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?