| Melasma Melasma is a natural darkening of the skin on your face caused by excessive production of melanin — the pigment that causes your skin to tan. That's why the sun, which increases melanin production, usually makes your melasma worse. Melasma can be mild, moderate or severe, depending on how much of your face is discolored and how much darker than normal your skin has become. Melasma is usually caused by normal hormonal changes in women — during pregnancy or when taking birth control pills or hormone replacement therapy. Because of the way it looks when it usually occurs, melasma is sometimes called the "mask of pregnancy." Men can develop melasma, although it is rare. Melasma may be associated with the use of certain anti-epileptic drugs. Melasma only occurs on the areas of your skin that are exposed to the sun. Exposure to the sun, even during normal daily activities, can further darken melasma. Who gets melasma? Melasma is a common skin condition that occurs predominantly in women. In fact, about 6 million women are estimated to have melasma. Anyone can have it, though it seems to be more common in people with light brown skin, especially Hispanics and Asians. Treatment for melasma. The most common prescription treatment is hydroquinone in varying concentrations. There are several prescription formulations in use. Most people with melasma are familiar with Obagi and Tri-Luma since they both contain hydroquinone. The US FDA has a preliminary white paper stating that hydroquinone has been known to cause exogenous ochronosis, a gradual blue-black darkening of the skin, whose occurance should prompt discontinuation of therapy. This has been observed in people of all Fitzpatrick skin types and has prompted the European Union and Japan to ban its use. Other known unwanted side effects of hydroquinone are erythema, desquamation, burning, dryness and pruritus. Obagi contains 4% hydroquinone and is used in combination with tretinoin (Retin-A). Tri-Luma is a combination formula that contains fluocinolone acetonide, hydroquinone, and tretinoin. Tri-Luma contains sulfites which may cause severe allergic reactions including anaphylactic symptoms and life-threatening asthma attacks. Tri-Luma® Cream is contraindicated in individuals with a hypersensitivity, allergy or intolerance to fluocinolone acetonide, hydroquinone or tretinoin. Exposure to sunlight, sunlamps or UV light and extreme heat, wind or cold should be avoided. Use of sunscreen with appropriate SPF of 30 or higher is required. Wear protective clothing and change to nonhormonal forms of birth control, if hormonal methods are used. Tri-Luma® Cream contains the corticosteroid fluocinolone acetonide. Systemic absorption of topical corticosteroids can produce reversible hypothalamic-pituitary- adrenal (HPA) axis suppression with the potential for corticosteroid insufficiency after withdrawal of treatment. |
| Aesthetic Medicine Today |
 | |  | |  | |  | |  | |  |
 | |  | |  | |  | |  | |  |
 | |  | |  |