In the last newsletter, I discussed the pigmentation problem that frequently arises in the summer known as melasma. Although the ultimate cause of this condition is unknown, sun exposure increases the production of melanin abnormally which results in patchy areas of greater darkening of the skin.
These darkened skin spots can be particularly embarrassing when they appear in the most conspicuous locations of the face, neck and forearms. If other people can see them, the urge for treatment becomes greater.
The key principles of treating melasma involve attacking separate aspects of the skin darkening process. These include inhibiting the synthesis of melanin, removing the melanin already deposited in the skin, and disrupting the melanin granules.
All of these approaches will lighten the skin to varying degrees. The variation of lightening depends on the individual’s characteristics, amount of ongoing sun exposure, how long the condition has existed for that person, and how dark the patches have become prior to treatment.
Bleaching agents are the primary method to inhibit melanin synthesis. For many years, hydroquinone (HQ) was considered to be the most effective bleaching agent for melasma. However, it has found that the bleaching effects of HQ can be enhanced without resulting side effects if combined with other agents.
The best mix appears to be a combination of HQ with a topical retinoid (tretinoin, brand name RetinA) and a steroid cream. Studies have shown that combination therapy can result in complete clearance of melasma in 26% of patients, and 75% reduction in 70% of patients.
I generally tell people not to waste their money on the over-the-counter creams for spots advertised on TV. These creams are not only expensive, but I have never seen them to be effective.
One of the many reasons I have been excited about carrying the Obagi line of skincare products is the Nu-Derm system. This combination therapy has been shown to be very effective for bleaching superficial melanin if used consistently and on a long-term basis of at least 3 months. For those who want a topical treatment that they can use at home and is not aggressive but is effective, Nu-Derm is the real deal and highly recommended.
To remove existing excess melanin, chemical peels have been helpful. Peels generally should only be administered by a trained aesthetician or doctor and also only in those with fair skin. They should not be used in darker skin types due to higher incidence of side effects.
Finally, laser therapy is the best method to disrupt melanin granules within skin cells at various levels. I always warn people undergoing this approach that the pigmented areas will look darker for several days after the laser treatment. For this period, the areas will gradually lighten over a period of several weeks.
Small spots may resolve completely whereas larger patches may “break up” due to different levels of pigmentation within the patch of affected skin. After one month, the areas treated will be as light as it will be with the previous laser treatment and that then is the time for repeat treatment to attack the next layer of pigment.
Due to a lack of adequate controlled studies, there is no standard therapy for melasma. That is, a treatment that works for one person may not work for another. In my experience, many of the individual differences from patient to patient also makes it difficult to have a “one size fits all” treatment.
Also, even though the treatment may be effective in removing existing melanin, melasma is a condition that can relapse, especially with repeated ultraviolet light exposure. As a result, those with melasma need to continue sun avoidance, and may need periodic maintenance therapy of the above treatments in various combinations.
But, the overall message is that if you or someone you know has melasma or abnormal pigmentation, there is hope and treatment. Give us a call at 207-873-2158 to arrange a free consultation so I can evaluate your skin and discuss options for your individual case.