En los libros de dermatología siempre ha constado su relación con estar tomando anticonceptivos o haber estado embarazada. Sin embargo, muchas mujeres sufren melasma sin ninguno de estos desencadenantes. Se trata de un cuadro vinculado a los estrógenos y aunque es verdad que aumentan en esas circunstancias, todas las mujeres los tenemos circulando por nuestra sangre, y por ello somos susceptibles de que nos aparezca el melasma. Tal vez sea tu caso.

En este blog puedes encontrar algunos artículos previos sobre el tratamiento del melasma y las diferentes formas de controlarlo (como el ácido tranexámico, por ejemplo). Recordemos que terapias efectivas para otro tipo de manchas, como los léntigos, pueden no ayudar en el caso del melasma, y viceversa. La verdad es que es una condición difícil, que generalmente recurre y debemos contemplar como crónica. De esta manera el enfoque que se recomienda en cuanto al tratamiento será continuo; ojalá tuviéramos una cremita, láser o pastilla mágica que lo eliminara de una vez para siempre. Lamentablemente, no es el caso.

Además de las diferentes medidas de tratamiento, la prevención es fundamental. Se sabe que el principal desencadenante del melasma es el sol. Incluso con baja exposición podemos ver que la mancha se reactiva en muchas ocasiones, por eso vamos a repasar aquí los factores a tener en cuenta a la hora de protegerte del sol si padeces melasma.

FOTOEVITACIÓN

Parece que al pensar en protección solar siempre nos vienen a la cabeza las cremas. Es cierto que son un instrumetno importante para filtrar la radiación del sol, pero no olvidemos que esta puede bloquearse de forma física.

Utilizar un buen sombrero o gorra en días soleados o de playa minimizará la incidencia del sol en nuestra piel de forma considerable. Además, reducir nuestra exposición en las horas centrales del día, así como buscar la sombra, son consejos básicos que pueden ser muy útiles a la hora de controlar un melasma en verano.

FOTOPROTECCIÓN

Si tienes melasma es bueno que tengas claro que el fotoprotector ha de ser tu principal aliado. Elige un producto con FPS 50+, que tenga también cobertura UVA.

Busca sobre todo un producto que te sea cómodo, ya que es ideal que lo reapliques cada 2 horas y en la cantidad apropiada (aproximadamente la longitud de 2 dedos).

Un buen fotoprotector adecuadamente aplicado bloqueará el paso de casi toda la radiación UVB a tu piel. El problema es que parece que el melasma está también estimulado por la luz visible, y los fotoprotectores estándar (incluso los que tengan FPS máximo) no tienen la capacidad de bloqueala en la mayoría de los casos.

Por este motivo, es muy recomendable utilizar un fotoprotector que tenga color o que apliques algo de maquillaje en las zonas afectas. Se ha visto en estudios científicos, que el óxido de hierro, molécula que se utiliza para dar color a los cosméticos, tiene la capacidad de bloquear la luz visible (especialmente la azul) y por tanto tendrá mayor efectividad en el manejo y prevención del melasma.

El hecho de que el fotoprotector con color aporte un tono a la piel, puede hacer que no lleguemos a aplicar la cantidad oportuna por ser una cantidad excesiva estéticamente hablando. Por eso siempre aconsejo la aplicación adecuada de un fotoprotector no tintado y añadir después otra capa de producto con color. En el melasma, más vale que sobre que que falte.

ANTIOXIDANTES ORALES

En las farmacias podrás encontrar suplementos orales en ocasiones etiquetados como “fotoprotección oral”. Este término puede llevar a confusión, pues estos productos no bloquean los rayos solares y por tanto no son una versión oral de las cremas fotoprotectoras.

Se trata de productos con poder antioxidante que podrían equilibrar a nivel de nuestra piel el estrés oxidativo que genera la radiación solar sobre ella (especialmente los rayos UVA e infrarrojos). Se trata de una medida complementaria, que al ayudar a minimizar el efecto del sol en nuestra piel, también prodría respaldar una mejor evolución del melasma.

Sin embargo, no has de contemplarlos para nada como la solución definitiva y mucho menos como una sustitución a los sombreros y las cremas con color de las que hablábamos más arriba.

¿Cómo proteges tu melasma del sol?

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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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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….

The post Two very different reasons to protect ourselves from the sun first appeared on Dra. LOREA BAGAZGOITIA.

1-What is sun protection?

When we talk about sun protection, we always think of the sunscreen or sunscreen spray we use at the beach or the swimming pool. However, sun protection is not just that. To protect ourselves from the sun we can use many other elements, as useful or even more useful than creams.

• Avoid the central hours of the day
• Always seek shade
• Wear a hat or cap
• Wear clothing with a sun protection factor (UPF).

2- What does the SPF (sun protection factor) mean?

The sun protection factor (SPF) of creams refers to their ability to block UVB radiation. It indicates the number of times multiplied by the time it takes for our skin to burn. In other words, if my skin turns red in 10 minutes in the sun, using an SPF50, it will turn red after 500 minutes.

An SPF 50 blocks almost 100% of UVB rays (more than 98%), so all products labeled with higher SPFs will actually have very little difference with SPF50. Thus, it is not true that an SPF 100 protects twice as much as a 50. European regulations recommend labeling all SPFs higher than 50 as “SPF50+” in order to avoid this type of confusion.

UVA radiation, which has the greatest influence on skin aging, is also blocked by sunscreens. European regulations require products to have at least one third of the protection indicated for UVB.

3- What should I look for when choosing sunscreen?

My advice, as a dermatologist, will always be to go for the maximum SPF, i.e. 50+.

The protection provided by creams is greatly reduced by our imperfect way of using them, so I think it makes sense to go for the one that provides the most protection.

Some people use 30 for the body and 50 for the face, which makes no sense to me. Many times it is because of the desire to get a tan. However, let’s remember that there is no such thing as a healthy tan. Any degree of pigmentation of our skin is a defense mechanism against something that feels like aggression, in this case, sun exposure. The more tanning we have, the more signs we have that the skin has had to defend itself against something it considers harmful.

4-When should I apply my sunscreen?

Traditionally it was heard that it was important to apply the sunscreen 30 minutes before, for it to take effect. This is currently considered a myth and I will explain why in this article.

However, on beach or pool days, I think it is advisable to apply it quietly at home a while before arriving at the beach or pool, as it is likely to do so with greater precision and forcefulness.

Remember that it is advisable to reapply the sunscreen every 2 hours and after each swim.

5- What about children?

Babies under 6 months of age should preferably be protected with clothing, an umbrella and a hat. From that age, in addition to clothing (which in my opinion are much more practical) and a hat, we can use photoprotection creams normally. The whole family can safely use products for children, which are usually specifically tested, and also contain less alcohol and perfumes.

Do you use sunscreen?

The post 5 questions about sun protection first appeared on Dra. LOREA BAGAZGOITIA.

WHAT IS polymorphic light eruption?

These are skin lesions of different shape and appearance (hence the name “polymorphous rash”) usually located on the neckline, shoulders and back of the hands. It is rarer, but can also affect the legs. Characteristically, it appears in areas that are usually covered during the winter.

Polymorphous light eruption is the most common form of sun allergy, usually appearing in spring and improving as summer progresses.

Small pimples (most common), welts or even vesicles or small blisters may appear. Sometimes it resembles insect bites. It usually appears in spring or early summer, fading as the weeks go by and disappearing again at the end of summer. It often recurs year after year.

Images of polymorphic light eruption

¿HOW IS polymorphous light eruption DIAGNOSED?

The appearance and evolution of the pimples are often sufficient to make a diagnosis. In specific cases, a skin biopsy may be necessary to confirm the diagnosis.

PLE is the most common form of sun allergy; however, it is important to rule out other causes of sun allergy.

If pimples or other lesions appear after sun exposure, it is important to consult a dermatologist to confirm whether it is a polymorphous light eruption or other skin diseases that are also aggravated by the sun.

Is polymorphous light eruption HEREDITARY OR CONTAGIOUS?

It is thought that there is a certain genetic component in the appearance of polymorphous luminal rash, so that up to 45% of people who suffer from it have some history in the family.

Can polymorphic light eruption be prevented?

•SUN PROTECTION:

Obviously the most important measure to take is photoprotection. It is important to use physical measures (such as hats, T-shirts…) and protective creams for UVB as well as for UVA. All sunscreens in the European Union are required to protect against UVA at least 1/3 of what they protect against UVB; but from this minimum there are those that cover more and those that cover less. This is important, because both UVB and UVA (and even in some cases, visible light) can trigger the appearance of pimples.

•PHOTOTHERAPY:

Curiously, it seems that as exposure to the sun increases, the skin acquires a kind of tolerance to the sun. Somehow it seems to get used to it and as the summer progresses, the appearance of pimples becomes less likely. Therefore, in cases where photoprotection is not sufficient, their appearance can be prevented by phototherapy (UVA or UVB rays administered in a medical center). Phototherapy prepares the skin before sun exposure, so that when it arrives, the skin is already “prepared”.

Sun protection is the most important preventive measure. In some cases, it can be prevented with dermatologist-controlled phototherapy.

•VITAMINS AND OTHER ANTIOXIDANTS:

Vitamin supplements with antioxidants can be taken a few months before sun exposure, although their effectiveness is still controversial, since there are not enough scientific studies with clear conclusions to recommend their use in all cases.

HOW IS polymorphic light eruption TREATED?

In cases where you have not been able to prevent the appearance, the spots can be treated with a corticosteroid cream; with which the spots disappear within days (as long as you do not continue to expose yourself to the sun :). In more severe cases, it may be necessary to take corticosteroids in pill form.

HOW LONG does polymorphic light eruption last?

It is considered to be a chronic disease, so it is likely to appear year after year and relevant prevention and precaution must be maintained over time. But it is also true that over time (within years), in about half of the cases the symptoms tend to diminish or even disappear.

In conclusion…

The most common cause of sun allergy is polymorphous light eruption. This is not a serious disease but it tends to recur every year. To prevent it, sun protection (UVB and UVA) is essential, not only with sunscreen but also with hats, shirts,…. In some cases more specific treatment is needed, for which it is advisable to see a dermatologist.

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