The Health & Wellness <strong>Issue</strong> 16 THE CIRCUIT September/October 2012
Health & Wellness | Looking Great Health & Wellness Why Won’t My “Sun Spots” Go Away? By Dr. Kimberly Moskowitz The Heartache <strong>of</strong> Melasma Melasma, derived from the Greek word Melas, meaning “black,” appears as symmetrical irregular patches <strong>of</strong> tan or brown pigmentation on sun exposed areas <strong>of</strong> the face such as the cheeks, forehead, upper lip, and chin. <strong>This</strong> 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 <strong>of</strong> bed in the morning with youthful flawless skin. Irregular pigmentation on the face is one <strong>of</strong> the earliest signs <strong>of</strong> aging skin and it <strong>of</strong>ten makes people appear older than they are. Melasma is <strong>of</strong>ten associated with Moms-to-be as it is notoriously known as the “mask <strong>of</strong> pregnancy.” Although the majority <strong>of</strong> patients with melasma are not pregnant, it tends to creep onto our skin during the reproductive years, and <strong>of</strong>ten 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 <strong>of</strong> melasma. Aside from genetics, the most important factor in the development <strong>of</strong> melasma is exposure to the ultraviolet rays <strong>of</strong> the sun. The paradox <strong>of</strong> living in Florida is that our beautiful Gulf <strong>of</strong> 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 <strong>of</strong> protecting or shielding the deeper layers from injury. <strong>This</strong> 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 <strong>of</strong> excess pigment in the dermis and epidermis. Daily application <strong>of</strong> broad spectrum UVA- UVB – protective sunscreen with an SPF <strong>of</strong> 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 <strong>of</strong> sunlight, and daily application <strong>of</strong> sunscreen, potentially successful treatments for melasma are doomed to fail. While Melasma is physically harmless, it is <strong>of</strong>ten emotionally damaging and embarrassing. Fewer than 10% <strong>of</strong> patients will have remission <strong>of</strong> melasma without treatment. Hydroquinone aka “bleaching cream” has been used to treat disorders <strong>of</strong> 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% <strong>of</strong> patients. Prescription regimens combining glycolic acid, daily use <strong>of</strong> a broad spectrum sunscreen, and “triple cream” (Hydroquinone 4%, Retinoic Acid 0.05-0.1%, flourinated steroid cream), clears melasma in 85-90% <strong>of</strong> patients within 3-6 months. Beware <strong>of</strong> 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 <strong>of</strong> “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 <strong>of</strong> 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 <strong>of</strong> 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 <strong>of</strong> Laser treatments. Fraxel has catapulted laser technology into a resurfacing revolution with the treatment <strong>of</strong> wrinkles, sagging skin, droopy eyes, sun damage, stretch marks, pre-cancerous lesions and melasma. Rather than leave millions <strong>of</strong> 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 <strong>of</strong> exasperation trying to cure a disorder that we can control but <strong>of</strong>ten cannot cure. If the curse <strong>of</strong> melasma is casting dark shadows on your face don’t allow it to conceal your beauty forever and never underestimate the tenacity <strong>of</strong> 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