WHAT IS MELASMA?

Melasma (or chloasma) refers to the dark patches that appear—most commonly in women of childbearing age—symmetrically on the cheeks, upper lip, bridge of the nose, or chin.

In any case, it is advisable to consult a dermatologist, as there are other types of spots similar to melasma that must be distinguished from it (lentigines, post-inflammatory hyperpigmentation, drug-induced hyperpigmentation, ochronosis, pigmented contact dermatitis, and poikiloderma).

WHY DOES MELASMA OCCUR?

The exact cause is unclear.

On the one hand, since it is more common during pregnancy or in women taking oral contraceptives, it is known that hormones play a role. In any case, it can also occur (and in fact is quite common) in women who do not fall into either of these two categories; therefore, there must be other factors involved that we do not yet understand.

On the other hand, melasma is more common in people with darker skin, who generally have a higher risk of hyperpigmentation. Therefore, skin tone also influences the likelihood of developing it: the darker the skin, the higher the risk of developing melasma.

Pregnancy, birth control, having darker skin, and sun exposure are the main factors involved in melasma.

Finally, we know that the key trigger for melasma is the sun. This is evident because the spots appear exclusively in areas exposed to the sun (for example, it is extremely rare to see them under the chin). Sunlight is composed of different types of waves. It is well known that ultraviolet (UV) radiation increases skin pigmentation, but in the case of melasma, you may have noticed that even visible light can stimulate its formation, which makes prevention very difficult.

HOW IS MELASMA PREVENTED?

As you might guess, the most important factor in preventing melasma is sun protection. People prone to melasma should use a sunscreen with SPF 50+ daily and reapply it if they spend more than 2 hours in the sun.

Since we know that UV radiation isn’t the only factor involved in melasma, sunscreen alone may not be enough to prevent it completely, as it protects against UV rays but not against visible light. Therefore, it’s advisable to minimize sun exposure and wear a cap or hat during the hours you spend outdoors each day.

HOW IS MELASMA TREATED?

Typically, depigmentation treatments are not performed during the summer, and we focus on preventing the appearance of new spots. In any case, sun protection in itself is already a form of treatment.

As a complement, there are sunscreens—in the form of makeup with varying levels of coverage—that can help us conceal uneven pigmentation during the summer, while also preventing this pigmentation from worsening.

Treating melasma is not easy, but we have various options that are typically started after the summer.

Treating melasma is complex: sun protection must be combined with topical depigmenting products for several weeks. In cases where this is not effective, chemical peels or laser treatments may be used. But we’ll address all these options in due time—once the summer season is over, when the sun is less intense and we can get down to business treating the dark spots on the face.

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1. There are various REASONS why bugs bite us:

Mosquitoes feed on plant matter, but female mosquitoes need to supplement this diet in order to lay eggs. They obtain blood from various animals, including humans, which is why they bite us. When a female mosquito bites us, she sucks blood from the tiny blood vessels in our skin to feed and thus produce eggs. During this process, her saliva comes into contact with our body, which, in self-defense, produces a substance called histamine. Histamine causes the redness and itching typical of mosquito bites.

At this National Geographic link, you can watch some interesting videos on the subject.

Unlike mosquitoes, ticks and fleas feed exclusively on the blood of other animals (both males and females in this case), which is essential for their survival.

Female mosquitoes, ticks, and fleas bite to feed, while bees and wasps do so to defend themselves.

Hymenoptera (bees and wasps, among others), however, sting us as a means of self-defense, not as a means of survival. When they inject their stinger into our skin, they release venom that damages our skin and causes pain and inflammation. Unlike mosquito bites, bee or wasp stings rarely go unnoticed. The venom they inject is what causes potential allergic reactions, which are more common with hymenoptera than with mosquitoes.

2. After the bites, more “FALSE BITES” may appear:

This is a fairly common phenomenon that can cause some concern. Typically, after noticing a few bites that we can clearly identify, more and more similar-looking ones appear in the following days, but they’re located on other parts of the body (they may be far from the area of the initial bites). All the new bumps look like bites, but they aren’t actually bites; this is what we call papular urticaria or prurigo strofulus.

Papular urticaria is more common in people with atopic dermatitis, especially in children. It also appears that fleas are more likely to cause this condition than mosquitoes.

Papular urticaria is more common in children and is caused by a kind of “allergy” to the initial bites.

It is considered a hypersensitivity reaction to the first bites (a kind of “allergy”) that can lead to the continuous appearance of new bumps, which can last for months. If in doubt, it is important to consult a dermatologist, as treatment is relatively simple.

In this link you can see pictures of papular urticaria.

3. Bites usually occur in PAIRS

When you suddenly develop numerous bites without realizing there was a “bug” nearby, it can be cause for concern. It’s easy to wonder: Why did these bumps appear all of a sudden? Could it be something serious?

Well, if the bumps are clustered in pairs or in a line, it’s very likely that they’re insect bites. Few (if any) skin conditions can cause similar symptoms, so when we see this—especially if the bumps also itch—the diagnosis is very clear.

4. Insect bites can TRANSMIT DISEASES

In our environment, it is most common for bites to last a few days, with the itching gradually subsiding until the bumps disappear completely. In rare cases, bites from certain arthropods can transmit diseases.

Some mosquitoes can transmit diseases, especially in tropical areas

Perhaps the best known and most studied is the bite of the Anopheles mosquito, which can transmit malaria. The Zika virus, which is currently the subject of so much discussion, as well as dengue and chikungunya, are transmitted by the Aedes mosquito. Yellow fever is transmitted by Aedes or Haemagogus mosquitoes. The vast majority of these diseases are transmitted by mosquitoes endemic to tropical regions and are very rare in our country. Cases of these diseases in Spain generally involve people who have traveled to endemic countries. Therefore, to prevent them, it is essential to follow the specific recommendations for the country you are visiting.

Ticks can transmit Mediterranean spotted fever or Lyme disease, among others. These diseases do occur in Europe, so if you experience general malaise or a rash after a tick bite, it is important to see a doctor.

In conclusion…

In general, insect bites are minor. They appear as itchy bumps that last for a few days and then fade away. In some cases, the symptoms may persist due to papular urticaria. After being bitten by mosquitoes in tropical countries or by ticks, you should consult a doctor if you experience general discomfort or develop a skin rash.

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What does athlete’s foot look like?

It is characterized by red, flaky skin or small blisters accompanied by itching, which usually begins between the toes and may spread to the sole or top of the foot. It sometimes appears after activities that cause sweating.

If athlete’s foot is not treated properly from the start, it can become chronic. In these cases, the skin between the toes is usually less red than at the onset of the condition, but the peeling spreads to the soles or the tops of the feet (when this occurs, it is called “moccasin ringworm”). The infection can also spread to the other foot or even to the hands.

More pictures of athlete’s foot

What causes athlete’s foot?

Athlete’s foot is caused by a type of fungus called “dermatophytes” (Trichophyton mentagrophytes, var. interdigitale, and Trichophyton rubrum, which is more common). This name means that they feed on the keratin in the skin (the protein that forms the outermost layer of the skin, as well as nails and hair).

How is athlete’s foot spread?

Since the fungi that cause it are found on the skin’s surface, athlete’s foot is spread through direct skin-to-skin contact with an infected person or through floors or sports facilities where people walk barefoot.

How is athlete’s foot treated?

Athlete’s foot is treated with creams containing antifungals, which are medications that fight fungi. This is usually sufficient, and oral medication is not necessary. In any case, if you suspect you have athlete’s foot, it is advisable to see a dermatologist, who will recommend the most appropriate treatment.

Can it be associated with other skin conditions?

Occasionally, red patches of skin may appear on the hands or other parts of the body at the same time as the lesions on the feet. This does not mean that the fungus has spread, but rather that our body is reacting to it by developing these new lesions, called “ides.” The ides heal when athlete’s foot is treated.

On the other hand, it’s not uncommon for fungi to infect the toenails as well as the skin of the foot. We’ll discuss toenail fungus in another post…

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Both videos explain the different types of UV rays and the damage each can cause to the skin. They also provide a general overview of the different types of sunscreen. From this point on, each video takes a different approach. The first video explains the risks of developing melanoma, a potentially fatal form of skin cancer. The second, however, bypasses the topic of cancer and focuses on the cosmetic consequences of sun exposure, such as age spots, uneven pigmentation, wrinkles, and rough skin. It emphasizes that using sunscreen starting in one’s youth can prevent any of these issues.

Teenagers are more likely to use sunscreen to prevent wrinkles than to prevent skin cancer

The study shows that American teenagers are more afraid of wrinkles than of cancer. The researchers reached this conclusion by showing one group of young people one video and another group a different one. A greater number of teenagers who watched the video focusing on aesthetic concerns began using sunscreen, compared to the other group. I find this an interesting finding, though on the other hand it’s not surprising given the importance of physical appearance at that age. Which video makes the biggest impact on you?

It seems that the topic of adolescence and sunscreen is trending, because another leading dermatology journal, JAMA Dermatology, has just published another article noting that the use of UVA lamps among adolescents is associated with risky behaviors. Those who use them drink, have unhealthy eating habits, are more promiscuous, use illegal drugs and steroids, and smoke more frequently than those who do not use UVA lamps. It seems that the approach to sun protection needs to be different for young people than for those in other age groups….

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1.What is the UV index?

It is a number (greater than zero) that indicates the intensity of the sun’s UV radiation at the Earth’s surface. The higher this number is, the more damage the sun can cause to our skin or eyes, and the faster that damage will occur.

High SPF ratings indicate a higher risk of sun-induced skin damage and faster damage

2.Why was the UV index created?

In light of the clear increase in the incidence of skin cancer observed since the 1970s, the World Health Organization (WHO) promoted the creation of this index. In 1995, it was developed to provide a measure of the relative risk of sun-induced skin damage, based on our location and the time of day we are exposed. The idea was to warn people who are particularly sensitive to the sun of the risk when necessary.

The World Meteorological Organization, the United Nations Environment Programme, and the International Commission on Non-Ionizing Radiation Protection also participated in this initiative.

3.What is the UV index used for?

The purpose of this index is educational. The WHO recommends that it be reported in the media to raise public awareness of the risks posed by the sun, especially in the summer. That is why we hear about it on the news and on weather websites.

The UV index protects your health and can save lives

The UV index is considered to be:

1. saving lives.
2. protecting our health.
3. helping maintain a youthful appearance

4.How should we interpret this?

The UV index varies throughout the day, peaking at noon. The media usually report this value—that is, the highest UV index expected during the day. On the State Meteorological Agency (AEMET) website, you can view hourly values for a specific geographic area by clicking on the value.

The media are reporting the maximum UV index forecast for the day, which will occur around noon

This value is usually a whole number: the higher the number, the greater the UV intensity at the Earth’s surface. Sometimes, two values may be provided, indicating the range of maximum intensity that can be expected during the day. This is used primarily for partly cloudy days when the intensity can vary depending on the position of the clouds in the sky.

The UV index also varies depending on the month. The highest values in Spain are usually recorded in late June and early July. This data is also available on the AEMET website.

The highest UV index readings in Spain are recorded in June and July

UV index values are classified as low, moderate, high, very high, and extremely high, as shown in the following table:

5.What is recommended based on the UV index value?

Las recomendaciones de la OMS según el valor del índice UV son las siguientes:

6.How is the UV index measured?

There are two ways to do this:

• using a device called a spectroradiometer and the following mathematical formula:

  

• using a broadband detector that has been calibrated and programmed to directly measure the UV index.

In Spain, the UV index is measured continuously using broadband UV radiometers at more than twenty stations in the AEMET National Radiometric Network, as well as by the AEMET Brewer spectrophotometers located in A Coruña, Zaragoza, Madrid, Murcia, Izaña, and Santa Cruz de Tenerife. Atmospheric ozone must also be taken into account when making forecasts.

You can find more information about the UV index at the WHO’s webpage on the subject.

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Sun protection goes beyond simply using a sunscreen you like. It’s about “protecting yourself,” and there are many ways to do that—not just with creams, even though we tend to associate it with them. In the following points, I’ll explain why slapping on some sunscreen isn’t enough.

2. Optimize your sun exposure schedule

It goes without saying that being out in the sun at 8 a.m. is not the same as being out at 2 p.m. Choosing the least harmful times of day—by avoiding the middle of the day—is also a form of sun protection.

The same applies to different geographic locations and times of year.

The UV index, available on many weather websites, provides additional information on this topic.

3. Wear sun-protective clothing

In line with point 1, clothing designed for this purpose is a great way to ensure adequate sun protection.

Starting with a beach umbrella, followed by a good hat (preferably one that covers your ears), and T-shirts or cover-ups with UPF 50. Clothing with this rating blocks 98% of UVB rays.

4. Apply sunscreen properly

Now that we’ve covered the points above, sunscreen is an excellent way to protect our skin from the sun’s harmful effects. What’s the best way to use it?

• Apply the appropriate amount to all areas exposed to the sun. The correct amount is 2 g per square centimeter of skin. For an adult, the correct amount is estimated to be about the volume of a shot glass . That’s probably much more than any of us actually use.
• Sprays and aerosols are somewhat less reliable, because part of the applied amount does not reach the skin properly.
• It is not essential to apply the sunscreen 30 minutes in advance, as has traditionally been recommended. Five to ten minutes is sufficient.
• Reapply sunscreen every two hours, after swimming, and if you sweat a lot.

¿Tienes alguna duda sobre fotoprotección? Comenta e intentaré ayudarte.

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You were probably surprised when you noticed them, because you haven’t bumped into anything, and besides, they don’t itch or hurt. But what are they? Why did they appear?

What are pigmentary and purpuric skin dermatosis?

Also known as capillaritis, pigmentary and purpuric dermatoses (PPD) are a group of benign skin rashes characterized by numerous small, blood-red spots that eventually develop into brown patches. They are different from ruby spots, which you can read about in this article.

They may feel slightly itchy, but unlike bruises, they don’t hurt. They most commonly appear on the legs or feet of adults, although they can also appear in children.

More images of PPD

Why do pigmentary and purpuric skin conditions occur?

Various possible causes for the onset of PPD have been suggested. I will list them below, but the reality is that none of them has been fully proven. In most cases, we are left wondering why it occurred.

The proposed possible causes are:

• poor circulation
• intense exercise
• spending many hours on one’s feet
• infections
• alcohol consumption
• certain medications: DPP has been linked to many medications from various classes.
• chemical exposure
• systemic diseases

How is pigmentary and purpuric dermatosis diagnosed?

Generally, dermatologists can diagnose this condition through a physical examination. Occasionally, we order blood tests to confirm that there are no issues with blood clotting or platelets.

In specific cases or when there is uncertainty, we usually take a skin sample (skin biopsy), which confirms the diagnosis.

How are pigmentary and purpuric skin conditions treated?

Unfortunately, there is no completely effective treatment for this condition. The scientific literature includes reports of cases treated with a wide variety of medications, but none have demonstrated clear effectiveness.

Since it usually causes no symptoms, the rash is often left untreated. In other cases, we recommend measures to promote venous return and prevent leg swelling, or topical corticosteroids to reduce skin inflammation.

Furthermore, although it may be a chronic condition, the spots often disappear on their own after a few weeks, months, or even years. For this reason, we generally opt for a wait-and-see approach.

Different names for this conditon…

Perhaps while reading this article, you’ve realized that this is exactly what’s happening to you; however, your doctor may have used a different term to diagnose you. Don’t be surprised. There are several types of DPP with rather unusual names—whose significance, in my view, is purely academic—which I’ll list below. For simplicity’s sake, they can all be grouped under the umbrella term DPP or capillitis.

The types of DPP are:

• Schamberg’s purpura
• Purpura annularis telangiectodes (Majocchi’s purpura)
• Gougerot-Blum’s pigmented purpuric lichenoid dermatitis
• Lichen aureus
• Eczematous purpura of Doukas and Kapetanakis

Has this ever happened to you? Tell us how it turned out :)

The post Red and brown spots on the skin: pigmentary and purpuric dermatoses first appeared on Dra. LOREA BAGAZGOITIA.

What are RUBI SPOTS?

Ruby spots are also known by other names, such as senile angiomas, capillary angiomas, cherry angiomas, or Campbell–De Morgan spots (named after the dermatologist who first described them).

These are small, bright red lesions measuring 1–4 mm that typically appear mainly on the trunk and limbs. They occur in adults, most commonly in those over 50, although they can also be seen in younger people. They do not itch or cause any symptoms.

More pictures of rubi spots

WHY do red spots appear?

They can be considered a normal part of the skin’s aging process, and hormonal factors are believed to play a significant role in their development, though their exact cause remains unclear. It is common for several members of the same family to have them.

Ruby spots are benign and do not indicate any underlying disease.

In any case, it is clear that they are not caused by any infection, so they are not contagious, nor do they reflect any internal disease that could cause problems. We can consider them “healthy skin.”

HOW are rubi spots diagnosed?

It is very easy to identify ruby spots. They must be distinguished from certain types of moles, other types of angiomas, or petechiae; however, a clinical examination is usually sufficient, and it is very rare for a dermatologist to need to use any special techniques to diagnose them.

How are rubi spots TREATED?

Ruby spots respond very well to laser treatment and can also be treated with electrocoagulation. Both are quick and simple methods that can make them disappear.

They can be treated with electrocoagulation or laser therapy, but there is no preventive treatment.

Unfortunately, there is no known treatment that can be used to prevent more from appearing.

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Recently, several friends have asked me what those little white bumps are that appear near their eyes or on their cheeks. The answer is that they are milia cysts, and in the vast majority of cases, they don’t pose any health risks—beyond whether or not we like having them.

But let’s talk about this in a little more detail:

WHAT are the milium cysts

They are small, whitish bumps about 1 mm in diameter that appear spontaneously on the cheeks and, more commonly, around the eyes. They are less common on the forehead and even rarer in the genital area, although they can appear there as well.

Here you can see more photos of milia.

WHY do milium cyst form?

Milium cysts originate from what are known as “pilosebaceous follicles”—that is, the “pores” through which fine hairs and skin oils emerge. It is believed that damage to or blockage of these follicles causes these small cysts to form.

They can appear spontaneously (most commonly) or following skin damage (such as burns or certain skin conditions that cause blisters), on scars, after prolonged use of strong corticosteroids, or following the use of certain medications. In any case, they most often appear “out of the blue,” without any clear cause. Some people are more prone to them than others.

In newborn babies, it is very common to see milia cysts on the face or even inside the mouth (“Epstein’s pearls”) or on the palate (“Bohn’s nodules”). In this case, it is believed that they appear due to the immaturity of the sebaceous follicle.

HOW do milium cysts DEVELOP?

Milium cysts in newborns disappear on their own within a few weeks; therefore, no treatment is necessary.

In babies, they disappear on their own, whereas in adults they usually persist.

In older children, adolescents, and adults, milium cysts typically persist. They usually do not cause any symptoms or discomfort, other than purely cosmetic concerns.

Do milia cysts pose ANY RISK?

In extremely rare cases, they may be associated with certain skin conditions, such as Bazex-Dupre-Christol syndrome, Rombo syndrome, or Gardner syndrome.

Milium cysts are benign

In the vast majority of cases, milia are benign lesions with no serious medical implications. If in doubt, it is advisable to consult a dermatologist.

HOW are milium cysts TREATED?

De When it comes to treatment, it is important to have an accurate diagnosis, as there may be other types of “white bumps” that require different treatments. If you have questions about your condition, you might be interested in my online dermatology service.

In newborns, they are not treated, as they disappear on their own. In all other cases, treatment is not medically necessary, but many people choose to have them removed for cosmetic reasons.

Milium cysts are easily removed with a sterile needle

Milium cysts are easily removed with a sterile needle. It is a simple procedure that does not require anesthesia. In some cases, the use of a laser or an electric scalpel may also be helpful.

Do you have milium csyts?

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We see that the basis of the process is an increase in sebum production, which is clearly linked to androgens—the male hormones present in both men and women. That is why treatments designed to counteract the effects of androgens are so effective in treating acne, especially in women.

One of the most commonly used tools for this is birth control. A meta-analysis published a few years ago in the journal of the American Academy of Dermatology showed that, although they work more slowly, their effectiveness after 6 months is comparable to that of antibiotics.

This makes them very useful because all international acne treatment guidelines agree that antibiotics should not be used for more than 3 months, due to the risk of developing bacterial resistance. Oral contraceptives, however, can be used long-term.

How do birth control pills affect acne?

Oral contraceptives contain an estrogen component (ethinyl estradiol) and a progestin that varies depending on the type or brand.

The overall mechanism by which the estrogens in contraceptives improve acne is not entirely clear. It is possible that the estrogens themselves compete with circulating androgens in the sebaceous glands. On the other hand, they may cause the ovaries to produce fewer androgens through a negative feedback mechanism. Finally, they induce an increase in circulating SHBP (sex hormone-binding protein), to which androgens would bind, thereby preventing them from acting on the sebaceous glands.

The effectiveness of a contraceptive for acne will depend on the progestin it contains.

Which birth control methods are suitable for acne?

Oral contraceptives containing progestins with antiandrogenic effects are particularly effective for treating acne in women. In this way, in addition to the effects mentioned in the previous section, the contraceptive contains a molecule that specifically counteracts the effect of androgens on the sebaceous glands.

Antiandrogenic progestins include:

• Drospirenone
• Cyproterone acetate
• Chlormadinone acetate
• Dienogest

There are also contraceptives that contain only progestins. In such cases, we would choose one that contains drospirenone.

Which birth control pills are NOT suitable for acne?

Oral contraceptives containing certain progestins may not only fail to improve acne but actually worsen it, as some have pro-androgenic effects. Here are the ones to avoid:

• Noretindrone
• Desogestrel

IMPORTANT NOTE:

Birth control pills are useful tools for improving your acne. However, you should always discuss the benefits and risks with your doctor. This article is for informational purposes only and does not replace a comprehensive medical consultation in which the suitability of this treatment can be determined.

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