Surgeon General finally warns about Skin Cancer

Look how the sun hits your body while swimming and playing...

Look how the sun hits your body while swimming and playing…

This past Tuesday, the United States surgeon general issued a call to action to prevent skin cancer, calling it a major public health problem that requires immediate action.

Nearly 5 million people are treated for skin cancer each year. According to the American Cancer Society,  more cases of skin cancer are diagnosed annually than breast, prostate, lung and colon cancer cases combined and skin cancer rates are increasing.

“We all need to take an active role to prevent skin cancer by protecting our skin outdoors and avoiding intentional sun exposure and indoor tanning,” said Acting Surgeon General Boris D. Lushniak, MD, MPH.

I say this all the time, but it bears repeating as often as possible:

“Most skin cancer is 100 percent preventable.” 

Most cases of melanoma – as many as 90 percent – are believed to be caused by cumulative exposure to UV rays. UV rays are also a major risk factor for the most common curable forms of skin cancer,  basal and squamous cell skin cancers. Exposure to UV rays comes from the sun and other sources like tanning beds and sunlamps and the U.S. Food and Drug Administration (FDA) now requires that tanning beds and sunlamps carry a warning stating people under 18 should not use them. Lushniak said there is a flawed perception in the US that tanned skin looks healthy, and that needs to change. I always say,

“Tanned skin is damaged skin.”

According to the Melanoma Education Foundation, One blistering sunburn before age 20 doubles your lifetime risk of melanoma. Three or more blistering sunburns before age 20 multiplies your lifetime risk by five.

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How many times have you gotten a bad sunburn?

Reduce your risk of skin cancer for yourself and your children:

-Jodi, proud owner of a lily white complexion.

Can babies go in the sun?

Question:  I’ve heard conflicting opinions about what age babies can go in the sun. Is there a sun exposure rule for healthy skin for babies?

Always have baby wear a had to shade her face in addition to sunscreen in babies over 6 months

Always have babies over 6 months in age wear a hat plus sunscreen and other protective clothing

Answer:  I  second the advice of the The American Academy of Pediatrics, the U.S. Food and Drug Administration and the American Cancer Society: Keep babies under 6 months old out of the sun entirely and do not apply sunscreen on babies younger than 6 months.  Babies who are 6 months or older should be protected with clothing, hats, a broad-spectrum sunscreen and shade. Look for broad-spectrum formulations specifically for babies and toddlers who have more sensitive skin than adults. The time that they spend in the sun should be very limited.

Did you know? More than half of a person’s lifetime sun exposure occurs before age 20. Remember, skin keeps impeccable records, so every minute spent in the sun adds up as skin damage and possibly skin cancer. More than one million Americans develop skin cancer every year mostly from long-term exposure to ultraviolet radiation from the sun.

UV exposure makes you look old before your time and causes:

• Wrinkling

• Blotching

• Drying

• Leathering of the skin

Beginning with babies 6 months and older, limit time in the sun and protect skin with sunscreen and protective hats and clothing whenever exposed.

-Jodi

UV rays and location, location, location…

Question:  Is it true that the sun’s UV rays are stronger in the South?

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That big line on the globe is the equator – Do you live near it on either side?

Answer: Yes, this is true. The closer your location is  to the equator (the line that is equally distant from the South Pole and the North Pole which also separates the Northern Hemisphere from the Southern Hemisphere on a map or globe), the more potent the sun’s rays. This is because they hit the earth more directly for a greater part of the year which accounts for the higher skin cancer rates in  “sun belt” locations. People who live or vacation in the Southern United States  or in Central and parts of South America and Africa should be especially aware and diligant of the need for sunscreen, hats and protective clothing and eye glasses whenever outside.

You may see lots of tanner people in these locations and that’s because they are exposed so much more to the UV rays from the sun. Remember, there is no such thing as a healthy tan (no matter what society would lead us to believe) because tanning is the skin’s response to the sun’s damaging rays.

If you’re unsure how close you are to the equator, check this global equator map.

-Jodi

Want to be 25% less likely to get age spots?

Well, I’ve been saying this to my patients for years:  Daily sunscreen use prevents the ugly results of photo-aging (spots, roughness and wrinkles caused by years of cumulative sun exposure which speeds up your skin’s natural aging process)  and finally a study published in a June issue of the Annals of Internal Medicine entitled, “Sunscreen and Prevention of Skin Aging,” has proven this to be true.

shutterstock_124869277Studies have already proven that sunscreen prevents skin cancer, but previous studies on photo-aging had always been done on mice so this new study performed on over 900 white people in Australia under the age of 55 and measured over 4 years just confirms what we dermatologists have been saying to our patients:

“If you want to keep spots and wrinkles at bay,  use sunscreen every day.”

Initially, the researchers weren’t sure exactly what effect regular comprehensive use of sunscreen would have on skin aging caused by the sun over the years and they were also curious about the effect of taking dietary antioxidants such as β-carotene supplements to delay skin aging so they tested both.

The study was broken randomly into 4 sunscreen use groups:

  1. Specific daily use of broad-spectrum (protects against both UVA & UVB rays) sunscreen of SPF 15 applied to head, neck, arms, and hands each morning and after bathing, after spending more than a few hours in the sun, or after sweating heavily and 30 mg of β-carotene.
  2. Specific daily use (as described above) of the broad-spectrum SPF 15 sunscreen and placebo.
  3. Use of broad-spectrum SPF 15 sunscreen at the discretion of the participant and 30 mg of β-carotene.
  4. Use broad-spectrum SPF 15 sunscreen at the discretion of the participant and placebo.

Photos were taken of the backs of participants’ hands at the beginning of the study and 4.5 years later and were examined for microscopic changes of skin aging by researchers without the knowledge of  which study groups the participants had been assigned.

The sunscreen use findings:

Interestingly, not all of those in the daily use group applied their sunscreen daily as directed. But more participants assigned to the daily sunscreen use group reported applying sunscreen at least 3 to 4 days each week compared to the participants in the discretionary-use group. Those in the daily-use group were 24% less likely to have increased skin aging after 4.5 years than were those in the discretionary-use group.

No overall effect of taking β-carotene supplements on skin aging was found.

My advice:  If you want to prevent discolorations, spots and wrinkles from forming due to cumulative exposure to the sun’s rays as you age, use a broad-spectrum sunscreen (and make sure it specifies so on the label) daily of at least SPF 15 whenever you are outside and exposed to the sun.  Also,  seek the shade whenever possible and wear a broad-brimmed floppy hat and sun glasses to protect facial skin and your eyes!

-Jodi

Allergic to sunscreen? Read labels!

Question:  My daughter is apparently allergic to many of the sunscreens I have tried on her and gets an itchy, burning rash. What is it in the sunscreens that is causing this reaction?

Answer: There could be many different chemicals causing a skin reaction.

Read those sunscreen labels!

Read those sunscreen labels!

Most commonly, allergic reactions to sunscreens are caused by one of the original UVB sunscreen protection ingredients called para-aminobenzoid acid  or PABA.

Read sunscreen labels and look for refined and newer ingredients called PABA esters (such as glycerol PABA, padimate A and padimate O) instead of the original staining, reaction-forming PABA.

 

New “broad spectrum” sunscreen ingredients

This year,  the FDA requires sunscreens to protect against both UVB and UVA rays (labeled “broad-spectrum”), so new sunscreen ingredients have been developed and included such as include Mexoryl SX (ecamsule) and  Parsol 1789 (avobenzone) which protect against UVA rays.

Physical sunscreens including  titanium dioxide and zinc oxide have been around for decades. Remember Zinc Oxide on the noses of lifeguards back in the day? These ingredients physically block and scatter UV rays. These singular sunscreen formulas have no other chemical ingredients and so may be a better choice for sensitive skins. They also go on thicker and appear “whiter,”  but they also stay on longer and are gentler to sensitive skins.

Despite advances in technology, formulating products with these ingredients without the skin-whitening effect has proven difficult.   Zinc oxide has recently been approved by the FDA, like titanium dioxide, in microsized or ultrafine grades as  an allowable active ingredient in sunscreen products with the ability to provide more full-spectrum protection. Zinc oxide is less whitening in this form than titanium dioxide and provides better UV protection. You  can now find sunscreen products that contain these ingredients in combination with other sunscreen ingredients to increase their stability in water and sun and decrease unwanted “whiteness.”

But remember sunscreen protection is all in the proper application.  And, a lot has changed in how we recommend sunscreen to be purchased and used, so it pays to stay up on the news about sunscreen so you don’t get burned (literally!)

Other buzz words for sensitive skin

You will notice  lots of colorful kids’ sunscreen products on store shelves you might want to stay away from. Try to  avoid any sunscreen products containing dyes or perfumes, which are known allergens. And, for acne-prone or oily sensitive skins, definitely check for specific products labeled, “non-comedogenic” or “won’t clog pores.”

I cannot stress enough how important it is to be aware of sunscreen ingredients, especially when allergic reactions are concerned, and take the time to stand in the store aisles and read those labels!

-Jodi

Black Salve no skin cancer salvation!

Question:  I’ve read many accounts online about an alternative therapy of using an herbal “Black Salve” to treat skin cancer, but then I also saw many scary photographs and read many scary stories of disfiguring skin damage from the treatment. What’s your opinion?

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Just say “NO” to Black Salve and alternative cures you see online as skin cancer cures!

Answer: My opinion is firm:  When it comes to any type of skin cancer, medical treatment has more than a 90 percent cure rate when lesions are caught early and removed and conventional medicine has an excellent track record in successfully treating skin cancer and restoring health. In fact, while there may be a genetic predisposition (family history or skin type) to skin cancer, statistics show that 90 percent of all skin cancers are caused by long-term, unprotected exposure to the sun’s UV rays. Those at highest risk are people with fair skin, blond or red hair, and those with blue, green or grey eyes and workers in outdoor occupations.  So skin cancer prevention falls on you for keeping unprotected sun exposure to a minimum and in checking your own skin for suspicious growths and actively having them checked at least once per year by a dermatologic practitioner.

The skin cancer fear factor…

Once cancer is diagnosed, patients can get scared and can fall prey to online cure scams and alternative therapies that can do more harm than good, according to a 2009 FDA release entitled, “Beware of Online Cancer Fraud.”   “Anyone who suffers from cancer, or knows someone who does, understands the fear and desperation that can set in,” said Gary Coody, R.Ph., the National Health Fraud Coordinator and a Consumer Safety Officer with the Food and Drug Administration’s (FDA) Office of Regulatory Affairs. “There can be a great temptation to jump at anything that appears to offer a chance for a cure.”

Black Salve on the FDA list of Fake Cancer Cures

From what I’ve read, Black Salve is the most the most widely known alternative therapy you will find online. It is an herbal topical treatment classified as an escharotic which is a substance applied to the skin that causes tissue to die and fall off.  The types of Black Salve available on the internet today can be made from ingredients such as zinc chloride, chapparal (larrea tridentata) or bloodroot which are all caustic (or escharotic) to the skin.

The FDA release outlines how the salves are sold online despite being illegal and how they are sold with false promises that they will cure cancer by “drawing out” the disease from beneath the skin. “However, there is no scientific evidence that black salves are effective,” says Janet Woodcock, Director of FDA’s Center for Drug Evaluation and Research (CDER). “Even worse, black salves can cause direct harm to the patient.” The corrosive, oily salves “essentially burn off layers of the skin and surrounding normal tissue,” says Woodcock. “This is not a simple, painless process. There are documented cases of these salves destroying large parts of people’s skin and underlying tissue, leaving terrible scars.”

Black Salve does not distinguish diseased from healthy skin.

If you are questioning an alternative cancer cure you see online, check the FDA list, “187 Fake Cancer Cures Consumers Should Avoid.”

That being said, I would not recommend desperate attempts at using Black Salve or other alternative therapies once skin cancer has already taken hold, especially since Melanoma is dangerous and can spread. Here’s why:

  • Alternative therapies have not been medically and scientifically tested for efficacy and safety .
  • The use and sale of alternative therapies online is completely unregulated so you cannot be sure the purity or concentration of ingredients you are putting on your skin.
  • Alternative therapies can contain unknown compounds with questionable benefit and the potential for great harm and they are promoted on the internet illegally without full consideration or information about potential toxicity.
  • With alternative therapies instead of surgical procedures and medically researched treatments, there is a large risk of incomplete tumor removal and tumor growth and metastases (spreading).
  • Alternative therapies untested on healthy skin leaves unwary patients open to damage of surrounding healthy tissues and marked scarring with poor cosmetic outcomes

If you think you have a lesion, spot or growth that could be skin cancer, go directly to the dermatologist who will test the tissue via a biopsy and advise you whether the tumor needs to be removed.  In cases such as skin cancer, when medical treatment has a high success rate, don’t look elsewhere at alternative therapies.

Have you been tempted by Black Salve? Did the online photos scare you away?

How to get rid of age spots, sun spots, liver spots

Question:  I have a dark brown oval-shaped spot on my forehead and a cluster of them on my upper chest. I’ve heard them called age spots, sun spots and liver spots. What are they and how can I get rid of them?

Answer: These spots are medically called solar lentigines because they resemble the shape and color of a lentil bean and are flat (not elevated or depressed).  It’s a discolored oval spot. Usually, they are caused by sun exposure and the incidence is age-related (hence the term “age spots”) because the older you get, the more you’ve been exposed to the sun, the more likely they are to become visible. They closely resemble freckles, but are usually larger and darker than freckles (remember the lentil?) Freckles are usually genetically determined whereas, unfortunately, solar lentigines are often a mark of photo (sun)-damage.

It’s important to remember that this type of hyper-pigmentation can be a mark of malignant melanoma or other type of skin cancer such as a basal cell carcinoma or a squamous cell carcinoma and they may be accompanied by other chronic  degenerative changes in the skin caused by sun damage.  Early lesions of lentigo maligna (melanoma in situ) may be light to medium brown and mimic solar lentigines.  Lentigo maligna, benign solar lentigo and pigmented actinic keratosis all occur on sun-damaged skin and multiple lesions of different types in the same area are common.Always see a dermatologic practitioner when a brown spot appears or changes, as a biopsy may be appropriate (remember the ABC’s of spots?)

That said, we have many means of removing them and normalizing the discoloration, depending on where they are located and how many you have there:

Cryotherapy:  Melanocytes (pigmented skin cells that cause the darkened spot) are very sensitive to cold temperatures and can actually be destroyed at -4°C to -7°C, therefore we effectively use liquid nitrogen cryotherapy  applied to a singular spot for 5-10 seconds. The brown spot will turn white and crusty and new skin will emerge underneath in about a month. For one simple spot that is not on your face, cryotherapy is a great and inexpensive option.

Chemical peels: Medium depth chemical peels such as Trichloroacetic acid (TCA), for example, have been studied and had a fair response, but we use them cautiously because of irritation and redness. A chemical peel can be a good choice for a larger area  or cluster of spots such as on the upper chest, but may need to be repeated to achieve desired results because you are only removing the outer-most layers of the skin each time.

Laser therapy: Of all the lasers available, some are more pigment-specific and attract the discoloration and act on it better than others. I have found Argon, Q-switched ruby and Er:Yag lasers are all effective on solar lentigines. We also use Intense pulsed light idepending on skin type, location and other variables.  I also love  fractionated laser technology for solar lentigines such as the Fraxel DUAL 1550/1927 or the Deka DOT Laser.  I usually use fractionated lasers to treat the whole face, arms, legs or chest because it works so well for larger clusters of spots, although it is the most expensive option. Complications such as post-inflammatory pigment  alterations (discoloration) can occur afterwards, so sun protection after laser is a must.

Topical treatments:  The use of topical prescription retinoid preparations definitely takes longer, but they are an effective and certainly less expensive alternative to laser therapies for both a large cluster of spots or one spot, no matter where it is located. In studies comparing 0.1% tretinoin versus placebo, after the initial 10 months of treatment, there was an 83% improvement versus 29% in the placebo group and the upper extremities responded as did the face. After an additional 6 months of treatment, the lesions that had resolved during initial treatment did not recur during the 6 month follow-up period and patients continued to Improve. The major side effect: redness and irritation. Bleaching creams containing 4-5% hydroquinone used over a period of several months will lighten solar lentigines but possibly only temporarily. We have found that a combination of the tretinoin and 4% hydroquinone plus a corticosteroid may be even more effective for your specific spots than the individual components alone, although tretinoin alone does work beautifully on Asian skin.

No matter what your age, if you never want to see solar lentigines pop up on your skin, always use sunscreen labelled “broad spectrum”  that blocks both UVA and UVB rays.

Have you successfully gotten rid of age-spots and solar lentigines? Share what worked best for you!

Little known topical ways to prevent and treat skin cancer

Question:  My dermatologist gave me a topical cream with special ingredients to prevent skin cancer where he thought it might be forming. How is that even possible?

Answer:  It is now possible and FDA-approved.  There are some new topical medications that target different mechanisms to halt cancer cells from growing.

5-fluorouracil (5-FU):  This long-standing chemotherapy drug has been used internally and is also now FDA-approved for use on top of the skin to prevent and treat superficial Basal Cell Carcinoma (BCC). It is the active ingredient in proprietary topical skin cancer prevention formularies and several prescription creams with 5-FU or related medications available by prescription.

When applied on the skin topically, 5-FU selectively targets and destroys only cancerous or precancerous skin cells damaged by sun and aging while leaving normal skin cells alone. It’s something you can use at home, under a doctor’s supervision, on many parts of the body  such as chest, neck, hands, legs and back.

A course of treatment usually lasts approximately 14 days.  After several days of initial application,  the appearance of redness, scaling, and eventually crusting occurs on treated areas and indicates that precancerous cells are dying; how soon they appear and their severity depends on the strength of the 5-FU product and how often it is applied. The end result is a healthier looking, more attractive skin with a reduced tendency to develop skin cancer.

Imiquimod:  This cream is FDA-approved to treat superficial BCC’s that works by stimulating the immune system and causing the body to produce interferon, a chemical that attacks cancerous cells. The cream is rubbed in the  the lesion 5 times a week for 6-8 weeks (sometimes longer).  This treatment can also produce some discomfort, redness, irritation and inflammation.

Cure rates for both are 80-90 percent because they kill active cancerous or precancerous cells over time instead of all-at-once.

Never self-diagnose or try to use these medications without a doctor’s supervision, as in the rare case a BCC is locally advanced or  metastasizes (spreads), the cancer can become dangerous, even life-threatening.

Have you tried 5-FU or any of the topical skin cancer prevention treatments?

 

 

 

 

 

 

 

 

 

 

See how simple a Basal Cell Carcinoma removal can be

Question: My dermatologist said my scab was a Basal Cell Carcinoma…Now what? Do I have cancer?

Answer:  Relax. A Basal Cell Carcinoma (BCC) is rarely the spreading cancer that requires the systemic chemotherapy you’re thinking of. Cure rates for BCCs are close to 100 percent, and are easily treated when caught early.

After having your skin examined, the diagnosis of BCC is confirmed by biopsy, which is when the skin is numbed with a local anesthetic and a sample of your lesion is removed and sent to be a lab for examination under a microscope. If tumor cells are present, treatment is required.  BBCs rarely spread beyond the original tumor site so we simply remove them by  any number of methods depending on the type, size, location and depth of the tumor as well as your age and general health. Since BCCs are visible on the surface of the skin, we also take the likely outcome to your appearance into consideration.

Usually, treatment is performed on an outpatient basis in a dermatology office.

A local anesthetic is almost always used so pain during the procedure is minimal, although you may have some mild discomfort afterwards.  After removing a small BCC, wounds heal and the scars are usually cosmetically acceptable (and there are many other methods or repairing  or improving any resulting damage that is undesirable to you).

The types of treatment include:

  • Curettage and electrodesiccation: The growth is scraped off with a sharp, ring-shaped instrument (called a curette), and the tumor is dried out (dessicated) and destroyed with an electrocautery needle. The procedure is often repeated during the same procedure to ensure that all the cancer cells are eradicated. It has a 95 percent success rate for smaller lesions (and often for the first biopsy), although often not useful for aggressive BCCs or in those sites that where any scarring would be highly undesirable as sometimes a white scar is left at the surgical site.
  • Mohs Micrographic Surgery:  A physician specially-trained in Mohs Micrographic Surgery removes a thin layer of tissue containing the cancer and while the patient waits, the frozen previously removed sections are examined under a microscope by the Mohs surgeon. If skin cancer is still present in any of the tissue, the procedure is repeated only on the area where those cancer cells were identified, until the last layer is cancer-free. This technique saves a great amount of healthy tissue and has a high cure rate of 99 percent or better. It is often used in cosmetically important or large, critical areas and in those areas that have recurred, are hard to pinpoint or in critical areas  with little tissue to spare such as around the eyes, nose, lips and ears.
  • Excision surgery: We use a scalpel to remove the entire growth along with a surrounding border of apparently normal skin (called a safety margin) and then the site is closed with stitches.  A specimen is sent to the laboratory for microscopic examination to verify that all cancerous cells have been removed. Although cure rates are above 95 percent, if the tissue analysis shows cancer cells at the margin of tumor, a repeat excision may be necessary.
  • Radiation: X-ray radiation may be used in tumors that are hard to manage surgically, elderly patients or other patients in poor health. The radiation is directed at the tumor, with no need for cutting or anesthesia and total destruction usually requires several treatments a week for a few weeks. Cure rates are around 90% because the technique is not precise in identifying and removing cancer remaining at the margins of the tumor
  • Cryosurgery:  While not often used, sometimes we can destroy very superficial BCCs  by applying liquid nitrogen  to the growth with a Q-tip or a spray to freeze it, which also does not require cutting or anesthesia. After the treatment, it may be blistered,  crusty and fall off within weeks and the procedure can be repeated.
  • Erivedge™ (vismodegib): The first oral medication approved by the FDA for the treatment of  advanced BCC which is used for the limited circumstance where the nature of the cancer prevents the use of other treatment options. (Should not be used in woman who are pregnant or child-bearing.)
  • Topical medications: Certain prescription topical creams, gels and solutions are FDA-approved  to treat limited specific BCCs and some are used to prevent possible BCCs from growing.

The best treatment for BCCs is prevention:  Always wear sunscreen of SPF 30 or higher on exposed skin exposed and wear a hat whenever possible!

What’s your story about BCCs?

 

 

 

Roaring mad about spotted skin!

Don’t get mad…get to the dermatologist! Most cases of melasma are easily treated.

Question:  What are these brownish spotted areas on matching sides of my face and how can I get rid of them?

Answer:  Those brown spotted areas on your face are called melasma, and the discoloration is caused and worsened primarily by sun exposure. The result can be a mask-like, spotted or confetti-like appearance that generally involves cheeks, forehead, upper lip, nose, jaw line or chin.  Melasma occurs more frequently in Fitzpatrick Skin Scale types III, IV and V, (which I described in my last post about post-inflammatory hyperpigmentation), and 63% of all cases of melasma are in darker-skinned Caucasians.  Melasma doesn’t cause any other skin symptoms aside from the unwelcome skin discoloration which is usually (unhappily) matching on both sides of the face.

The hormonal influence…it’s a woman thing

Female hormonal triggers play a large role so the condition generally affects women. In fact, melasma occurs in 50%-70% of pregnant women, usually during the 2nd or 3rd trimester, and is called chloasma or, “the mask of pregnancy.”  In women who use oral contraceptives, we see melasma on the upper lip, both sides of the forehead and jaw line. We also see melasma form on post-menopausal women when hormone replacement therapy includes progestational hormones.

How sun exposure (UV radiation) stimulates melasma formation:

  • Skin cells which produce melanin (skin pigment) are stimulated by UV exposure
  • This causes a rapid onset of melasma and speeds up formation  once a hormonal trigger is in place

3-Step Rx for melasma

Good news:  Melasma is usually treatable when it occurs in the epidermal (outer) layers of the skin, which is 70%-90% of cases. Here’s how we get rid of epidermal melasma:

  1. Sun Protection:  Avoiding sun (UV radiation) exposure is the first line of defense for treating melasma now and avoiding melasma in the future. Wear sunscreen on your face daily and use additional protection such as a hat to protect your skin from further discoloration.
  2. Use a 4% hydroquinone cream: Considered the gold standard in skin discoloration treatment, this ingredient inhibits the enzyme activity responsible for melanosome formation (melanin-containing cells) and the conversion of tyrosine to melanin which forms the dark spots. Treatment is usually 20 weeks.
  3. Use a retinoid cream in addition:  Retinoids (vitamin A derivatives) increase the rate of epidermal skin cell turn-over so the excess pigmentation is carried out of the skin where it can be sloughed off. Retinoid treatment is also 20 weeks.

A new topical cream we are using is called Tri-Luma® Cream because it contains a combination of 4% hyrdroquinone, a retinoid and an anti-inflammatory all-in-one. In studies, 29% of patients experienced complete clearing of skin when used for only 8 weeks of treatment.

For those with an allergy to hydroquinone, alternative ingredients include kojic acid and azalea acid, although considered weaker hyperpigmentation agents. They are also often used in conjunction with other topical medications. For more severe cases, peeling agents or laser treatments may be indicated but must be balanced against the risk of post-inflammatory hyperpigmentation afterwards.

Basically, if you don’t want melasma, don’t give the sun any face time!

Have you ever noticed spots the sun has left on your face?