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Melasma: Identification and Treatments

By: Robert Manzo
Posted: January 31, 2014, from the February 2014 issue of Skin Inc. magazine.

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In Image 2, you can see the result of a course of this type of topical treatment. The treatment included a glycolic-based cleanser with pH 3.5–4.0 to encourage desquamation of the corneocytes; an anti-inflammatory serum with barrier repair actives formulated to reduce multiple pathways of inflammation; a formulated lightening product including active ingredients for PIH suppression; as well as 4% hydroquinone, and a moisturizing treatment lotion for hydration purposes. This course of treatment took six months.

Case Study 3. The second client can be seen in Case Study 3: Epidermal Melasma. This client presented with dark map-like areas on the cheeks, forehead and upper lip. The images show the hyperpigmented areas in color UV reflected light imaging, which confirms epidermal melasma with little dermal melasma present. This is a confirmed case of epidermal melasma. Client history indicates a 10-year progressive history of active melasma with birth control use for more than 25 years.

The approach taken with this client was the use of topically formulated products, along with a series of medical-grade peels. It is important to understand the condition of the skin before applying topical ingredients and peels. This client did not have an impaired barrier, and there was little inflammation present; therefore, an aggressive peel regimen was prescribed. The peel included 2% hydroquinone, as well as lactic, kojic, salicylic and citric acids. A series of three peels, four weeks apart was undertaken. The topical regimen included a glycolic acid cleanser to maintain a regular desquamation pattern; a hydrating 4% hydroquinone lotion formulated specifically with a melanocyte-stimulating hormone inhibitor; a tyrosinase inhibitor; and a melansome transfer inhibitor. The results of this treatment can be seen in Case Study 3: Aggressive Peels.

Many variables

There are many variables when dealing with hyperpigmentation—in particular, melasma. The proper diagnosis is critical in clearing the client and not worsening the condition. As was evidenced in Case Study 1, if chemical or light therapy was used, the probability of worsening the client’s condition was high. It is also critical that the topical regimen is appropriate for the client.



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