Solar lentigo

Lentigines are brown spots of varying sizes, either round or irregularly shaped. They appear in areas that have been exposed to the sun throughout our lives.

They are not harmful in and of themselves, nor do they pose a particular risk of becoming malignant and turning into melanoma. However, they are a sign that the skin where they appear has been damaged by sun exposure. In some cases, lentigines become raised, leading to seborrheic keratoses. There are times when they can closely resemble melanoma; therefore, if you notice any changes, noticeable growth, color alterations, or bleeding, it is important to consult a dermatologist.

Here you can see pictures of solar lentigo

Si te preocupa qué hacer con ellos, los léntigos solares pueden tratarse con láser, luz pulsada o nitrógeno líquido de forma muy sencilla.

Melasma

Melasma is more common in women than in men, because it is often related to pregnancy or the use of birth control. However, in many cases, women who have it are neither pregnant nor taking birth control; the sun is the primary cause, which is why it typically worsens in the summer.

To prevent its onset, it’s extremely important to use a good sunscreen (preferably one that also blocks infrared and visible light). Once the sunny season is over, you can try to improve the condition with depigmenting creams, chemical peels, or, in some cases, certain types of laser treatments. Keep in mind that achieving optimal results is very difficult, but with the arrival of fall and throughout the winter, we can significantly improve the appearance of these spots, so that we can start next summer with clearer skin. At that point, it will again be crucial to take every measure within our power to prevent their recurrence.

Postinflammatory hyperpigmentation

When the skin becomes inflamed due to a skin condition (such as eczema, lichen, etc.), a burn, a scar, or even a pimple or insect bite, it’s possible that, once the inflammation has healed, that area will remain darker than normal. We call this post-inflammatory hyperpigmentation, and it’s much more common in people with darker skin.

Here and here you can see more pictures of postinflammatory hyperpigmentation

It’s not usually a mark that lasts a lifetime; rather, it tends to fade over time. In any case, it’s important to know that it can last for months or years, and the treatments available to us (creams, lasers) aren’t usually very effective.

In conclusion…

There are many different causes of skin pigmentation after summer sun exposure. In most cases, these conditions can be improved using lasers, chemical peels, or certain skincare products—always in combination with sunscreen. This summary may be helpful, but it’s certainly best to consult your dermatologist so they can advise you on the best option for your specific situation.

Do you have any doubt regarding your dark spots?

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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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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?

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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.

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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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