Melasma
Melasma is a unique condition where slight darkening occurs primarily on the upper cheeks (though it may occur elsewhere). Also known as "the mask of pregnancy", it most characteristically occurs in pregnant patients and Hispanic females. The cause is not known, but pregnant women or women taking oral contraceptives are especially susceptible to this condition suggesting a hormonal influence in these females. It is asymptomatic, but may be progressive over time leading to widespread darkening over much of the lower face.
The treatment of melasma is difficult as many patients ten to have their condition recur over time despite initial success. The treatment for melasma includes many of the combination treatments described in hyperpigmentation. Specifically, several treatments include:
* Hydroquinone cream 4% or greater twice daily
* TriLuma cream nightly for 6 weeks
* Hydroquinone and tretinoin combination twice daily
* Hydroquinone and glycolic acid combination twice daily
* Glycolic acid peels every two to four weeks
Use of a sunblock SPF 30 or higher 2-3 times daily is essential. Laser treatment has proven unsuccessful in inducing complete remission of melasma, although mild temporary success may be achieved. As with hyperpigmentation, all patients undergoing treatment must be strongly advised to avoid sun-exposure for risk of longer treatment times and higher probability of treatment failure. Even a single day of sunlight exposure can reverse progress from many weeks of therapy.
Newer treatments include the use of fractional resurfacing laser technology (Fraxel®, Starlux®). The data is still quite new, but the results noted have been extremely promising. Other laser technologies have been shown to inconsistently reduce melasma with a majority of cases eventually relapsing.
Don Mehrabi MD, FAAD
Dermatologist, Certified by the American Board of Dermatology
Los Angeles, California
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