Forever 25 Medical Center shares common skin disorders 630 420 8080 Melasma It is a common complexion problem that predominantly affects women and causes brown to dark brown patches on the face. Although UV exposure is one of the leading causes of hyper pigmentation, it commonly occurs with oral contraceptive use and during pregnancy and resolves after delivery, hence it is referred to as the mask of pregnancy. Although the exact reason in unknown, there is much debate tying melasma to increased estrogen, progesterone, and melanocyte-stimulating hormone activity. Other causes include photosensitizing medications (Tetracycline, Doxycycline, Statins, Isotretinoin, Retinoic acid, Furosemide). it may be associated with some thyroid, adrenal or ovarian dysfunction and the use if some cosmetics in some individuals. The patients usually complain of pigmentation occurring temporally during pregnancy or in relation to using oral contraceptive pills. Upon examination there are three distributions seen in patients. One type may involve the forehead, cheeks, nose, upper lip, and chin. Another type may involve only the nose and the cheeks. another type may involve the sides of the jaw. A commonly used tool would be the Wood’s Lamp to visualize the excess melanin in the epidermis or the dermis. It is important to differentiate melasma from other conditions. Melasma can be difficult to treat. Since the onset of the disease is gradual, the resolution is gradual too. Hydroquinone still remains the first choice, although there are concerns regarding adverse effects with long-term use. It acts by interfering with the pigment producing cell’s function and viability. Those medications are potent and have their own set of side effects, like, skin irritation, and redness. Burning crusting and swelling would warrant discontinuation. hypo pigmentation may occur, and sometimes secondary hyper pigmentation, with prolonged use. If used with benzoyl peroxide, or other peroxide products, dark staining of the skin may occur. Other medications are retinoids (Retin-A). Retinoids act by increasing keratinocyte turnover and decreasing melanocyte activity. Since retinoids are known teratogens, it is important to place the patient on a reliable method of birth control. Retinoids are known to cause mild skin irritation, photosensitivity and hyperpigmentation. These treatments have an increased efficacy when used in combination with one another. The FDA has approved a cream with the combination of ( hydroquinone, tretinoin, and corticosteroid ) a triple topical cream used for treatment of melasma. Tri-Luma contains 3 medications: hydroquinone is a skin lightening agent, and tretinoin is a form of vitamin A. fluocinolone is a steroid. Other topical medicines include azelaic acid, kojic acid and ascorbic acid that may help lighten the melasma. Procedures for melasma include chemical peel microdermabrasion Galvanic or ultrasound facials with a combination of a topical crème/gel. Green LED light, used regularly, may also help as it is known to help fade dark spots and hyper pigmentation. Laser can be used in patients that have more extensive disease that is refractory to alternative modalities. Non ablative laser has been used to reduce the discoloration, and Fractional resurfacing, showed a 75-100% clearing of melasma after 4 – 6 treatments. Regardless of treatment, lifestyle modification is key in preventing the recurrence of lesions. Patients are instructed to avoid sun exposure, and tanning beds, and to use protective clothing, and high SPF sunscreen (SPF 30 and above), every 2 hours, and to wear a wide-brimmed hat when outside. Melasma tends to be a chronic condition and there is no magic bullet for treatment. As it develops slowly, it improves slowly with a combination of treatments. Excessive sun exposure and tanning will always be a significant factor in lack of response to melasma treatments.
Posted on: Sun, 02 Nov 2014 15:15:09 +0000
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