Dermatologist can lighten unsightly skin discoloration

Doctors unsure why pigment-producing cells get kicked into overdrive.
SCRIPPS HOWARD NEWS SERVICE
Do you have dark, patchy discoloration on your cheeks, forehead, jaw line or around the mouth? If so, you might have melasma, a skin condition that affects six million women in the United States. Although we know who has it (Hispanics, Asians, Native Americans, and those of Middle Eastern and Northern African descent have the highest incidence, although Caucasian women can also suffer from it), dermatologists are still a little unsure of why. The condition can be traced to over productive melanocytes, pigment-producing cells in the skin, but doctors still are debating the reason that these cells get kicked into overdrive in the first place.
The causes
Melasma seems to have a link to hormones. Birth control pills, hormone replacement therapy, pregnancy and hormonal imbalances have all been fingered as possible melasma triggers. And if you're prone to the dark patches, add a little sun exposure and you have a recipe for skin discoloration.
The treatments
Your dermatologist should be the first stop if you think you have melasma. Once you are diagnosed correctly, you can start discussing treatment. Your dermatologist will most likely prescribe a bleach-based topical product to help lighten existing dark areas and prevent new patches. One of the latest prescriptions to fall into favor with dermatologists is Tri-Luma, which contains hydroquinone and tretinoin as well as a steroid to successfully treat melasma over eight weeks. Hydroquinone, which shuts down pigment production, is one of the most popular lightening agents, but it must be avoided if you are pregnant or nursing or are planning to become pregnant. Sensitive skin also may have trouble tolerating hydroquinone.
So what if you're not a candidate for hydroquinone? Check the ingredient label for naturally derived brighteners and lighteners such as azelaic or kojic acid. One to try: DDF Intensive Holistic Lightener ($48).
It's important to keep in mind that skin-lightening products can take six months or more to show results. And since bleaching agents can't tell the difference between normal and abnormally pigmented skin, apply the product twice a day, taking care to apply only to the areas you would like to lighten.
Your dermatologist also has in-office treatments that can reduce the appearance of melasma. Chemical peels can provide improvement in conjunction with any topical treatments you're using. Ask your dermatologist about glycolic, TCA or Jessner's peels. Another option is the tretinoin peel, a vitamin-A-based peel developed in Brazil to treat sun damage.
Prevent the patches
Does the key to preventing melasma reside in a bottle? Yes -- a bottle of sun block, that is. There wouldn't be melasma if it weren't for sun exposure, so an SPF of at least 30 is recommended, and you'll probably want to add a hat for good measure. More importantly, many melasma treatments (i.e. hydroquinone and chemical peels) can actually increase sun sensitivity, so daily sunscreen use is a must.