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Melasma/Brown Spots and Associated Treatment Options

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With summer coming to a close and autumn quickly approaching, now is a good time to assess the negative effects that the sun may have had on our skin during the warmer months. Despite our best efforts at wearing sunblock every day and trying to avoid exposure during peak sun hours, our skin can still sustain damage from sunlight. Sun damage can be revealed in many ways, but increased brown pigment is one of the most common.

Although a suntan will gradually fade, some brown spots may remain long term. These pigmented spots represent sun damage and can be potentially permanent. Fortunately, the vast majority of brown sun damage is only of cosmetic concern, but occasionally a brown spot can turn out to be a skin cancer such as malignant melanoma. Furthermore, individuals with a greater degree of brown sun damage are at higher risk of developing such skin cancers and should be examined at least annually.

Every year at Advanced Dermatology our medical providers diagnose and treat dozens of melanomas and hundreds of non-melanoma skin cancers. At the same time, our providers are busy diagnosing and often treating many more people with non-threatening brown spots. For example, freckles and lentigines are two of the most common types of benign brown spots found on the skin. They are caused by the sun and are completely harmless. Freckles may increase in number and darken with sun exposure, then lighten during the winter months. However, lentigines will usually remain darker year round. Though these types of spots are ultimately due to sun exposure, some people are genetically more predisposed than others to develop them.

If, for cosmetic reasons, a patient wishes to reduce the number and darkness of freckles or lentigines, our providers have both at-home and in-office treatments available. First and foremost, sunblock containing zinc oxide such as skinfo® Pure Protection Ultra ($43) with 20% transparent zinc oxide is essential. Reducing or removing freckles and lentigines cannot be accomplished without proper sun protection. In addition, patients may be advised to apply one of several skin lightening agents, such as Glytone Clarifying Gel ($33), to the affected areas each evening. With proper usage of both sunblock and a lightening agent, most individuals will see noticeable improvement within one to two months.

For those wanting quicker or more complete results, our providers can choose from several different laser or intense pulse light devices for in-office treatment at Advanced Dermatology. Fraxel®, Revlite, Clear + Brilliant, Perméa™, Elos Plus, and eLight are a few examples of such devices. During a cosmetic consultation scheduled with one of our Cosmetic Coordinators, a provider will decide upon treatment options based upon the concerns of the patient, the degree of sun damage, and the skin type. Many of our devices can even address multiple issues during one treatment session. Some treatments are relatively painless, but others may require topical anesthesia. In addition, all treatments require a few days of minimal downtime for recovery, and pre- and post-treatment sun avoidance is crucial.

In comparison to freckles and lentigines, melasma is a much more difficult condition to treat. Melasma, also known as “the mask of pregnancy,” usually involves excessive large brown pigment patches occurring in a somewhat symmetric pattern on the forehead, cheeks, nose, and the skin above the upper lip in genetically susceptible individuals. Melasma affects ten times more women than men, and natural internal hormones or prescription hormones seem to play a causative role. In addition, people with darker skin types tend to be more prone to melasma. Lastly, skin care products or treatments that irritate the skin can make melasma worse, especially with sun exposure.

In comparison to treating other types of brown spots, treating melasma is generally much more complex. As with the treatment of many chronic medical conditions, responses vary widely. Unfortunately, melasma is a chronic skin condition that may not completely respond to treatment. In addition, recurrence is possible despite the best efforts of both patient and provider.

In some cases, melasma will fade on its own. If not, your medical provider at Advanced Dermatology can recommend prescription and non-prescription applications for home usage, as well as in-office treatment. In most cases, both will be utilized. At home, in addition to previously described sunblock, aggressive lightening agents such as skinfo® Bright Rx 8% ($105) may be recommended. For more sensitive skin, azeleic acid, SkinMedica® Lytera 2.0 ($154) may be recommended.

After using topical applications, if the response is inadequate or a more aggressive approach is desired, in-office treatments may be employed. Clear + Brilliant, Perméa™, a very safe procedure with minimal discomfort and downtime, will usually be the first-line treatment. For patients with more stubborn melasma, treatment with the Revlite laser may be recommended. Both treatment protocols recommend multiple treatments over a period of months to attain good results.


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