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Mastering the Treatment of Melasma
By: Raffy Karamanoukian, MD, and Hratch Karamanoukian, MD
Posted: February 28, 2012, from the March 2012 issue of Skin Inc. magazine.
Because melasma is a chronic condition with high rates of recurrence, clients who are predisposed to developing melasma may find current treatment modalities needlessly frustrating and difficult.
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Hormones. Melasma can be influenced by normal, or abnormal, levels of the female hormones estrogen and progesterone.1 Internal hormonal influences include baseline circulatory levels of estrogen or progesterone, pregnancy or abnormal hormone levels caused by endocrine abnormalities. External hormonal influences include fertility drugs, oral contraception or hormone replacement therapy. Foods rich in phytoestrogens, such as soybeans, soy milk and soybean oil, can also influence melasma development. Clients should be aware of these influences, and understand that melasma treatment may be long-term unless these hormonal influences are controlled or abated.
UV exposure. It has been argued that UV exposure is the single most important risk factor for melasma development.2, 3 The current understanding of melasma cannot yet explain why irregular patches of melanocytes are more susceptible to UV exposure than the surrounding normal tissue. UV exposure upregulates melanocytes and increases the basal rate of melanogenesis. This likely leads to the irregular patches of pigmentation that are characteristic of melasma. Because of this, and for many other reasons, exposure to UV rays should be avoided.
As a skin care professional, your clients commonly seek skin care guidance from you. Although it may often be difficult to discuss noncompliance with your clients, it is in your best interest to do so. They expect results and demand that you deliver core improvements in their skin condition with every visit.
In the case of melasma, there are many areas of noncompliance that must be addressed during every interval examination. Avoiding these issues compromises your ability to produce outstanding results. Although it may be in your short-term interest to avoid the issue of noncompliance with your clients, you risk compromising your results, which may ultimately hurt you in the long run. Remember, clients will refer their friends to you if you deliver results.
In order to increase compliance, every clinical examination should include a discussion of lifestyle and melasma prevention. Discuss the following issues during each visit, and do not be afraid to explain why results may be compromised if clients do not follow recommendations.