Rejuvenate, Refresh, Repair

Melasma/Dyschromia

Dyschromia or dyspigmentation is a relatively common skin condition, particularly among individuals with darker skin color.  Melasma is a form of dyschromia that is usually triggered by hormonal changes, particularly among women who are pregnant or are on estrogen-based oral contraceptive.  We recommend the use of a bleaching cream, and adhering to these three principles:

• Consistent sun protection:  You must wear a hat and at least a SPF30 broad spectrum sunscreen daily to protect the affected skin.  Re-apply sunscreen every 2-3 hours while in the sun, as even inadvertent exposure on a sunny afternoon may cause discoloration to return, even if it was previously successfully treated.  Physical blocks such as titanium dioxide or zinc oxide are preferred as they offer superior protection against both UVB and UVA.

• Gentle cleansing:  Avoid using scrubs to cleanse your skin.  Intensive cleansing of the affected areas can cause inflammation and micro-injuries, which may worsen this condition.

• Stop estrogen-based oral contraceptives: This type of hormone treatment may contribute to dyspigmentation, and make this condition difficult to reverse (even with the use of prescription bleaching cream).

A note about bleaching creams: Virtually all bleaching creams can be irritating initially.  Reduce irritation by waiting 10-15 minutes after washing the skin to apply the cream.  Start by applying the cream to the affected area every other day then increasing up to the instructed schedule.  With most prescribed bleaching creams, skin lightening generally occurs within 2 months of starting your medication.

Your physician will supervise your care to be sure you do not develop a rare condition called ochronosis, in which the skin becomes darker instead of lighter. We may recommend the use of non-hydroquinone products to relieve the skin of this strong agent and reduce this adverse reaction. In addition to topical agents, we may recommend laser surgery for some patients.