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Successful Treatment For Melasma
SUCCESSFUL TREATMENT FOR MELASMA
(INCREASED PIGMENTATION ON THE FACE)
INTRODUCTION
Melasma is a chronic progressive darkening of the facial skin. The degree and extent of darkening varies from patient to patient. It can be mild and involves only the cheekbone on both sides, or it can be dark brown and affects many areas on the face, such as forehead, cheekbones, cheeks, upper lip and chin. It is more common in Asians, Hispanics, Indians, Middle Eastern people, etc. In other words, it is more common in darker skinned individuals. Women are, by far, more frequently affected than men. It is not life threatening. It is a cosmetic disorder and concern. However, the emotional and social devastation from this condition is indeed all too real. It is not about vanity either. The good news is, for the most part, there is effective treatment to control this progressive skin condition. Therefore, the sooner you take care of this, the better the result you will have.
1. If you are on a BCP, this will increase the darkening of your facial skin. You should consider another method for birth control.
2. Pregnancy tends to increase the facial pigmentation in susceptible women. This is just a statement.
3. Be PATIENT. It takes time to bleach out or lighten your skin. Do not rush it.
4. Gentle facial wash is extremely important. DO NOT USE SCRUBS, BEADS, abrasives, wash cloths, or anything that will, in anyway, irritate the skin. You should always wash your face as if you are washing a ‘baby’s bottom’, very gently. Use only lukewarm water to wet down your face. Use a very gentle cleanser (Purpose gentle cleansing wash, Cetaphil daily facial cleanser, Neutrogena fresh foaming cleanser, or Cetaphil gentle cleansing bar), lather it, and wash your entire face with only your fingertips in a gentle massaging motion for only 30 seconds. Rinse thoroughly with lukewarm water, and pat dry with the softest towel. DO NO RUB.
5. Avoid any chemical, make-up, lotion or whatever that causes irritation, burning or redness to the face, because they may darken your skin further.
6. Melasma will never be improved or controlled without what I call “sun smart living’. You need vigorous sun avoidance. Sun is the biggest contributor to the development of Melasma. It is the most damaging factor in Melasma. For example, if you can stay in a dark room with absolutely no sun exposure for 30 days, you will notice a significant improvement in your Melasma. Practice “sun smart living”. Read the handout. Never leave home without your sunscreen; reapply as needed. Do everything mentioned in the handout. If you work in an office with rows and rows of overhead fluorescent lights, they will also worsen your Melasma. Therefore, sunscreen will be necessary as well in this environment. Sun protection/avoidance/sunscreen is by far the most important step to successful Melasma control.
7. Finally comes medication. 4% Hydroquinone (available only by prescription) is the standard treatment (bleacher) for Melasma. It does not discriminate between dark and normal skin. Therefore, you have to be extremely careful about applying this cream to only darkened skin. Otherwise, you can imagine what may happen. You should see improvement within 1-2 months. Generally, this medication is used from 2-6 months to achieve a desirable result. It is applied twice daily, both morning and night. A thin even coat is all you’ll need. The more is not better. Over the counter (OTC) 2% is generally not strong enough, and I do not recommend it. Perhaps the best product on the market at this time is Triluma, a very expensive prescription medication (close to $ 90-100 per tube). This is my first choice in treating Melasma. Since Melasma is considered a cosmetic condition, Triluma is not a covered prescription benefit. It is totally out of your pocket expense. This medication also has 4% Hydroquinone as one of its 3 active ingredients. To learn more about Triluma, go to www.triluma.com. It is used only once daily, in the evening before bedtime. It is applied only to the darkened areas of your face. As with the above instruction on using 4% Hyrdoquinone, only a small amount is needed, enough to cover the affected area with a nice thin even coat. Do not go beyond the affected border more than 1/8 inch. Wash your face in the evening as in step 4; allow the face to dry naturally for at least 20 minutes before applying Triluma. Allow the medication to dry and be absorbed (~ 15 minutes) before lying down to sleep. Do not wash off until the next morning.
Warning! Whether it is the 2% Hydroquinone (OTC), the 4% Hydroquinone (prescription) or Triluma (Prescription) you are using, if at any time in the course of treatment, the medication is causing more darkening of the skin, instead of the usual lightening result, you may have developed a condition called “exogenous ochronosis”. You need to discontinue the medication immediately and notify me.
8. Education is a must. I expect you to log on to my home page and learn more about this condition.
9. Remember that this is a chronic condition. You need to be patient. You need to practice vigorous, vigorous sun smart living 365 days a year, even after you have achieved an acceptable level of control. Otherwise, your Melasma will return with a vengeance. Furthermore, you need to be realistic about the final result. All we are doing is lightening the dark spots. To expect these darkened areas to be completely clear is unrealistic. However, in my experience, if your Melasma is the superficial kind, in the majority of the time, you should expect significant improvement if you practice everything written here faithfully and diligently. The decision is yours. If you have any questions or problems, you are welcome to call me on my private line: Dr. Peter Yao, Kaiser Dermatology (559)448-4923
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