Trending Now: Collagen Supplements for Anti-Aging

If you read beauty blogs and magazines, chances are you have heard of the latest craze to hit the anti-aging market — collagen supplements. Collagen supplements claim to make the skin look younger, may help with brittle nails, and may even reduce the appearance of cellulite. But do they really work? We examined the current scientific literature to determine if collagen supplementation can transform your skin and make you look years younger.

What is collagen?

Collagen is the most abundant protein in the body and is responsible for the structure, stability, and strength of the underlying tissues. The deposition of collagen into the skin gradually decreases over time as the skin ages, but it can be accelerated due to photoaging from excessive sun exposure. Aside from aging, the biggest reason individuals are deficient in collagen is a poor diet. Consuming animal and vegetable sources that are protein-rich, such as beef, chicken, fish, beans, eggs, and dairy products can help ensure adequate intake of collagen.

The science:

Several limited studies have shown promising results in individuals taking collagen supplements for their skin. These studies have noted benefits in transepidermal water loss (skin hydration), skin elasticity, roughness, and wrinkles. Two separate studies showed a possible benefit of collagen supplementation in patients who have brittle nail syndrome as well as in women who suffer from moderate cellulite. Animal studies further revealed that administering collagen hydrolysates to mice for 6 months led to significantly increased collagen content and density of the skin.

Can I benefit from taking a collagen supplement?

If you are eating a healthy diet and feeding your body all of the nutrients it needs to make collagen, you probably do not need a supplement. However, as the body ages, you may no longer absorb or synthesize nutrients as efficiently as you used to. Taking a collagen supplement can make up for a deficiency if it is present. A 2017 study in the Journal of Agriculture and Food Chemistry showed that collagen hydrolysates can be transferred through the bloodstream directly to the skin, which explains the probable pathway for the beneficial effects of taking a supplement. However, some scientists postulate that the skin is a much lower priority to the body than major muscles, like the heart, diaphragm, and brain, where collagen will be distributed first. Therefore, only patients with a significant deficiency will likely benefit from taking collagen supplements. In addition, the cost and bulk of supplementation may be prohibitive for patients. Supplements in pill form require swallowing six a day to get a 6-gram dose. Powders are often double the price of pills, running from $15-$40 for a month’s supply.

Bottom line:

Limited studies on the benefits of collagen supplements have shown some promise, however, questions remain regarding which patients will benefit and how much collagen is actually absorbed into the skin. Cost and administration may be factors in compliance. It should be noted that for individuals who wish to add more collagen to their diet, bone broth—while not in hydrolysate form—offers six grams of collagen-rich protein and may be a tastier way to get your collagen fix.

 

 

References

  1. Jhawar, N., Wang, J. & Saedi, N. Oral collagen supplementation for skin aging: a fad of the future? Journal of Cosmetic Dermatology, August 14, 2019. https://doi.org/10.1111/jocd.13096
  2. Choi, F.D., Sung, C.T., Juhasz, M., Mesinkovska, N.A. Oral collagen supplementation: A systematic review of dermatological applications. Journal of Drugs in Dermatology. 2019; 18(1): 9-16.
  3. Vollmer, D.L., West, V.A., & Lephart, E.D. Enhancing skin health by oral administration of natural compounds and minerals with implications to the dermal microbiome. J. Mol. Sci.201819(10), 3059.
  4. Hexsel, D., Zague, V., Schunck, M., Siega, C., Camozzato, F. & Oesser, S. Oral Supplementation with specific bioactive collagen peptides improves nail growth and reduces symptoms of brittle nails. Journal of Cosmetic Dermatology; August 2017, available online at: https://doi.org/10.1111/jocd.12393.
  5. Krieger, E. Collagen supplements show early promise for skin and joints, but don’t stock up yet. March 26, 2018, The Washington Post. Available online at: https://www.washingtonpost.com/lifestyle/wellness/collagen-supplements-show-early-promise-for-skin-nails-and-joints/2018/03/23/1cd480e2-27d6-11e8-bc72-077aa4dab9ef_story.html
  6. Schunck, M. Zague, V., Oesser, S., & Proksch, E. Dietary supplementation with specific collagen peptides has a body mass index-dependent beneficial effect on cellulite morphology. Journal of Medicinal Food. Dec 17, 2015: Available online at: https://doi.org/10.1089/jmf.2015.0022
  7. Cruel, J. Does drinking collagen supplements actually do anything for your skin? Self, August 22, 2017. Available online at: https://www.self.com/story/collagen-supplements.

How Dermatologists Use Lasers and Other Light-Based Devices

Rocket projected onto the Washington Monument during the celebration of the 50th anniversary of Apollo 11.

As we celebrate the spectacular achievement of the moon landing 50 years ago, we can reflect on the technological advances that have had an impact on dermatology. In the half century since Dr. Leon Goldman pioneered the medical application of lasers, they have become integral to state-of-the- art dermatology practices. So how do dermatologists use lasers and other light-based devices?

Uses for Laser, Light and Energy-based Devices

Remove unwanted hair

Lasers remove unwanted hair from the face and body by targeting the pigment of the hair and damaging its follicle so that hair growth is slowed. In order for lasers to be effective, the hair must be treated while in its “active growth” phase. This is why multiple (usually six to eight) treatments, spaced four weeks apart on the face, and as much as eight weeks apart on the body, are needed to achieve good results. The same lasers are also effective for excessive sweating or hyperhidrosis. Note: Only specific lasers are appropriate for darker skin types, and those with tanned skin should avoid the treatment.

Do away with those age spots

Sun damage and aging can result in unwanted brown spots, called lentigines, on sun-exposed areas such as the face, chest and hands. Those spots can successfully be treated with Q-switched lasers and IPL (Intense Pulsed Light) devices. Several treatments may be required to achieve optimal results.

Treat redness and broken blood vessels

Lasers are effective at treating skin redness from conditions such as rosacea as well as benign vascular growths such as angiomas and broken blood vessels that can occur from sun damage. The treatment works because lasers at certain wavelengths can target hemoglobin that is found in blood. Typically one to a few treatments may be needed for optimal results. It is important to use a broad-spectrum sunscreen after the treatment.

Banish those breakouts

Lasers and light-based devices can successfully treat mild to moderate acne. While conventional methods to get rid of acne include topical and oral medications, such as antibiotics and retinoids, the use of photodynamic therapy can be effective in achieving long-lasting clear skin. Photodynamic therapy combines the use of a photosensitizing chemical that is absorbed both by the oil glands and the bacteria that produce acne – followed by a light source or laser to activate the chemical. This results in shrinkage of the oil glands and killing of the bacteria.

Refresh and rejuvenate

A newer generation of devices today allows for skin resurfacing that removes the top layer of skin to eliminate signs of aging and photodamage such as fine lines, wrinkles, crepiness and brown spots as well as reducing enlarged pores – all with minimal downtime.

Soften the look of scars

Lasers can improve the appearance of scars – whether they were caused by acne, trauma or surgery. Some devices – like the pulsed dye laser – can help reduce the redness associated with scars. Fractional resurfacing lasers can successfully improve a scar’s texture and tone. Depending on which device is used, there may be a period of downtime following the treatment and a need for several treatments.

Take care of that ‘turkey neck’

With age comes a loss in collagen, which can result in loose skin on the neck and under the chin – affectionately known as “turkey neck.” Fortunately, there are non-invasive technologies that utilize ultrasound and radiofrequency to stimulate collagen production – resulting in skin tightening and lifting. These treatments also can be used for wrinkles on the décolletage, that crepe-paper look on the upper chest.

Rethink the ink

Fortunately there are options for those 20 percent of people who experience tattoo regret. Q-switched lasers have been used for decades to heat up and destroy the tattoo ink particles, usually over multiple treatments. Newer technology using ultra-short bursts of energy can achieve the same results in fewer treatments.

If you think one of these treatments could be right for you, contact us to schedule a consultation. Located in Chevy Chase, MD, our dermatology office serves the greater Washington D.C. area.

Progress Being Made in the Dermatology Field

The annual American Academy of Dermatology meeting took place in DC in March and I was thrilled to serve as faculty along at the Live Injection Course. My colleagues – leaders from around the country- and I demonstrated injection of fillers and toxin to a packed audience. This came right after our office hosted the International Peel Society workshop in which visiting dermatologists learned state-of-the-art peel techniques. Best part of all of this was how much I leaned from my colleagues!

The AAD meeting is the largest assemblage of dermatologists anywhere and it was full of cutting-edge research from around the world.

What We Learned

In the war on melanoma, continued progress in melanoma immunotherapy has vastly improved survival rates. Future melanoma treatment may consist of personalized therapy in which a vaccine is created based on the specific antigens most expressed on an individual patient’s tumor. In this way the patient’s immune system is encouraged to recognize and attack his or her own melanoma cells.

We also learned a lot about a new class of medications called “JAK” (Janus Kinase) inhibitors. These agents are game changers for alopecia areata, atopic dermatitis, vitiligo and psoriasis. These are systemic medications, taken by mouth, but even the topical cream version has been shown to be effective in children with alopecia areata.

And for melasma, the difficult to treat darkening of the skin, there was encouraging news. Tranexamic acid in pill and topical form along with a new agent reduce the pigment that is so resistant to treatment.

Progress is being made on nearly every front in our field!

Older woman's hands on keyboard, aging hands

What Can Be Done For Aging Hands?

Did you know that your hands can reveal your true age, well before other areas of the body begin show signs of aging? While aging of the hands typically begins by age 50, with the first signs being discoloration and age spots, hands can start to age sooner if individuals are frequently exposed to the sun without the proper protection. By age 50-60, people also tend to lose volume in their hands, making veins and tendons more prominent and further contributing to aging hands. The good news is there are treatments available that can slow or reverse some of the signs of aging hands. Treatments can be tailored to the individual, depending on their specific concern:

Age spots:

Pigment-specific lasers are used to treat dark brown spots on the hand by delivering a beam of light that penetrates the skin surface. Following treatment, brown spots appear darker for about a week and then will scab, fall off, and turn pink as the skin begins to heal. One to two treatments are usually needed before improvement is noted. Results can last for years as long as proper care is taken to avoid sun exposure to these areas.

Topical retinoids and bleaching creams, like hydroquinone, can also be used to diminish the appearance of dark spots. They can be used either alone, or in combination with lasers, to reduce the appearance of age spots.

Volume loss:

Injecting fillers into the back of the hand is a quick, in-office procedure that can be achieved by using a non-allergic product called calcium hydroxylapatite. Results are immediate and can last for 1-2 years.

Applying a lotion or cream after washing your hands helps to trap water in your skin, and can provide a temporary plumping effect.

Rough, scaly patches:

If you have fair skin and spent a lot of time in the sun, you may notice rough spots or patches on your hands. These rough patches may be actinic keratoses (AKs), which are pre-cancerous growths that need to be evaluated and treated by a dermatologist. Liquid nitrogen (cryotherapy) can treat the individual AKs, while topical medicated creams or photodynamic therapy can treat the entire area at once.

Wrinkly “crepey” skin:

Applying sunscreen to your hands every day can prevent wrinkly skin on your hands. To treat wrinkles that are already there, your dermatologist may recommend a lotion containing retinol or glycolic acid or light chemical peels.

Radiofrequency treatments, which use heat directed deep into the skin, can help tighten loose skin. Most people only need 2-3 treatments on their hands to see results.

Brittle nails:

Brittle, aging nails typically present as lines running lengthwise on your nails, appearing like ridges. You may also notice that your nails peel or break easily. Certain activities such as cleaning with harsh chemicals or spending a lot of time with wet hands, can cause brittle nails, so it is important to wear rubber gloves when cleaning and doing dishes.

It is also important to moisturize the hands regularly with a urea- or petrolatum-containing moisturizer, preferably after every hand washing and before bed.

The nails reflect overall health. Changes in nail color or shape can signify a systemic problem that should be evaluated by a dermatologist.

Follow up:

It is important to follow up with your dermatologist after your treatments to help maintain your results as long as possible. Sun protection is essential at all times, and can be achieved by using a broad spectrum water-resistant sunscreen with SPF 30 or higher and reapplying regularly throughout the day. UV-protective driving gloves are also helpful in blocking out the sun’s harmful rays.

References:

American Academy of Dermatology. “What can make my hands look younger?” Available online at: https://www.aad.org/public/skin-hair-nails/anti-aging-skin-care/younger-looking-hands

American Academy of Dermatology (August 2012). “Busy moms deserve a hand: Dermatologists offer tips to prevent premature aging of the hands.” Available online at: https://www.aad.org/media/news-releases/busy-moms-deserve-a-hand-dermatologists-offer-tips-to-prevent-premature-aging-of-the-hands

 

Frequently Asked Questions Regarding Infini Wrinkle Reduction

Infini is a technology developed for surgical scar improvement that can also enhance and rejuvenate aging skin, providing consistent results and low downtime.

One of the many benefits of Infini is that it can be used at any time of the year and on any skin. Infini does not directly affect the epidermis. It is a non-invasive procedure that addresses both post-operative scars and the skin laxity such as wrinkles and textural changes that are a consequence of sun exposure.

Q: What is this procedure good for?
A: Overall skin rejuvenation; fine lines and wrinkles, improving tone and textural changes- especially “crepey skin”, sagging skin, acne scarring

Q: What parts of the face/ neck can it improve?
A: Brows, crows feet, upper lip, neck and chest

Q: How does it work?
A: Energy delivered into the skin stimulates the natural growth of collagen and elastin—natural  “scaffolding.”

Q: Why is radio-frequency an important addition to microneedling?
A: The radio-frequency delivered via gold-plated microneedles is a powerful stimulant for new collagen production.

Q: What preparation is involved?
A: Application of a topical numbing cream in the office for approximately 2 hours

Q: How long is the procedure?
A: About 30 min

Q: What is the downtime?
A: There is redness and swelling for approximately 48 hours, which may take up to a week to resolve. Make-up may be applied after 48 hours

Q: How quickly will I see results?
A: It takes a few weeks to begin to see results. Improvement continues over a period of up to 6 months

Have questions or want to make an appointment at Dermatologic Surgery Center of Washington? Click here to contact us.

Back to School Rash

I love September! To me, Back-to-school means clean notebooks, new horizons and the memory of a fresh box of Crayolas. My excitement is just another in a long list of quirks that my children find perplexing and irritating. I somehow haven’t completely transmitted the enthusiasm my own parents had for the start of the school year.

My dad, a college president who saw the potential student in almost everyone, looked upon the beginning of the semester like a child anticipates Christmas morning. His own education was a transformative gift, and he never got over his wonder and gratitude. My mother excitedly planned first-day-of-school outfits and staged multiple photos, but one year she got a little ahead of herself. As she pulled out of the elementary school driveway, having dropped me and my brothers off at the front entrance, the custodian waved down her speeding station; the first day of school wasn’t until the NEXT day. I get it; summer vacation can get too long when you have three kids underfoot.

In the wonderful world of dermatology, the fall also brings particular skin conditions. One of these back-to-school rashes is hand, foot and mouth disease.

Hand, foot, and mouth disease is a viral infection that causes sores in the mouth and a rash on the hands and feet. It is common among children under the age of 5, particularly in daycare settings, as it spreads by close contact with infected people. It’s not usually serious, and nearly all people recover within 10 days without medical treatment. (1)

Symptoms of Hand, Foot and Mouth Disease

● Fever
● Poor appetite
● Sore throat
● Rash – Small red bumps or blisters on the palms, soles of the feet, and sometimes the knees, elbows, buttocks, and genital area.
● Painful sores in the mouth

Symptoms typically appear 3-6 days after the initial infection (incubation period), with fever as the first sign, followed by a sore throat. (2)

Transmission

Hand, foot, and mouth disease spreads through contact with infected individuals’ nasal secretions, throat discharge, saliva, stool, or respiratory droplets after a cough or sneeze. It may also spread through contact with blisters on the skin.

Infected individuals are typically most contagious during the first week of illness, but the virus can remain in the body for weeks after the signs and symptoms are gone, resulting in further transmission. Some people, particularly adults, can pass the virus without showing any signs of the disease. Outbreaks of the disease are common in the summer and autumn in the United States and other temperate climates. (3)

Treatment for Hand, Foot and Mouth Disease

There is no specific treatment for hand, foot, and mouth disease. Symptoms, such as fever, can be managed with over-the-counter analgesics, like Ibuprofen or Tylenol. It is important that infected individuals drink plenty of fluids to stay hydrated, particularly if fever is present. Complications of hand, foot, and mouth disease are rare, but may include viral meningitis or encephalitis. High fevers not relieved with analgesics, headache, stiff neck, or back pain warrant further evaluation by your physic.

 

 

 

(1) CDC (June 28, 2018). Hand, Foot, and Mouth Disease. Accessed online at:
https://www.cdc.gov/features/handfootmouthdisease/index.html .

(2, 3) Mayo clinic (July 26, 2017). Hand, Foot, and Mouth Disease . Accessed online at:
https://www.mayoclinic.org/diseases-conditions/hand-foot-and-mouth-disease/symptoms-causes/syc-20353035 .

What is Seborrheic Keratoses?

Have you ever been concerned about a dark mole on your skin, only to be told by your dermatologist that it’s not a mole but a seborrheic keratosis? We might tell you not to worry about it, but did you get a good explanation of what they are?

A seborrheic keratosis (SK) is a very common skin growth caused by a thickening of an area of the top skin layer. It usually appears as a brown, black, or light tan growth on the face, trunk or arms, and may have a waxy or scaly raised appearance. Despite the way they look, these growths are harmless. They do not usually cause any symptoms, but they may itch.

SKs typically occur in middle-aged and older adults and there may be a tendency in families to grow multiple lesions. SKs are not contagious.

Treatment Options for Seborhheic  Keratosis

Treatment of SKs is usually not necessary, but may be desired for cosmetic reasons. Under local anesthesia, they may be removed with a scalpel, scraped off with a special instrument, or burned off with an electric current. The most common treatment for SKs is liquid nitrogen therapy. However, all of these treatments have the potential to leave behind a white mark or scar. Eskata is a new treatment that is able to remove the SKs without leaving a scar or affecting the pigment in the skin.

What is Eskata?

Eskata is an FDA-approved topical and non-invasive treatment that is indicated for raised seborrheic keratoses (SKs). It consists of a clear, colorless solution of 40% hydrogen peroxide intended for application by a healthcare provider in an office setting. We are happy to announce that we are one of the first practices in the Washington, DC region to be trained and certified in Eskata application.

How does it work?

We carefully apply the concentrated hydrogen peroxide liquid to the SKs four times, about a minute apart. The SKs may turn white initially and then form a scab. Over the next few days, the SKs should fall off without leaving a scar. Typically, two treatments are needed, about 3 weeks apart, to completely remove the SKs. Watch the video below to see an application.

What are the side effects of Eskata?

A tingling, burning, or itching sensation is common during the application process. Following the application of Eskata, patients may have redness and/or swelling that can last up to a week.

Is Eskata covered by my insurance?

Treatment with Eskata is considered cosmetic, and is not covered by insurance. One session will treat up to 7 SKs.

 

Contact us with any other questions or to make an appointment with a dermatologist.

excessive sweating

Hyperhidrosis Could be the Cause of Too Much Sweat

hyperhidrosis

Hyperhidrosis is a medical condition that causes excessive sweating that is not necessarily related to heat or exercise. Messages from your brain usually tell your body when to produce sweat, either to keep you cool in warm temperatures or as a reaction to anxiety. However, with hyperhidrosis, excessive sweating occurs regardless of the physical or emotional environment. This excessive sweating may interfere with daily activities and can cause significant social anxiety and embarrassment. Fortunately, several treatment options are available to help with this condition.

Treatments for Excessive Sweating

    • Antiperspirants: Antiperspirants are the most common treatment for hyperhidrosis and may be purchased “over-the-counter” at your local drugstore or with a prescription from a medical professional. They work by plugging your sweat ducts so that the sweat does not reach the surface of your skin.
    • Iontophoresis: This treatment uses a mild electrical current in a shallow tray of water to reduce excessive sweating of the hands and/or feet. It has been shown to reduce sweating by 81%1,2. Prescription iontophoresis machines cost under $1000 and insurance may cover some of the cost.
    • Botox: Botox is a natural, purified protein that, when injected, can temporarily block the secretion of a chemical in your body that controls your sweat glands. When used to treat excessive underarm or hand sweating, it has been shown to reduce sweating by 80-90%, with improvement lasting from 4-12 months. The cost of Botox varies depending upon the size of the body area treated and whether insurance covers any of the cost.
    • Oral medications: There are several classes of medications that may be used to treat excessive sweating, each having different side effects and precautions. Insurance usually covers the cost of this type of therapy.
    • Laser therapy: A laser can be focused into a narrow beam of energy in order to target, heat, and destroy sweat glands in the underarm area. Side effects may include swelling, bruising, and numbness, but usually resolve after 1-2 weeks. In studies, 82% of patients receiving laser treatment for hyperhidrosis said their results were “good” or “excellent”3. Insurance may not cover the cost of laser treatment, which can be up to $3000.
    • MiraDry: This device is used by a doctor to deliver microwave energy to the underarm skin, effectively destroying sweat glands. In research studies, MiraDry was shown to reduce underarm sweat by 90%4. Common side effects include swelling, redness, and tenderness lasting for several days. Best results are seen when two treatments are performed three months apart.
    • Obrexza: This non-invasive FDA-approved treatment is intended to treat axillary hyperhidrosis (underarm excessive sweating). One wipe is applied topically to both underarms once per day. It is approved for patients 9 years old and older.

    Other Causes of Excessive Sweating

    Hyperhidrosis may be caused by an underlying medical condition such as menopause, diabetes, Alzheimer’s, tuberculosis, or cancer. Certain medications, such as antidepressants or anti-anxiety medications may also cause excessive sweating.

    When sweating is caused by an underlying medical problem, this is called secondary hyperhidrosis. Unlike secondary hyperhidrosis, which has a sudden onset, primary hyperhidrosis tends to be a longstanding medical condition that typically begins prior to age 25 with no underlying cause.

    If excessive sweating is a problem for you, consult with your physician.

    Contact us with questions and to book your appointment.

     

     

     

     

    1. Karakoç Y. Safe control of palmoplantar hyperhidrosis with direct electrical current. Int J Dermatol. 2002;41:602-605.
    2. Bouman HD, Grunewald Lentzer EM. The treatment of hyperhidrosis of hands and feet with constant current. Am J Phys Med. 1952;31:158-169.
    3. Leclere FM, Moreno-Moraga J, Aleolea JM, Vogt PM, Rovo J, Corenjo P, Casoli V, Mordon S, Trelles MA. Efficacy and safety of laser therapy on axillary hyperhidrosis after one year follow up: a randomized blinded controlled trial. Lasers Surg Med. 2015; 47(2): 173-9.
    4. Lupin M, Chih-Ho Hong H, O’Shaughnessy KF. A multi-center evaluation of the Miradry system to treat subjects with axillary hyperhidrosis. Am Soc for Laser Med and Surg. 2011; 79.

    Skincare Tips for Diabetes Patients

    5 Skin Tips for People with Diabetes

    According to the 2017 National Diabetes Statistics Report there are 30.3 million people with diabetes (9.4% of the US population) including 23.1 million people who are diagnosed and 7.2 million people (23.8%) undiagnosed.

    Patients with diabetes are more susceptible to skin infections, especially on the feet and on the skin of the ear. More than 75% of patients with diabetes will have skin lesions. The most common is xerosis or dryness. Dry skin affects 50% of those with type 1 diabetes. Keratosis pilaris, or rough spots on the sides of arms affect about 10% of patients. Itching of the skin, especially on the torso, is very common.

    Also occurring are smooth yellow plaques on the front of the shins called Necrobiosis lipoidica. These lesions are usually painless and are 3 times as likely to occur in women than in men. They can be treated with topical creams as well as oral medications that improve circulation, such as low-dose aspirin, pentoxifylline, dipyridamole and nicotimamide.

    70% of diabetic men over 60 will develop diabetic dermopathy or shin spots. Over time these become dark depressions in the skin.

    Skincare Tips for Diabetes Patients

    So how does one prevent or treat these irritations caused by diabetes? Besides keeping your diabetes under control, here are some tips you can follow for skin care.

    1. Moisturize daily with an unscented emollient such as Cerave, Cetaphil or Uradin 10 lotion. Apply when skin is still damp- within 3 minutes of getting out of the bath or shower.
    2. Use a moisturizing, fragrance-free cleanser such as Dove soap. Oatmeal baths can also help reduce itching.
    3. Thoroughly dry skin folds such as underneath the breasts or between toes. Trapped moisture is a breeding ground for yeast and fungal infections.
    4. Check your feet daily for sores or cuts and treat with a topical antibiotic and bandage. Seek medical attention for any sores that have not healed or are red, swollen, hot or draining pus.
    5. Don’t cut cuticles around your nails as this can lead to infection.

    Note that not all-natural health and beauty products are 100% natural. Many include fragrance and other ingredients that can irritate sensitive skin. Be sure to read the labels.

    If you are concerned about your skin or whether you have diabetes, consult a physician.

    Contact us with questions and to book your appointment.

    melasma example dark spots on cheek

    What is Melasma & How to Treat It

    melasma example dark spots on cheek

    In addition to wonderful memories, summer can leave behind unwanted darkening of the skin.  Persistent hyper-pigmentation of the face, called Melasma, occurs on the cheeks, bridge of nose, forehead, upper lip and occasionally the forearms.  It is similar in appearance to age spots, but the dark patches cover a larger area.

    Melasma occurs in all skin types, but especially in skin of color.  East Asian, Southeast Asian, Hispanic and Blacks populations have the highest rates.  Up to 30 % of middle-aged Asian women exhibit Melasma.  In general, women are affected more frequently; the American Academy of Dermatology estimates that 90 % of Melasma sufferers are women.  Men are not immune; nearly 35 % of men from Central America – particularly Guatemala – develop the condition.

    What causes Melasma?

    Sunlight is the principal trigger.  The greater the sun exposure, the greater the risk.  Age increases the potential as does a history of vitiligo and the existence of multiple moles or birthmarks.

    The second most important cause is female hormones.  Not only is Melasma more common in women, it’s also more severe.  It occurs during pregnancy (the “mask of pregnancy” or Chloasma) and with the use of oral contraceptives and hormone replacement therapy (HRT).  Unfortunately discontinuation of the medication doesn’t necessarily reverse the pigmentation.

    Why does Melasma differ by ethnic group?

    Skin color is determined by the density and distribution of melanin, or natural pigment, in the skin.  All ethnicities have a similar number of melanin producing cells, or melanocytes, in their skin.  What differs is the level of melanocyte activity and how closely the cells are grouped together.  Skin types with more melanocytic activity, or darker skin types, react to inflammation or UV exposure with more robust melanocytic activity, leading to hyper (increased) and sometimes hypo (decreased) pigmentation.

    How is Melasma treated?

    Sun protection is the cornerstone of Melasma prevention and treatment.  Daily use of a broad spectrum (at least SPF 30) sunscreen that blocks both UVA and UVB is critical.  These should be applied at least 20 minutes before and 30 minutes after sun exposure.  Products  should contain one or more of the following ingredients in order to protect against the long UVA wavelengths: Zinc Oxide, Titanium Oxide, Ecamsule and/or Avobenzone (Parsol 1789).  Protection can also come from wearing iron oxide-containing makeup.  Hats with a 2-3 inch brim along with sunglasses are helpful in reducing UV light exposure.  It’s important to remember that damaging sun rays penetrate through a car window.

    Topical skin bleaching agents such as prescription-strength Hydroquinone, either alone or in combination with topical retinoids and steroids, are very useful in treating Melasma.  Their efficacy is enhanced when combined with a series of peels with either Glycolic Acid, Salicylic Acid or Trichloroacetic Acid.  Peels and topicals should be adjusted according to skin type for best results.

    Other agents also have a role in reducing pigmentation including vitamin C and E, Azelaic Acid, licorice, Kojic Acid, Ellagic Acid and Arbutin.  Lasers are often promoted for Melasma treatment but they are not as effective as they are for solitary age spots or blood vessels.

    Oral medications, such as Tranexamic Acid, are also helpful as an adjunct treatment for some patients.

    Summary:

    I find that a multi-modal approach, tailored to a patient’s ethnicity, location of pigment in the skin and underlying health status leads to significant and durable improvement in Melasma.  The good news is that if Melasma bothers you, it’s not something you have to live with!