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26 Jan 2009

melasma (hormonal pigmentation)
What causes this condition and what can i do to eliminate the dark patches?
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Anti-ageing expert
Anti-ageing expert

01 Jan 0001

Hi Annie, thank you for the question.

I must start by commenting that your best advice would be to consult an aesthetic doctor or a cosmetic dermatologist who can examine the areas of concern and prescribe the appropriate treatment.

Melasma also called Chloasma is a common acquired benign, symmetric form of hyperpigmentation found primarily in adult women. The exact cause of Melasma is unknown but sunlight exposure seems to be relevant, and its onset is often related to pregnancy, or the use of oral contraceptives. A women not on OC’s or pregnant may develop Melasma in the setting of significant repeated sun exposure, and especially if she is dark skinned or toned (men occasionally develop Melasma).
Melasma is characterized by symmetric, uniformly hyperpigmented, sharply defined patches on the face in the sun exposed areas. They appear as large patches or as confetti like macules (smaller patches). Melasma commonly affects the upper lip, cheeks, and forehead, but other areas may be affected.

The treatment encompasses a number of modalities:

The use of oral contraceptives or hormones should be avoided or stopped (discuss alternatives with your doctor)

Sun avoidance and adequate sun protection: SPF 30 or higher applied regularly that contains zinc oxide and/or titanium dioxide (my personal preference is Heliocare SPF 50)

Topical therapy:
Hydroquinone (2 to 4 %)
Topical creams – should contain glycolic acid, mandelic acid, vitamin A, vitamin C, kajoic acid, mulberry root extracts, citric acid, lactic acid, etc. and these ingredients can be found in NeoStrata’s Pigmentation Lightening Gel (night application) and Brightening Cream SPF 15 (day application).
Glycolic acid peels and mandelic acid peels (these 2 may be used in combination).

Technology Based Treatments:
Both laser (Fraxel, Ultrapulse FX, Palomar Starlux) and IPL based (Syneron eMax or eLight) may be used, but with caution. The operator of these machines must have experience with diagnosing and treating this form of pigmentation.

Often Melasma responds to combining all of the treatments starting with the topical regime (3 to 6 months) before considering technology.
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