Melasma (Hyperpigmentation)

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.
Melasma may be associated with the use of certain anti-epileptic drugs in both
sexes.  Because of the way it looks when it usually occurs, melasma is sometimes
called the "mask of pregnancy."

Men can develop melasma, especially men who work outdoors (police, firefighter,
construction, etc).

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

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.  
Tri-Luma® is currently OFF THE MARKET due to the
dangers associated with the corticosteroid.

Nerium AD  was introduced in September 2011 as a non-prescription topical use
cream for use in wrinkles and sun damaged skin.  Research on Nerium AD stems from
it use in oncology (skin cancer) in much higher doses than those found in Nerium AD.  
The cosmetic product has been clinically tested at various universities and by
independent third party laboratories and the results are phenomenal.  ST&T Research
released findings of 50% reduction in wrinkles and dark spots in 30 days!!
Aesthetic Medicine Today
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