What is melasma?
Melasma is a skin condition most commonly characterized by the presence of brown irregular patches on the face of a woman. Quite often, both sides of the face are involved symmetrically, with the most common sites of involvement being the cheeks, bridge of nose, forehead, and upper lip.


Melasma is extremely common, and it affects five to six million American women annually. Over 90% of melasma cases occur in women, and it is especially common in darker skinned individuals, particularly Hispanics, Asians, and women of Middle Eastern ancestry.


What causes melasma?
Although the causes of melasma are not completely understood, several factors are known to play a role. Clearly genetics is a factor, as women with a family history of melasma are more likely to develop the condition. Also, hormonal factors play a role, as pregnancy and birth control pills may also cause melasma. In addition, sun exposure is an important contributing factor.


It is believed that melasma results from exposure to the hormones estrogen and progesterone combined with exposure to ultraviolet light from the sun. This results in an over-stimulation of the pigment producing cells in the skin, increased production of melanin pigment, and the characteristic brown patches of melasma.


How is melasma treated?
Several modalities are available to treat melasma. Melasma resulting from pregnancy frequently, but not always, disappears spontaneously over a period of several months after giving birth. If melasma develops after starting birth control pills, it may improve after discontinuing their use. However, melasma that results from the use of birth control pills usually persists even after the pills are stopped.


Melasma treatment always starts conservatively. If at all possible, it is preferable for women undergoing treatment of melasma to discontinue their use of birth control pills. Although melasma can be treated while continuing the use of birth control pills, this is not optimal.


Sunscreens, sun avoidance, and depigmenting creams are three of the mainstays of melasma treatment. The sunscreen must provide both UV-A and UV-B protection. Regardless of how melasma is treated, the treatment will fail if sunlight is not strictly avoided. Prudent measures to avoid sun exposure include hats and other forms of shade combined with the application of a broad-spectrum sunscreen. Sunscreens containing physical blockers, such as titanium dioxide and zinc oxide, are preferred over chemical blockers because of their broader protection.


Topical depigmenting creams should also be used. Hydroquinone is the most commonly used depigmenting agent; it works by decreasing the production of melanin pigment. Some physicians also add tretinoin (retinoic acid) and a steroid to the hydroquinone. The tretinoin acts by increasing cellular turnover, resulting in a quicker response to therapy. Tri-Luma cream conveniently combines hydroquinone, tretinoin, and a steroid in one medication, and is available by prescription. Other medications for melasma include azelaic acid, kojic acid, and peels containing alpha hydroxy acids such as glycolic acid.


Patients who have not responded to conservative treatment can consider laser treatment. The FDA has approved the use of the Fraxel laser for the treatment of melasma. At the Santa Monica Laser and Skincare Center, we have had good success in treating melasma by combining Fraxel laser treatment with hydroquinone, sun avoidance, and the regular use of sunscreen. Generally, an optimal result can be obtained after four or five Fraxel laser treatments given at four to six week intervals.


Melasma treatment is complex and should be managed by a dermatologist. Generally, several months of therapy are required to significantly improve melasma. Any of our patients who believe they may have melasma or who have abnormal pigmentation in their face are invited to make an appointment with Dr. Amerian.


The “Bright Eyes” Summer Rejuvenation Makeover

With summer and the traditional summertime outdoor entertainment season starting soon, our office is offering an exceptional eyelid rejuvenation package so that more of our patients can look their best. The package begins with the eyelid Thermage procedure to lift and tighten the skin of the eyelids and the tissues around the eyelids. To ensure the best possible result from the eyelid Thermage, all of our patients receive a minimum of four or five complete passes of the Thermage treatment tip over the treated areas. After the eyelid Thermage, our patients can choose between having either a Botox treatment to the tissues around the eyes and eyebrows or a treatment with one full syringe of Restylane or Juvederm. We are offering this package for $1850 during June and July, which is more than a $750 discount from the regular price. We have been very pleased with the results we have achieved with eyelid Thermage, and our patients have truly enjoyed the cosmetic improvement the procedure provides.


In our office, the eyelid Thermage procedure is performed only by Dr. Anterasian, a board certified physician and surgeon. He was one of the first physicians in Los Angeles to perform eyelid Thermage, and he has extensive experience with the procedure.


Eyelid Thermage is one of Dr. Amerian’s favorite procedures, and Dr. Anterasian has performed the procedure twice on Dr. Amerian’s eyelids during the past nine months. Dr. Amerian will be happy to show any of our interested patients her “before and after” photographs.


Any of our patients who wish to take advantage of this special opportunity to rejuvenate their eyelids are invited to call our office at 310-829-9396 and make an appointment with either Dr. Amerian or Dr. Anterasian.