Interview with Dr. Binstock: First Steps in Treating Melasma

Melasma is a tan or dark skin discoloration

Hi, I’m Tiffany. Until last year I had perfect skin. Then, I noticed a small dark spot on my upper right cheek. Over time, the spot spread onto the bridge of my nose. Now, I check my skin from all different angles in various lights and mirrors. I’m panicked!

Mom told me that her mom, my Italian maternal great grandmother, had the exact same “shadow” in the same spot. Mom calls it melasma (muh-LAZ-muh).

At different times, I’ve used Esoterica® and Porcelana® to keep them away. They help, but I need more. I need stronger treatments.

When Tiffany arrives at our office she’s wearing thick concealer and maximum coverage powder to hide the “rash.” What follows is a typical initial conversation between people with melasma who seek Dr. Binstock for confirmation and treatment options.

Tiffany: What is melasma?

Dr. Binstock: Melasma is a common skin problem that causes brown to gray-brown patches. Most people get melasma on their cheeks and also on the bridge of their nose—as in your case. These bothersome patches may also appear on the forehead, chin, and above the upper lip. In fact, they can appear on other parts of the body that get lots of sun, including the forearms and neck.

Tiffany: Why do I have it?

Dr. Binstock: We don’t know, exactly, but it appears to be associated with the female hormones estrogen and progesterone. Women taking birth control pills, and hormone replacement therapy are more likely to develop melasma.

Tiffany: I was told to ask for Fraxel® laser treatment for my melasma. Is this a good treatment?

Dr. Binstock: Yes, Fraxel laser can be very helpful. It can fade and help control the patches, but no single treatment achieves complete or permanent removal. The Fraxel laser can be combined with other treatment for best response; and we’ll consider this for you.

Regardless of the treatment you receive here, continued sun protection and using skin care products for melasma are essential.

Tiffany: How do we start?

Dr. Binstock: To start, you will minimize exposure to the sun. Treat you skin with a bleach cream for a few weeks, and then return here for the treatment that we will discuss first. You will continue to use the bleach cream after your treatment. It may take from up to three treatments for the best results.

Tiffany: What side effects might I expect to have?

Dr. Binstock: Any swelling is typically minimal and subsides within a day or two. Any redness fades in a few days. Other temporary side effects might include minor itching, dry skin, peeling or flaking, and a bronzed skin appearance. There is a limited risk of infection, hyperpigmentation, or scarring.

Tiffany: Might Fraxel make my melasma worse?

Dr. Binstock: Melasma is a tough condition to treat. Occasionally, Fraxel might flare your melasma. Most importantly, it will come back as soon as you get too much sun exposure. If we decide to use Fraxel, you will still have to continue to care for your skin in order to control the melasma. For example:

  • Use high quality sunscreen each morning: SPF 60 or higher.
  • Wear wide-brim hats.
  • Use bleaching creams that will be prescribed.
  • We will also consider changing your contraception or decreasing your estrogen dose.

Do you have melasma? For consultation and more information about our approach to treating melasma to achieve the best results for you, contact Aesthetic Dermatology and Skin Cancer: Jeffrey H. Binstock, M.D. Drs. Binstock and Physician Assistant Cullinane will answer your questions. Call our office in Mill Valley (415) 383-5475.


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