Topical Products

Lightening Agents -  Although there are many products used to lighten the skin, most contain the same active ingredient - its generic name is hydroquinone. The product that Dr. Green most often prescribes is Glyquin®, because it is one of the most effective and well tolerated of the hydroquinone-containing formulations. It is applied twice daily, usually for months, to produce skin lightening. Even after improvement is achieved, application is often continued to prevent the return of the pigmentation. Exfoliating Agents -  There are many exfoliating agents that are used in the treatment of melasma. These are all weak acids that promote epidermal renewal, hopefully with the production of an epidermis that contains less melanin. These agents include: glycolic acid, amino fruit acids, retinoic acid, salicylic acid, lactic acid, ascorbic acid, among others. Dr. Green most often prescribes a glycolic acid and an amino fruit acid product because these tend to be most effective while being well tolerated. In particular Dr. Green recommends Glyderm® (cream, lotion or solution) - incorporating glycolic acid - and Excel AFA gel® - an amino fruit acid product. Treatment Treatment is aimed at reducing the increased pigmentation that develops in melasma. This includes the use of topical (external) products often in combination with procedures. At the present time, there are no oral (internal) drugs used for this disorder. An array of topical products is available, usually consisting of lightening and exfoliating agents. Depending upon the extent of the melasma and its response to topical products, procedures that accelerate exfoliation or actually remove the outermost layers of skin may be recommended, including QuantumIPL light treatment, microdermabrasion and chemical peeling. Lasers may also be used to reduce patches of increased pigmentation. These treatments are detailed below:

Procedures

Microdermabrasion -  This technique, which takes 20-30 minutes, uses fine crystals that are passed over the surface to remove the outermost layers of skin. This procedure may, in and of itself, reduce the increased pigment in the skin. In addition, the removal of the outermost layer of cells permits more effective penetration of the topically applied lightening and exfoliating agents. Immediately after the procedure, your skin will feel smoother. Although slightly pink after treatment, you may immediately resume activities including returning to work. After a series of microdermabrasions, often in combination with glycolic acid peeling, the skin is usually lighter. This regimen may need to be repeated on an annual basis as maintanence. Quantum IPL™/Photorejuvenation -  This novel device uses laser-like technology to treat the skin with high intensity light. The light used is safe, being in the visible and infrared ranges. This treatment is known as non-ablative rejuvenation because there is no injury to the overlying skin as occurs with more invasive ablative lasers, such as Erbium and Carbon Dioxide alluded to above. It attempts to promote a more even skin complexion that has been altered as a result of melasma and photoaging. In addition, it attempts to improve the skin texture by stimulating the production of new collagen in the dermis. After treatment the skin may be pink and slightly swollen for a few hours or longer, but often no visible changes are present and you can immediately resume all activities. A series of 6 treatments are initially administered at intervals of 3 weeks. Chemical Peels -   Glycolic acid peels:  This technique involves the application of a solution that removes the outermost layers of skin. The term chemical peeling is a misnomer, because there is no actual peeling involved with this procedure. Instead these chemical solutions dissolve the outer layers of skin. The solutions are often the same acids used in the topically applied exfoliating agents discussed above, but in higher concentration. The solution used is a weak acid, most often glycolic acid (AHA peels, 'alpha-hydroxy' peels, 'lunchtime' peels). Like microdermabrasion, the procedure not only attempts to lighten the skin but it also permits more effective penetration of the topically applied lightening and exfoliating agents. These peels may be associated with mild stinging, but it doesn't last long and is usually well tolerated. Although your skin may be pink and there may be some flaking over the next one or few days, you may immediately resume activities, including work. Usually, a series of 6 to 8 peels are performed, in progressively increasing concentrations of solution, often in conjunction with microdermabrasion. This regimen may need to be repeated on an annual basis as maintenance. Trichloroacetic acid peels:  In most women, the use of the topically applied lightening and exfoliating agents in combination with microdermabrasion and glycolic acid chemical peels provides some visible improvement in the pigmentation of melasma. However, if the melasma is quite dark, or has resisted the above treatments, slightly stronger chemical peels are administered, usually using varying concentrations of trichloroacetic acid (TCA peels, Obagi Blue Peels®). These peels may produce more stinging than glycolic acid peels, but this is for a short duration. The reaction of your skin is similar to a sunburn. Depending upon the concentration of the solution and how your skin reacts, there is a varying amount of redness, swelling and 'peeling' of skin. For lower concentrations of solution, you may resume all activities, including work. However, for slightly higher concentrations or if your skin is quite sensitive, you may wish to take a few days off from work. It may be necessary to repeat this procedure to achieve acceptable lightening of the skin. Do you have a question? - Email: skincare@laserderm.net