BLOTCHY BROWN SKIN

Melanie spends half an hour each morning applying several layers of foundation over her face to ensure that the brown blotches are camouflaged by the time she leaves her front door each day. She is afraid to reveal the "pinto pony look" that she conceals on her face. The brown discolorations are irregular, large, dark, and contrast markedly against her otherwise fair skin

Melanie spends half an hour each morning applying several layers of foundation over her face to ensure that the brown blotches are camouflaged by the time she leaves her front door each day. She is afraid to reveal the "pinto pony look" that she conceals on her face. The brown discolorations are irregular, large, dark, and contrast markedly against her otherwise fair skin. They extend along her jawline and down her neck. If it weren’t for her hair we would notice the same pattern of blotchiness over her forehead that becomes continuous around the temples and onto the high cheeks. The makeup is conspicuous because it is thick, but she prefers that to the truth about her skin. She would desperately like to find an effective means of diminishing her hyperpigmentation, but it is deep and thus far there hasn’t been much optimism about this common form of deep hyperpigmentation, called Melasma. She has been given creams that might help some for awhile, but even the laser specialists haven’t been particularly keen to accept the challenge of deep melasma.

Marie had been bothered for years, since the birth of her 8 year old, about the mask of dark color around her mouth. She was informed that this was common in pregnancy, and takes it’s name for that association. "Masking of pregnancy" is listed in all the prenatal books as common in pregnancy, while hormone levels push production of pigment to new limits. Marie has never been able to diminish her "mask". Although her skin is inherently a light brown, masking is common even in fair skinned women during pregnancy. Marie admits that she loves the sun, and she spends as many days outside as she can during our short summers. She has never bothered to use sunscreen because she never sunburns.

Stacey was planning her wedding, and accordingly thought it was time to seek help for her hyperpigmented upper lip. She used to wax every month for the dark hairs that were making her upper lip shadow, but she took care of that once and for all with laser hair removal. She was happy with this, but unfortunately the skin itself was deeply pigmented along the upper lip. To the rest of the world the dark upper lip might have been a shaved moustache! She had tried the creams but she wasn’t getting very far with any of them. She had been advised that this was melasma and difficult to treat. She was encouraged that it would lighten up after menopause, no solace at all! She was becoming increasingly concerned about the possibility that this obvious discoloration was here to stay.

All of the women above are dealing with melasma, a particularly problematic form of hyperpigmentation that occurs mostly in women of reproductive years. Even fair skinned people experience this, although those that tan easily are those that hyperpigment easily. And pregnancy is a time of high likelihood because the female hormones are exceptionally high. In contrast, menopause is a time of relief because female hormones are greatly reduced. But youth and beauty come together, and blotches won’t do.

If a youthful solution is to be had, the women above will need to understand a few principles of management. First, melasma is a maintenance problem, not a curable condition. (Not yet, anyway.) But take heart! The outlook is better than it was even a couple of years ago, by newer laser therapies. However, before you bother with the bigger ticket items, first understand that UV protection of the problem zone is paramount, even if your skin is brown and you have never sunburned. This doesn’t mean you can’t enjoy our short but sweet summer. Just make sure you cover with hat and screens, diligently. And by the way, "the creams" do work, but not usually in isolation. A triplet of creams is clearly the winner, as far as the creams are concerned. And the more you combine lasers and creams and behavioral modifications, the better the outcome will be.

If you are masked, the worst thing to do is to wax the hair, or otherwise irritate the skin. It would be better to laser the hair away, over a short course of treatments, rather than routinely for the long term wax and irritate the skin. Finally, the lights and lasers provide marked improvement. As always, the buyer should beware that not all lights and lasers are capable, and so Health Canada clearances of the real medical devices should be your first question. The second question should pertain to the qualifications of the operator, as hyperpigmented skin is more risky in terms of side effects, especially if the light or laser is the "real McKoy". The operator should be a medical person with plenty of experience with lasers and cosmetic medicine who understands the challenges of melasma so that you minimize the risk of side effects and you maximize the bang for your buck. And, there is good news on the forefront of laser research, and that has to do with newer types of lasers that have been shown to be "best yet" for melasma! A specialist will help you to understand that even highly effective laser therapies work much better in combination with the "creams" and sun protection. So the outlook is cheerful for the women described above, and others like them. There is more they can do!

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