So let’s get to the point: what types of spots are the most common? In general, when we start to worry about spots in our thirties or forties, they can be divided into two main groups.

SOLAR LENTIGO

What are solar lentigos?

They are flat spots, reminiscent of freckles, although they are usually larger. They appear in areas where we have been exposed to the sun. This exposure does not necessarily have to be the previous summer, but they are caused by all the sun accumulated throughout our lives. That is to say, you may have been taking care of the sun for decades, but if in adolescence you did something excessive, this may be the cause of these lentigines. The skin has a memory.

How to treat solar lentigos?

Lentigines respond very well to physical treatments such as laser or pulsed light. These systems work by emitting a light source that reacts with the color of the blemish. The darker the spot and the lighter the underlying skin, the more likely it is that the treatment will be successful, which is why it is especially interesting to perform the treatment at times when we are paler, as is often the case in winter.

In the following 4 weeks it is equally important to avoid the sun as much as possible. Sun exposure on “inflamed” skin after laser treatment could cause another type of stains called post-inflammatory hyperpigmentation, which is not at all desirable.

The treatment causes some changes in the spots that will last a few days/weeks: in the case of laser it can be a purplish tone or crusts and in the case of pulsed light, the spots take on a grayish color. Then they will progressively fade until they disappear.

MELASMA:

What is melasma?

Also called chloasma, they are more diffuse spots that usually cover the area of the cheeks, forehead or upper lip, usually appearing in women. Generally lighter than lentigines but larger in size. They are usually related to having gone through a pregnancy or taking contraceptives, although many women suffer from them without any of these factors. In this link I talk more about melasma.

How to treat melasma?

In general, melasma is more complex to treat than lentigines. Contrary to what one might think, physical techniques in this case do not work as well and are generally relegated to the background.

The initial approach to melasma should always include rigorous sun protection, preferably with colored products (either a tinted sunscreen or using makeup over it) to block the effect of visible light (which influences the appearance of melasma).

Specific treatment is done with depigmenting creams, which almost always include hydroquinone. This can be supplemented with retinoids or other depigmenting agents (kojic, niacinamide, tranexamic, azelaic), as well as peelings.

In recent years, moreover, scientific evidence has shown the effectiveness of an oral treatment that helps us to complement topical therapy with creams: tranexamic acid, which you can read about in this article.

Melasma reappears very frequently, so it is very important to maintain strict sun protection habits at all times (both summer and winter).

Do you have lentigos?

The post How to treat skin blemishes? first appeared on Dra. LOREA BAGAZGOITIA.

It is likely that just this summer you were pregnant (“pregnancy cloth”) or on oral contraceptives. Melasma tends to appear more frequently in these cases, but don’t be surprised if it did not. Many girls get these spots for no reason at all. Often we do not find a clear cause, although it seems that estrogens (female hormones) have something to do with it, since this type of spots occur mainly in women.

It is also known that the sun is clearly involved, as spots tend to worsen after exposure to the sun, especially in summer. We have already talked on other occasions about the different radiations emitted by the sun and that sunscreens are mainly effective against UV rays. It seems, however, that other radiations such as infrared or visible light may also be involved in melasma, and blue light in particular is known to be more damaging in brown people. Therefore, even if you use the best sunscreen in a perfect way, it may not be enough to prevent the appearance of melasma.

The reality is that melasma is very difficult to treat; but we can improve it. Normally, those who have melasma will always have a tendency for certain areas of the skin to darken, but we can find ways to attenuate it and avoid/reduce its appearance. Winter is the time to lighten it and in spring-summer we have to do our best to prevent it. Here are the keys.

1. SUN PROTECTION: 

This is most important, especially in spring and summer. Remember that sun protection does not mean just sun “cream”, but avoiding the radiation coming from the sun in the best way we know how. A good sunscreen with SPF 50+ will avoid more than 98% of UVB radiation, and part of UVA, infrared and visible light…but not all! Tinted sunscreens block visible light, and are advisable in persons with melasma.

Photoprotection is not only sunscreen; complement it with a hat and umbrella.

Always keep this in mind. It is important to complement topical photoprotection with other means: avoid the central hours, wear a hat or cap or use an umbrella.

The more you minimize the sun’s incidence on your face, the less likely it is that melasma will be accentuated when summer arrives.

2. BLEACHING PRODUCTS:

The star depigmenting agent is hydroquinone. It is the most potent product available, which we usually use in concentrations of 2-4% and can be used alone or in combination with others.

Hydroquinone is the most effective depigmenting agent, alone or in combination with other products.

In addition, we can also use azelaic acid, kojic acid, retinoids, hydroxy acids or even topical corticosteroids. We usually use combinations of these elements. It is best that your dermatologist assesses what is best suited to your case, depending on the sensitivity of your skin or its color.

3. ORAL TREATMENTS: 

Tranexamic acid has recently been found to be useful in improving or preventing melasma. It is a drug that some girls use to reduce menstrual bleeding. At lower doses, it has been found to prevent sun-induced skin pigmentation.

Tranexamic acid is a novel treatment for melasma

4. OTHERS: 

Lasers, pulsed light and peelings are excellent aesthetic techniques that help us for a lot of aesthetic treatments (scars, certain spots, hair removal, wrinkles, veins) but in the case of melasma, we limit their use to specific cases in which the above does not work, because their effectiveness is usually not so high.

Lasers or peels may be useful in some cases.

In conclusion…

∼Melasma is difficult to treat, but fortunately we have several treatment options with which to keep it at bay, first to lighten it and on the other hand, and not least, to prevent it.

∼Get advice from your dermatologist who will recommend the best option for you. Not all skins are suited to the same thing.

The post Treatment of melasma: 4 key points first appeared on Dra. LOREA BAGAZGOITIA.

Melasma is difficult to treat, but in recent years we have a new therapy that can help us in this regard: tranexamic acid.

What is tranexamic acid?

Tranexamic acid is an antifibrinolytic agent. It reversibly binds to a molecule called plasminogen, preventing it from being converted into plasmin, which reduces bleeding. On the other hand, it interferes with the formation of new blood vessels in tissues.

It has traditionally been used by surgeons to prevent bleeding during surgery. It may also be used to reduce menstrual bleeding in women. It is considered a safe medication.

Why is it used for melasma?

Plasmin (by binding to epidermal cells and inducing these cells to release a molecule called prostaglandin E2) has the ability, when exposed to UV radiation, to activate the enzyme tyrosinase, which produces melanin (skin pigment).

Blocking the formation of plasmin by tranexamic acid reduces skin pigmentation by decreasing tyrosinase activation.

In addition, the vascular component is important in some cases of melasma. Thus, tranexamic acid’s ability to reduce the formation of small cutaneous blood vessels may also be helpful.

Is tranexamic acid effective for melasma?

To date, no fully controlled clinical trials (the most rigorous scientific studies) have been published. However, there are large series that show the efficacy of tranexamic acid in lightening melasma.

The largest study was conducted by Lee et al. They followed 591 patients with melasma who took the drug twice daily for 4 months. 87.9% of them improved and only a quarter of them had a recurrence of melasma.

Is tranexamic acid a safe treatment for melasma?

Yes, it is safe. Adverse effects reported in studies are rare and generally mild. However, there are some situations in which it should never be given:

• Pregnancy
• Personal or family history of thrombosis
• Coagulation disorders
• Severe renal insufficiency
• Impaired color vision

There are certain situations in which it is generally better not to take it, but it can be individualized and assessed on a case-by-case basis:

• Breastfeeding
• Renal or hepatic insufficiency
• Use of oral contraceptives.

How should tranexamic acid for melasma be used?

Tranexamic acid is taken twice daily. It comes in 500 mg tablets. It is advisable to divide it in two, taking half in the morning and half in the evening.

If you prefer not to take drugs or if you have any of the above-mentioned medical contraindications to their use, there is a possibility of administering them by mesotherapy (through small punctures in the area of the blemish). Some studies show an efficacy comparable to hydroquinone (the most effective depigmentation cream) with hardly any side effects.

In conclusion..

Tranexamic acid is another alternative that we can add to the usual depigmenting treatments that we use in the complex management of melasma.

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