Nikki Sommer, a nurse practitioner with Key West Surgical Group, joined Good Morning Keys on Keys Talk 96.9/102.5FM this morning for Medical Matters.
Melasma is a skin condition that causes brown or grayish patches usually on the face, cheeks, forehead, upper lip and chin.
Sommer said, “It is not dangerous, it is not cancer, but it definitely can be frustrating and affect confidence. It’s more common in women than in men, and it does show up more so in the reproductive years. So a lot of times women have during pregnancy, they get what’s called that pregnancy mask, and then it could last afterwards. A lot of women, once you become a mom, it’s like you want to put less effort into your makeup routine. But unfortunately for people, for melasma, they are constantly trying to cover it up and even out their skin tone.”
Several triggers are involved with melasma.
Sommer said, “The biggest trigger, especially down here, is sun exposure. It’s the major trigger that will trigger the pigmentation to stand out. Heat. And this is big. So two things that we have down here are sun and heat, and the two biggest contributors to worsening of melasma. Hormones. Like I said, pregnancy and birth control can contribute to melasma. Genetics. If it runs in the family, you’re more susceptible to having it. Inflammation or irritation. So a lot of times, even if you get, like, contact dermatitis, it can exacerbate this condition. If you go into a sauna or a steam room, hot yoga, even cooking over a stove can trigger your melasma. It’s excessive melanin production, so it can exacerbate that and make the patches become darker.”
Heat stimulates melanocytes.
Sommer explained, “Melanocytes, just like the UV does. So even if you’re wearing sunscreen, heat alone can worsen melasma. So I’ve had clients come in and it’s a consistent routine that they need to keep up. And they get frustrated because they’ll do topicals or what have you, even they feel like it doesn’t work. But we spend a lot of time here out in the sun, a lot of people, they live downtown, they ride their bike, they walk, they run, so they’re in the sun, they’re exposed to it all the time. And even on a cloudy day where we talk about, you still need to wear sunscreen. It’s really heat, in combination with that can make melasma worse.”
What does melasma look like?
Sommer said, “Most women that have melasma, I’ll tell you right now, you’ll never know, because they’re wearing makeup to cover it, but when they come in to see me, it’ll be like a really dark patch. It does kind of look like a mask, like it’ll be a patch of brown, blueish gray here on the top of their forehead. It’s like solid patches, all over the face, where we talk about other types of hyperpigmentation, of sun damage, you’ll see spots. When people come in, I’m like, I’m going to treat your darker spots. And they they’re kind of almost like a larger freckle. These are actual patches of pigment on their face.”
Can it be cured?
Sommer said, “Just like rosacea, this is a controlled situation. There is no cure for melasma, and that is the hardest thing for people to understand and grasp. I mean, nobody wants to tell you that you have a skin condition that’s never going to go away. It’s with you possibly forever. It is chronic, and it does relapse. So the main thing is, we get under control, and it can fade pretty light. However, if you don’t maintain a routine and consistency with skin care, it can come back.”
Treatment for melasma is a multi layered approach.
Sommer said, “People will try and seek treatment on their own. They will see a dermatologist, their provider, they will start with topicals. It’s hydroquinone, which is usually prescription strength topical, retinoids you can get over the counter. Or they’re even stronger by prescription azelaic acid and tranexamic acid. Those are the four topicals that you can use to try and control the melasma. In selected cases, you can take oral tranexamic acid. It comes with a little bit of side effects, so you have to be careful and that’s for women who, again, probably have those really big dark patches where it’s prevalent, even makeup will not cover it. Then you have procedures like chemical peels are one. They go into and help shatter the pigment in the epidermis. Laser treatments like the PicoSure Pro and the LaseMD Ultra, which also helps deliver those topicals, it gets it in there and tries to suppress the pigment. It’s a consistent routine and maintenance. It’s not just one and done or just one topical that you use every day that’s going to keep everything at bay.”
How can lasers help?
Sommer said, “Our lasers, the PicoSure Pro, it is FDA approved to treat melasma, and the Ultra, they shatter and suppress the pigment. We’re attacking the pigment in two ways. We want to shatter it and we want to suppress it. So the PicoSure Pro shatters the pigment. It works by delivering ultra fast energy pulses. It’s a trillionth of a second. That’s what a picosecond is. So it breaks it down into tiny particles, shattering it like glass, your body will naturally clear it over time. It’s not burning the skin. It’s like a photo acoustic effect or a wave. It’s not heat based damage, even though I tell people it feels hot when you have the laser, but it’s your skin’s reaction to that photo acoustic energy, and then that is why it cools down faster. We just talked about how heat can exacerbate melasma. We want to keep that under control.”
What does the Lase MD Ultra do?
Sommer said, “It suppresses the pigment, so it opens those micro channels, and we do a lower energy. We don’t treat people with melasma when we use the ultra at a high energy, we do it lower so we can drive in those topicals to help the pigment fighting serums go deeper and calm that inflammation and suppress that pigment, the melanocytes, from producing more.”
Why combine these treatments?
Sommer explained, “When combined together, you get more controlled results. You’re shattering the pigment and you’re suppressing it at the same time. So that is the goal. Sometimes it depends on the patient or the client. I will separate it. I will say, come in. Let’s do the Pico two weeks. Let’s do the Ultra. It just depends on what their skin looks like when they come in, if it’s more of like an inflammation, or sometimes they’ll come in and they’re not taking any topical arrangements. So I’ll have to start them on something before we even go after it with the laser.”
Sunscreen is really important.
Sommer said, “SPF 30 is a minimum. So 30 or above, I tell people, I even tell people, if you’re going to be out on the water. Are you going to be hanging out in the pool? Do 50. Tinted sunscreen also helps. It helps with visible light. A lot of women like to use tinted sunscreen because it does help cover these dark patches. But the biggest thing that people don’t do is reapply. It says on the bottle that however many minutes it is good for, you need to reapply. And that includes you need to take into consideration whether you’re swimming in the pool or ocean, or you’re exercising and you’re sweating excessively, you need to reapply.”
Melasma can have an emotional impact on those who are afflicted by it.
Sommer said, “When my clients come in to see me, the biggest thing is they want to be able to leave the house without makeup and just put sunscreen on, and they can’t, because some of them, and some is worse than others, but when they have those really dark patches, and it’s on their cheeks, it’s on their forehead, without lots of makeup to even out their skin tone, they don’t feel good about themselves. It definitely is self esteem and self confidence. The biggest thing is getting them back on a routine. Because they will come in and they will say, I tried this topical. I tried this topical. It didn’t work. Are you doing anything now? No. Okay, well, we’re going to do the laser. We’ve got to put you back on a regimen. So whether they’ve had products that they used in the past, some of them come and they will show me pictures of their skin care, and their bathroom is just covered with all different types of serums and lotions and stuff. They have tried prescription, non prescription and it’s frustrating when you feel like you’re doing the right thing every day and it’s not improving. So again, it’s a combination of lots of different moving parts to keep it under control. Laser is not a cure, but it’s part of the process.”
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