treatment options available.
Bleaching Creams
- What they are?
Over-the-counter creams contain 2 percent hydroquinone, which is a bleaching
agent. Prescription creams may use single agents such as Retin-A (tretinoin) or
combinations of medications such as hydroquinone with tretinoin plus a cortisone
cream.
- What are the risks?
Over the counter bleaching creams are usually well tolerated and may gradually
lighten melasma over a couple of months however, they are not very effective.
Prescription formulations are often more effective but may cause more side effects
(such as redness, drying, and peeling) plus they are expensive. Creams may not
work for everyone and the risks and benefits need to be discussed with your
physician.
Chemical Peels
- What they are?
Your physician can administer a peel using a variety of different chemicals to
remove age spots, melasma, freckles, wrinkles, and fine lines. Chemical peels may
smooth and firm the skin and may lighten dark areas gradually. The superficial
peels such as a glycolic acid peel can be applied during your lunch hour and there
is no recovery time. Deeper peels are more effective but require longer recovery.
See more details under discussion chemical peels.
- What are the risks?
Different kinds of peels carry different risks. Superficial peels are usually
quite safe however, you may need a series of superficial peels (done approximately
once a month) before you'll notice improvement. Costs can add up if you choose a
series of peels. The risks and benefits vary depending on the kind of peel and
need to be discussed in detail with your physician.
Laser Resurfacing
- What is it?
Laser resurfacing is an in-office treatment where age spots, melasma, wrinkles,
and fine lines are “burned” off with a laser. Laser resurfacing can remove most
age spots, melasma, and wrinkles often in just one treatment. Some lasers, such as
the CO2 laser are considered the gold standard in terms of facial rejuvenation.
With good sun protection, the effects can last up to five years. See more details
under discussion of lasers.
- What are the risks?
Lasers actually remove the outer portion of the skin (called the epidermis).
Because of this, you may experience some pain as well as redness and peeling.
You may even form scabs in the days after the procedure with your recovery time
at least a week. Laser therapy is also expensive; one treatment can cost anywhere
from $1,000 to $5,000 depending on how much of your face is treated. The risks
and benefits of laser resurfacing need to be discussed in detail with your
physician.
Intense Pulsed Light Therapy (IPL)
- What is it?
IPL is one of the newer forms of facial rejuvenation. Unlike lasers, which use
intense, focused light, IPL is intense broadband light. Although IPL delivers
energy to both the superficial and deep layers of the skin, the epidermis is
spared from damage. Thus, there is virtually no recovery time. In the studies
that have been performed so far, IPL can smooth the skin and fade age spots,
freckles, melasma, and even broken blood vessels. With good sun protection,
improvements usually last for about a year.
- What are the risks?
IPL is safer than laser therapy because it does not damage the epidermis.
There may be some pain during the procedure but no recovery time is required.
Unlike laser therapy however, you may need multiple treatments (average is 4-6 at
three weeks intervals) to gain the full benefit. The cost is variable, but is
usually more expensive than peels and less expensive than lasers. The risks and
benefits of IPL therapy need to be discussed in detail with your physician.
Other facts about melasma
Sun exposure is said to be the biggest culprit. In the summer, melasma tends to
darken after exposure to the sun and then fade in winter when the sun is not as
harsh. Melanin absorbs the energy of the sun’s rays in order to protect the skin.
Tanning occurs as a result, causing dark areas to get even darker.
The melasma pregnancy mask syndrome impacts primarily Latino and Asian women by
producing darkened coloring spots on the face. Skin inflammations from allergic
reactions or waxing of facial hair, especially above the lip can also be a trigger
in addition to a predisposition to the affliction. Some medications, such as the
antibiotics like tetracycline along with some anti-seizure and anti-malarial drugs
can also contribute to its cause.
The good news is that melasma symptoms tend to fade over time, usually a 3 to 4
month period, after initial manifestation. Laser skin resurfacing offers a
relatively successful and controlled short-term strategy to the facial areas
affected by melasma. Chemical peels are also a consideration. An alternate for use
that tend to produce encouraging results may be steroidal creams and even skin
bleaching cream formulations that include hydroquinone or retinoic acid.
It is vital that you avoid the sun in addition to contraceptive pills that are
prone to this type of reaction. Lifestyle choices also have a heavy impact on the
rise and spread of melasma. Genetics and family heredity are key initial factors but
avoidance of these two main elements can really impact the continued affliction.
Complex factors may trigger melasma in women as well as the 15% of men that are
afflicted. Topical creams have been known to produce great results, as have skin
bleachers, chemical peels and laser skin resurfacing which all provide positive
effects. Left alone and not intensified by sun exposure, melasma tends to stay
around for less than a year. Impacted skin cells with the discoloration are
"surface" cells and melasma becomes "permanent" if the discolored area splits,
allowing these hyper-pigmented cells to go deeper into the skin layers. When the
discolored cells with melasma are settled within your deeper dermal tissue levels,
they resist conventional treatments.
Be aware of the health of your skin is a major responsibility. Try to avoid
drying your skin out, as well as over moisturizing it. It is a good rule of thumb
to avoid sun exposure, but to use sunscreen daily with atleast a SPF 30 while taking
in the appropriate supplements to counter the sun’s rays, ensuring both your inside
health and outside appearance are as well as they can be.
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