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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.

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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Noncompliance with the topical regimen. If you are recommending topical skin care products, you must provide clients with detailed instructions on usage. Often, these instructions should be accompanied by a description of the quantity to be used with each application. In practice, it may be easier to quantify usage with simple tools of measurement. For example, you may ask clients to use a chocolate chip-sized portion or a toothpaste-sized portion of a cream with each application. In addition, always specify frequency of application and duration of treatment.

Another important way to measure compliance with topical products is to have clients bring in their products during each interval examination. That way, you can gauge how much of each product they are using. As an example, if 0.5 grams of Cream A was recommended for twice daily application, a client should be halfway through a 60-gram tube in one month.

In addition, you may find it useful to tell clients how long a product will last if they are taking it as directed. This strategy reinforces the time line approach, described later in this article. Remind clients that the tube of hydroquinone they are using should be applied twice daily and should last approximately two months. If they are only through 10% of the tube at the two-month interval, they are likely not using the product correctly.

Intermittent or chronic UV exposure. Intermittent or chronic UV exposure may exacerbate melasma and may even darken areas that previously responded to treatment. UV exposure can come from tanning booths, direct sun exposure and indirect UV light reflected off water, ice or snow. Although some clients will find it hard to avoid UV exposure altogether because of lifestyle, it is prudent to discuss the ramifications of this behavior on melasma. In addition, clients who absolutely cannot avoid UV exposure may need reinforcement about the proper use of sunscreens.

Provide a time line

Client expectations are not always realistic. In the case of melasma, it should be emphasized that the condition is chronic and progressive, with a high chance of recurrence if left untreated. Although topical creams are the mainstay of therapy for melasma, improvement is generally gradual, and it may take months for clients to notice significant changes in melasma lesions. Clients who are given a time line for treatment generally fare better than those who do not have a global plan of action.

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