Brown spots, be gone

It's a common problem many women (and men) battle everyday - brown spots/areas on the face. 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. There is no cure and no set treatment. 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 most commonly prescribed topical treatment is the lightening cream hydroquinone. This should be used under a dermatologist's supervision.   Although there are reports of a possible association of cancer, nothing has been confirmed, and it is still considered the gold standard and first line treatment.  A very rare complication of this cream is a condition called ochronosis, which results in darkening of the skin. Fortunately, this is not common. Retinoid cream helps to lighten dark spots as well.  A prescription cream called Triluma combines hydroquinone, tretinoin, and a topical steroid cream and is very effective.  

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 Lytera.  It contains niacinamide, licorice extract, and retinol.   

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.