Find Yourself Asking "What Are These Darker Patches of Skin?"
If you are like the hundreds of individuals suffering from dark brown patches and spots on your face after being out in the sun, you probly have Melasma.
What is Melasma?
Melasma is a condition in which the skin darkens, unevenly, on sun exposed areas. It most commonly occurs on the cheeks, forehead and upper lip. It is the result of genetic predisposition, hormonal influences including child birth, birth control pills and hormone replacement therapy.
When it happens associated with pregnancy, some have called it "chloasma" or "mask of pregnancy". For some unknown reason, certain areas of the skin are sensitized to get darker with sun exposure. Melasma really is nothing more than certain areas of the skin getting a sun tan faster than other areas.
You should seek out a dermatologist who can diagnose your skin condition and check for any irregularities, just to make sure your skin is as healthy as it can be.
Getting Rid of Melasma (Dark Skin Spots)
A prescription strength treatment is designed to lighten the areas, and most importantly, sun protect the areas affected by Melasma so they don't re-darken with subsequent sun exposure.
Melasma Before & After Treamtent of Upper Lip
Crutchfield Dermatology is now also offering Melanage skin peels in the treatment therapy of Melasma
Melasma Before & After Treamtent of Face
Interview with Dr. Crutchfield About Melasma
Who gets melasma and why?
Melasma is a condition where melanocytes, the normal color producing cells in the skin, produce excess melanin causing a darkening or hyperpigmentation of the skin. Melanocytes represent only about 2% of the cells in our skin. Different skin colors are not due to different numbers of melanocytes, but rather due to an increased production in the brown pigment called melanin. Melasma is a condition where melanocytes located in certain parts of the face and sometimes arms become hyperactive and produce more melanin. This activity is under the influence of hormones, most notably birth control pills and/or pregnancy. Sometimes melasma associated with pregnancy is called chloasma, also known as the mask of pregnancy. The common areas for hyperpigmentation in patients with melasma include the forehead, cheeks, upper lips, and arms.
The way I look at melasma, it is a very rapid, uneven suntan. Under the influence of hormones, melanocytes in these particular areas when exposed to sunlight release premade color packets causing an immediate darkening and it causes them to produce more melanin over the next couple of days to cause a sustained darkening. The problem is that these cells can produce color high in the skin, low in the skin, or both high and low in the skin, and the medicines we have can only penetrate so far. So if you produce color deeper in your skin, we really don't have any effective treatments to bleach away or lighten the areas of darkness. So who gets melasma and why? Anyone can get melasma, but it is under the influence of sunlight, hormones, and genetics, usually associated with birth control pills and/or childbirth. It is my experience that once the melanocytes have been activated to produce color, about half the time if you stop the inciting event, that is, if you stop birth control pills, the melanocytes will calm down and the color will fade. Unfortunately, about half the time once you sensitize them, no matter what you do, even if you stop birth control pills, they remain sensitive and any time you are exposed to sunlight, the hyperpigmentation melasma will be produced rapidly.
Of the topical treatment arsenal, which is the first line treatment for melasma?
I don't have a single treatment for melasma; I like to use a combination of a few things. First, a bleaching cream that contains hydroquinone. But more importantly, I have patients also use sun protection, one that contains a UVA protectant because ultraviolet light type A is the one that causes melanocytes to produce color. So it's not just a matter of bleaching the color, it's also protecting the skin so the color doesn't return. I've had some patients with spectacular results in treating melasma and then they took a vacation to Mexico over the winter and didn't use any sunscreen, and when they came back, the melasma was as bad, if not worse, than ever. First line treatment is hydroquinone combined with sun protection. Using a good sunscreen or sun block in sun-protective clothing.
What additional therapies might you recommend?
Second line treatment, you can use other agents that will potentiate or cause the hydroquinone to penetrate slightly deeper and work better such as vitamin C and topical retinoids. Unfortunately, these can be a little bit irritating, so many times they will use an anti-inflammatory combined, as in a common popular prescription product called Tri-Luma. It has hydroquinone, retinoids, and an anti-inflammatory. There are also preparations called Phyto + which contain kojic acid, which is a nice lightening agent, ammonium lactate containing lotions, which will also produce lightening, in addition to retinoids like Retin-A. I also recommend a spectacular skin care program containing alpha-hydroxy acids that will also improve the appearance of melasma. We use the NeoStrata system, and it has worked very, very well. Over the last year, there's a new intense treatment called Melanage Peel. This is a beta-hydroxy acid with an after treatment system that works approximately 85% of the time. This is the most effective treatment we have for treating melasma, but not perfect.
What advice would you offer patients seeking melasma treatment?
First, there's no treatment that works perfectly for all patients. In my experience, topical medicines work 50-60% of the time and alpha-hydroxy acid treatments work approximately 70% of the time. Over the last year, there's a new intense treatment called Melanage Peel. This is a beta-hydroxy acid with an after treatment system that works approximately 85% of the time. This is the most effective treatment we have for treating melasma, but not perfect. I define success as an improvement of 50% or more.
What advice would you offer patients seeking treatment?
The advice is to be patient. Nothing works perfectly, and even when you have something that works well, you have to make sure you protect yourself from the sun, so the melanocytes don't produce melasma again. The treatment of melasma depends on how deep the color is in the skin. The deeper it is, the more difficult it is treat, and nothing works 100% of the time.
What is an average out of pocket cost a patient can expect to pay for treatment?
A good sunscreen may cost approximately $15-$40 and lightening creams can cost anywhere from $60-150. NeoStrata program for six months' worth of in-office peels with products is around $950, and the new Melanage Peel is around $995.
Charles E. Crutchfield III, MD
For additional information Dr. Crutchfield recommends:
TriLuma Cream information
Glyquin Cream Information
Dr. Crutchfield performs all Botox Cosmetic and Restylane/Perlane and Juvederm treatments personally. For other cosmetic treatments, such as Pixel laser treatments, Lipodissolve Ultra, AFT light treatments, he may provide a combined treatment with his highly trained staff or have a skilled staff member perform the treatment(s)completely.
If you have any questions feel free to discuss this with Dr. Crutchfield at the time of consultation.
Dr. Crutchfield offers a money back guarantee for the treatment of the frown lines in the glabella (only) with a combination of Botox Cosmetic and Restylane if a patient uses the treatment amounts that he recommends.