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Health & Wellness | Looking Great
Health
&
Wellness
Why Won’t My
“Sun Spots”
Go Away?
By Dr. Kimberly Moskowitz
The Heartache of
Melasma
Melasma, derived from the
Greek word Melas, meaning
“black,” appears as symmetrical
irregular patches of tan or
brown pigmentation on sun
exposed areas of the face such
as the cheeks, forehead, upper
lip, and chin. This confidence
crushing skin condition is nine
times more common in women
than men and affects more
than five million people in the
United States alone. There
are few things women enjoy
more than being able to roll
out of bed in the morning with
youthful flawless skin. Irregular
pigmentation on the face is one
of the earliest signs of aging
skin and it often makes people
appear older than they are.
Melasma is often associated
with Moms-to-be as it is notoriously
known as the “mask of
pregnancy.” Although the majority
of patients with melasma
are not pregnant, it tends to
creep onto our skin during the
reproductive years, and often
coincides with the mainstream
panic over fine lines, wrinkles,
age spots and gravity. Melasma
can also develop with oral
contraceptive use or hormone
replacement therapy. There is
a strong genetic predilection
for darker skin types such as
Mediterranean, Hispanic, and
Asian populations but to date,
there is no single known cause
of melasma.
Aside from genetics, the most
important factor in the development
of melasma is exposure
to the ultraviolet rays of
the sun. The paradox of living
in Florida is that our beautiful
Gulf of Mexico provides a
subtropical petri dish for many
frustrating skin conditions such
as sunspots, skin cancer, premature
aging, and melasma.
Melanocytes, the pigment
producing cells in the skin, are
stimulated by the sun’s UV rays
to overproduce melanin. Like
a callous, this is the skin’s way
of protecting or shielding the
deeper layers from injury. This
protective mechanism can
manifest as a suntan, a freckle,
an “age spot” or melasma.
Sun exposure, hormones,
pregnancy, skin trauma and
some phototoxic drugs cause
our melanocytes to become
overactive, resulting in splotchy
deposits of excess pigment in
the dermis and epidermis.
Daily application of broad
spectrum UVA- UVB – protective
sunscreen with an SPF of at
least 30, containing Zinc Oxide
or Titanium Dioxide is essential
for long-term success in treating
melasma and all pigmentary
disorders. Without strict
avoidance of sunlight, and daily
application of sunscreen, potentially
successful treatments
for melasma are doomed to fail.
While Melasma is physically
harmless, it is often emotionally
damaging and embarrassing.
Fewer than 10% of patients
will have remission of melasma
without treatment.
Hydroquinone aka “bleaching
cream” has been used to treat
disorders of hyperpigmentation
for more than 50 years. Hydroquinone
doesn’t really “bleach”
your skin. Instead, it interrupts
the abnormal pigment production
by melanocytes, making
your skin more uniform in color.
Alone, Hydroquinone 4% cream
clears melasma in 35-40% of
patients. Prescription regimens
combining glycolic acid,
daily use of a broad spectrum
sunscreen, and “triple cream”
(Hydroquinone 4%, Retinoic
Acid 0.05-0.1%, flourinated
steroid cream), clears melasma
in 85-90% of patients within 3-6
months.
Beware of over-the-counter
preparations and those found
in shopping networks, magazine
ads, and cosmetic counters
that convincingly promise
miracles yet cause you to lose
precious time and money.
They have little to no benefit
in treating melasma. A variety
of “natural” ingredients may
help slow pigment production
such as Azeleic Acid,
Kojic Acid, and L-ascorbic acid
(Vitamin C); however, none
have been shown to approach
the effectiveness of the “triple
cream.” Melasma is stubborn
and even prescription strength
creams may take as long as
3-6 months to show improvement,
and possibly a lifetime to
maintain it. Deeper variants of
melasma are invariably frustrating
because topical regimens
do not penetrate far enough
into the dermis to eradicate the
pigment.
Any discussion about treating
pigmentary skin disorders
would be incomplete without
a mention of Laser treatments.
Fraxel has catapulted laser
technology into a resurfacing
revolution with the treatment of
wrinkles, sagging skin, droopy
eyes, sun damage, stretch
marks, pre-cancerous lesions
and melasma. Rather than
leave millions of faces hidden
behind a mask, patients are
turning to Fraxel skin resurfacing,
which shows a 74-100%
clearance rate for abnormal
pigmentation including melasma.
Fraxel sends microscopic
thermal wounds through the
skin’s surface to break up the
abnormal pigment and destroy
over-producing melanocytes.
Fraxel Restore and Fraxel
Dual 1927 lasers have shown
the most promise for those
requiring immediate gratification;
however, results still must
be maintained with diligent sun
protection and triple therapy
to minimize the inflammatory
response.
Establishing realistic expectations
is paramount to avoiding
a lifetime of exasperation trying
to cure a disorder that we
can control but often cannot
cure. If the curse of melasma is
casting dark shadows on your
face don’t allow it to conceal
your beauty forever and never
underestimate the tenacity of
this masked marauder. You
can conquer melasma with a
single Fraxel treatment and
by taking simple daily steps
(Sunscreen and triple cream) to
unmask the radiant skin that is
already yours.
THE CIRCUIT September/October 2012 17