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“Melasma” or “blemishes” – Also known as the mask of pregnancy as it commonly occurs after pregnancy, “Melasma” is one of the most common pigmentary disorders of the skin, particularly in Indians. It is commonly seen in individuals who come from higher latitudes, spend more time in the sun, are on oral contraceptive pills, after pregnancy and also is more common in women suffering from thyroid disease. Melasma is more commonly seen in women, but also occurs in men. It presents itself as bilaterally symmetrical, brownish patches, typically seen on the cheek (malar), jawline (mandibular), or the cheeks and nose, along with the upper lip (centrofacial melasma).Validated questionnaires in several populations have shown that even a small amount of melasma can cause significant emotional and psychological distress, which is why it becomes crucial to treat this condition at the earliest. Is melasma treatable ?If you’re lucky stopping the drug triggering melasma or in cases post pregnancy melasma may completely clear without treatment. Patients are typically counseled to practice strict sun protection as this helps in preventing melasma relapses and / or reoccurrences. There are options available in the following forms:

Medical treatment in the form of topical creams, lotions and oral medication.

The aforementioned treatments certainly help in improving the melasma but unfortunately do not guarantee a cure which is due to the nature of the disease per se.

What sort of sunscreen should I use?One should use a sunscreen with a broad-spectrum coverage (SPF>30, UVA protection – PA+++ or Boots star rating of 4-5+ and / or critical wavelength of 380nm). The sunscreen should be applied before going out in the sun and usually 20-30 min after time spent in the sun (this maybe more on days full of activity). Sunscreens offering visible light and infra-red protection, now available worldwide are now being increasing advised for melasma.

I hate going out looking like this?

Try a good camouflage treatment, BB or CC cream or a good mineral sunscreen. Most importantly we urge our patients not to use over the counter medication for melasma, as this can lead to not only worse.

Freckles and Lentigenes – Also known as “sun spots” by many, these are usually seen running in families. Typically found as small brown spots on the face on both sides and across the nose as well. Strict sun protection is crucial for individuals with freckles. Although the condition is largely harmless, the person maybe bothered by the cosmetic appearance of the freckles. Typical treatment includes strict sun protection, skin lightening creams and if one wants an almost complete resolution then few sessions of the Q Switched Nd:YAG laser.

Lip pigmentation or smokers lips – Dark lips are commonly seen in individuals due to the following reasons:

  • Physiological or genetic smoking
  • Drugs
  • Freckles
  • Dry lips

Other less common conditions with systemic involvement. Although applications of topical creams and hydrating the lip helps to some extent, the Q Switched ND:YAG laser is probably the only modality which has shown some benefit in improvement of the color of your beautiful lips.

Dark underarms, dark elbows and knees – Darkness in the folds, particularly the under arms and groins associated with a person being overweight would require some testing and ruling out insulin resistance. Medical treatment and a healthy lifestyle would suffice in those cases along with topical treatment, for others the treatment maybe in the form of topical creams and / or lotions. Further, chemical peels help to a good extent in these cases for better outcomes. Other uncommon pigmentary disorders would require a proper diagnosis and treatment directed in the appropriate direction as per the individual case.