The war against dark patches

It's a common problem many women (and men) battle everyday - melasma.  These brown patches usually show up on the forehead, cheeks, upper lip, and chin area.  Women tend to be affected more often than men.  No one knows exactly what causes it, but we do know that there are certain factors that seem to trigger the increase in pigmentation.  Sun exposure and estrogen are the two biggies.  Birth control pills, hormone replacement therapy, and pregnancy (in which case it is called chloasma, or the mask of pregnancy) rev up melanocytes to produce more melanin, which is responsible for pigment in the skin.

Melasma is a difficult condition to treat.  Like many other conditions in dermatology (psoriasis, eczema, acne) there is no cure.  A combination of topical medications and procedures are used to improve it, but results need to be maintained.  The single most important factor is sun exposure.  People with melasma MUST protect their skin from the sun.  Sun avoidance, suncreen, sun protective clothing: the whole nine yards.

The gold standard in topical treatments is the lightening cream hydroquinone.  This can be prescribed by a dermatologist and should be used under their supervision.  A very rare complication of this cream is a condition called ochronosis, which results in darkening of the skin.  Fortunately, this is not common.  There are many other topical treatments available that do not contain hydroquinone.  These are often used as well to treat melasma.  These creams contain lightening ingredients such as azaleic acid, kojic acid, licorice, lignin peroxidase, etc.  One of my favorite non-hydroquinone containing creams is Elure.  It contains lignin peroxidase, a natural extract derived from a tree fungus.  Retinoids can help lighten dark spots as well.  If the treatments are irritating, a topical cortisone is sometimes used. 

In addition to topical treatments, light chemical peels can be performed in the doctor's office.  However, care must be taken to avoid hyperpigmentation (darkening of areas).  The Fraxel Dual Re:Store has been shown to be very effective for brown spots on the face and can improve melasma.

Just as exercise and diet are used to help maintain a healthy weight, strict sun protection and various dermatologist-prescribed treatments can help maintain skin.