Treating Melasma

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Dr. Joshua Fox of Advanced Dermatology, PC

Treating Melasma

Tips for a step-by-step approach to prevent and target the issue.

By Dr. Joshua Fox, Advanced Dermatology PC

Melasma is a common skin disorder that affects an estimated six million people in the United States. In fact, 90% of those afflicted are women, according to the American Academy of Dermatology. Melasma is often associated with sun exposure but it’s also common in pregnant women, hence the nickname the “mask of pregnancy.” Other common triggers include estrogen supplements and birth control pills.

The good news for patients is that technologies are evolving to better treat Melasma. The Fraxel laser (a type of fractional laser) is a tool that is increasingly used to treat Melasma, especially in severe cases and in cases where it doesn’t respond to other treatments. The Dual 1550/1927 Fraxel laser received new FDA approval specifically to treat skin pigmentation problems such as Melasma in June 2013. The benefit of the Fraxel laser is that it can safely treat the cells producing pigment yet it protects the outer layer of skin at the same time. Patients who go this route must be vigilant about avoiding the sun and must wear a high grade UVA/UVB sunscreen at all times.

Signs of Melasma

Melasma most often affects young women with so called “olive” or brownish skin tone. The condition is characterized by skin discoloration typically located on areas of the body more exposed to the sun, such as the cheeks, nose, forehead and chin, and to a lesser extent, the neck and arms.

While Melasma does not cause any physical discomfort, managing the psychological stress associated with the appearance can be a challenge. Melasma can rarely fade on its own but most women prefer to treat it because it’s not only unsightly but it also causes some degree of embarrassment. Appropriate treatment can significantly improve quality of life and restore self-confidence.

Tips for Treating Melasma

Fortunately, there are many treatment options to help manage Melasma. Dermatologists are excited about the FDA’s approval of Fraxel for treating Melasma. And while there is no magic bullet for the problem, we have additional therapies at our disposal that are safe and effective. These include:

· The first line of defense is a broad spectrum sunscreen, which will help prevent further skin discoloration. If a patient is vigilant about sunscreen use and stays out of the sun, the condition can spontaneously improve. More importantly, it will help prevent further discoloration.

· One of the first-line treatments is often a hydroquinone (HQ) cream, lotion or gel to lighten skin, which is available over-the-counter and in prescription doses. A dermatologist may also prescribe other topical medicines to lighten skin such as tretinoin (Retin-A), corticosteroids, azelaic acid and kojic acid. Several new products have been developed without HQ to treat the condition.

· Procedures for Melasma include chemical peels, microdermabrasion (a non invasive treatment that exfoliates skin), Fraxel Dual 1550/1927, Q-switched Nd-YAG and Ruby Lasers.

· A final option is a combination of several aforementioned therapies. In one recent study researchers in New York found that microdermabrasion and laser treatments used together can be a safe, a non-invasive approach with minimal or no recovery time, and it had long-lasting effects.

Note the importance of sun avoidance and sunscreen to help prevent Melasma. I recommends everyone apply sunscreen 20 minutes prior to going out in the sun. This is particularly important for people aiming to prevent or minimize Melasma. In addition, reasonable efforts to reduce sun exposure such as wearing a wide-brimmed hat and large sunglasses can also be helpful in avoiding the sun and aiding in the prevention of Melasma.

Advanced Dermatology P.C., Center for Laser and Cosmetic Surgery (New York & New Jersey) provides cutting edge medical, laser & cosmetic dermatology and plastic surgery services. Advanced Dermatology PC

Joshua L. Fox, M.D., F.A.A.D., is the founder and medical director at Advanced Dermatology P.C. He is a leading authority in the field of dermatology with expertise in skin cancer, cosmetic surgery and laser procedures and is program director of a fellowship in laser and cosmetic surgery.

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Tips for Treating Melasma

Tips for Treating Melasma

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Melasma is a common skin disorder that affects an estimated six million people in the United States. In fact, 90% of those afflicted are women, according to the American Academy of Dermatology. Melasma is often associated with sun exposure but it’s also common in pregnant women, hence the nickname the “mask of pregnancy.” Other common triggers include estrogen supplements and birth control pills. Joshua Fox, MD, a board certified dermatologist and medical director of Advanced Dermatology PC in Roslyn Heights, New York, cautions that patients should consult a dermatologist before trying any at-home remedies for melasma. “Some household remedies and over-the-counter treatments involve scrubbing and/or chemicals that can aggravate the skin and make the condition worse,” he says.

The good news for patients is that technologies are evolving to better treat melasma. The Fraxel laser (a type of fractional laser) is a tool that is increasingly used to treat melasma, especially in severe cases and in cases where it doesn’t respond to other treatments. The Dual 1550/1927 Fraxel laser received new FDA approval specifically to treat skin pigmentation problems such as melasma in June 2013. The benefit of the Fraxel laser is that it can safely treat the cells producing pigment yet it protects the outer layer of skin at the same time,” says Fox. He cautions that patients who go this route must be vigilant about avoiding the sun and must wear a high grade UVA/UVB sunscreen at all times.

Signs of melasma

Melasma most often affects young women with so called olive or brownish skin tone. The condition is characterized by skin discoloration typically located on areas of the body more exposed to the sun, such as the cheeks, nose, forehead and chin and to a lesser extent, the neck and arms.

While melasma does not cause any physical discomfort, managing the psychological stress associated with the appearance can be a challenge, says Fox. “Melasma can rarely fade on its own but most women prefer to treat it because it’s not only unsightly but it also causes some degree of embarrassment,” he says. “Appropriate treatment can significantly improve quality of life and restore self-confidence.”

Tips for treating melasma

Fortunately, there are many treatment options to help manage melasma. “Dermatologists are excited about the FDA’s approval of Fraxel for treating Melasma. And while there is no magic bullet for the problem, we have additional therapies at our disposal that are safe and effective,” says Fox. These include:

  • The first line of defense is a broad spectrum sunscreen, which will help prevent further skin discoloration. “If a patient is vigilant about sunscreen use and stays out of the sun, the condition can spontaneously improve,” says Fox. “More importantly, it will help prevent further discoloration.”
  • One of the first-line treatments is often a hydroquinone (HQ) cream, lotion or gel to lighten skin, which is available over-the-counter and in prescription doses. A dermatologist may also prescribe other topical medicines to lighten skin such as tretinoin, corticosteroids, azelaic acid and kojic acid. Several new products have been developed without HQ to treat the condition.
  • Procedures for melasma include chemical peels, microdermabrasion , Fraxel Dual 1550/1927, Q-switched Nd-YAG and Ruby Lasers.
  • A final option is a combination of several aforementioned therapies. In one recent study researchers in New York found that microdermabrasion and laser treatments used together can be a safe, a non-invasive approach with minimal or no recovery time, and it had long-lasting effects.

Fox reinforces the importance of sun avoidance and sunscreen to help prevent melasma and recommends everyone applies sunscreen 20 minutes prior to going out in the sun. This is particularly important for people aiming to prevent or minimize melasma. In addition, reasonable efforts to reduce sun exposure such as wearing a wide-brimmed hat and large sunglasses can also be helpful in avoiding the sun and aiding in the prevention of melasma.

Which Age-Defying Method Is Right for You?

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Skin Science

Which Age-Defying Method Is Right for You?

By Teri Brown

June 2008

New anti-aging techniques are allowing women to look younger for far longer than ever before. Botox, Restylane, Thermage, Microdermabrasion and a host of new laser methods mean women everywhere are taking advantage of the latest in age-defying techniques.

The downside to this explosion in skin science is the confusion it can bring to those of us who need it most. Which techniques should we use? We don’t want to spend money on Thermage when a round of facials would do the trick. Why waste time on Botox if lasers would be better? The following information will lead you through the maze of anti-aging techniques and help you make informed decisions.

 Thermage

Perhaps nothing has created as much excitement in the world of skin care as Thermage. This technique uses radio waves dispensed through a pen-like instrument in a grid formation over the face. The heat from radio frequencies tightens or lifts the skin, removing or reducing wrinkles and other fine lines in the skin as well as producing new collagen. The procedure takes about half of a day, and although many patients report a pinching sensation, there is very little real pain.

Dr. Joshua Fox, director of advanced dermatology at the Center for Laser and Cosmetic Surgery in New York City, N.Y., believes Thermage can be used on almost all areas of the face. “Thermage treatment was approved for wrinkle treatment around the eyes, yet we are finding that it offers even better results in other areas such as around the jaw, nasal labia folds, neck and chin areas,” says Dr. Fox.

Thermage isn’t for everyone, though. It works best for people in their 30s, 40s or 50s, who have some areas with wrinkles or sagging skin. It does not work as well for people who have advanced wrinkling or sun-damaged skin.

The results last between one and two years, and though costs vary, you can expect to pay about $2,000 for the procedure.

Lasers

Laser resurfacing is performed using a beam of laser energy that vaporizes the upper layers of damaged skin with controlled levels of penetration. As your skin heals, new cells are formed and tighter, younger looking skin is the result.

“There are two major types of lasers used in resurfacing: ablative and non-ablative,” says Dr. Fox. Ablative lasers include the Carbon Dioxide Laser and the Erbium, both of which remove the top layers of skin, tightening and remodeling the collagen. Dr. Fox says this improves the appearance of wrinkles, fine lines and to a lesser degree scars and sun damaged skin. There is approximately 70 to 80 percent improvement per treatment.

Non-ablative procedures, such as CoolTouch or Intense Pulsed Light, do not provide as much improvement, but usually there is not any down time. The non-ablative methods provide approximately 10 percent improvement per treatment.

When Monica Fedri, from Sherwood, Ore., wanted a laser treatment that would take care of her acne scarring, she chose a non-ablative method. Like many women, she needed something that would give her the results she desired, yet still allow her to return to work. “I had to wear a hat to protect my skin from the light, but the redness only lasted the day of the treatment,” says Fedri. “I was able to go right to work afterwards.”

According to Dr. Fox, some of the latest laser techniques combine both the Erbium and Carbon Dioxide lasers for better results. 

Botox
Botox burst upon the scene several years ago and just never went away. Botox is short for botulinum toxin A, and yes, it really is a toxin. One of the side effects of this toxin is paralysis. Other possible side effects include dysphasia, headache, neck pain, bruising/soreness at the injection site and nausea.

Botox successfully treats severe frown lines, because when it is injected into the muscle group surrounding the brow area, those muscles cannot scrunch up for a certain period of time. The injections last from three to eight months.

Restylane, Radiance, Cosmoderm and More

Dr. Cheryl S. Citron, dermatologist and former president of the New Jersey Dermatology Society, believes that fillers are perfect for women on the go. “The pervasive trend is toward the less-invasive procedures with decreased down time,” says Dr. Citron. “Working men and women can not afford the time at home hiding from the outside for days after a surgical procedure, so the less invasive options are much more appealing.”

The new generation of fillers, which includes Restylane, Cosmoplast, Cosmoderm and Radiance, are largely comprised of natural, human-derived products. Since people don’t often develop allergic reactions to them, delays for skin testing are no longer necessary.

“Since it is not made from animal products, we do not have to worry about allergic reactions,” says Dr. Citron. “It is used as a soft tissue filler, for the nasolabial lines and around the mouth.”

Fillers generally don’t take long to inject, and the results generally last from three to five months. Some of the fillers mentioned are not yet FDA approved, but are available at doctors’ offices.

Microdermabrasions, Dermaplaning and Facials

Dermatologists aren’t the only ones dealing with an industry exploding with new techniques. Aestheticians are now required to be both scientists and engineers as they utilize the newest potions and gadgets. Spas, such as the exclusive Belle Visage Day Spa in Studio City, Calif., are now offering facials that use both leading edge machines and the traditional creams and lotions.

The new ultrasound machines increase blood circulation and strengthen facial muscles. They can also reduce puffiness by draining excess fluid. These machines, used in conjunction with other techniques, can bring about amazing results.

Erica Trojan, a licensed clinical aesthetician from Wilmette, Ill., employs several different techniques in her practice. She is most known for her “medical facial” that uses different peels to exfoliate dead skin. Peeling is a method of taking off the top layers of skin to produce more of the necessary proteins that characterize younger skin. “It is multi-step and involves three different methods of exfoliation: an enzyme peel, a mechanical peel and a chemical peel,” says Trojan.

Enzyme and chemical peels vary in their aggressiveness. Enzyme peels use natural enzymes and herbs for a gentle peel that causes light exfoliation. You can buy and use these at home. Chemical peels are more aggressive and should be administered by a licensed aesthetician or dermatologist.

Mechanical peels can include Dermaplaning and Microdermabrasion. Dermaplaning uses a planing tool that gently scrapes away dead and inactive layers of epidermal tissue. Microdermabrasion involves a dual suction/polishing technology using crystals and suction to mechanically exfoliate tissue. Like peeling, both Dermaplaning and Microdermabrasion reveal new skin and can remove spots and blotchy patches.

Today’s anti-aging techniques are more diverse and more effective than ever before. With so many choices, women are sure to find a variety of methods that fit their lifestyles.

Coming Soon to a Salon Near You

The APTOS thread, or feather lift, was developed in the former Soviet Union and is expected to receive FDA approval soon. The threads, which are implanted at predetermined areas of the face, have barbs that lie in one direction and open up as the threads are lifted. The tissue is caught slightly in these barbs during the lifting process. The results improve over time as the collagen bunches around the areas where the barbs were implanted.

Diode lasers can be dialed to any wavelength needed, as opposed to the many different lasers doctors and other professionals now have in their offices. Presently, different lasers are used for different purposes. Diode lasers will make it easy for your skin care professional to adjust the process to suit your skin needs.

The JetPeel was developed in Israel and uses both saline micro-droplets and oxygen accelerated to incredible speeds to remove skin layers. This method is purported to both stimulate collagen and provide resurfacing. It is being tested in the United States, although it is not yet widely available.

Top Skin Conditions For People of Color

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Top Skin Conditions For People of Color

People of African, Asian, Latin and Native American backgrounds know that their skin, hair and nails are subject to conditions that do not affect lighter skinned people. “While most of these are not serious, they may be disturbing, troubling or unsightly,” says Joshua Fox, MD, a leading dermatologist, founder of Advanced Dermatology and an official spokesperson for the American Academy of Dermatology and the American Society of Dermatologic Surgery.

“Fortunately, your dermatologist is well acquainted with these conditions and can help people with dark skin to diagnose and treat their concerns early and quickly,” says Dr. Fox. He offers the following listing of the top skin conditions faced by people of color and how it differs from lighter-skinned individuals.

1. Acne – Many dark skinned women suffer from acne vulgaris, sometimes combined with hyper pigmentation, or skin darkening in spots or patches, which occurs in response to the outbreak of acne. Unlike fairer-skinned individuals, the discoloration plays an integral role in treatment. Surprisingly, these patients are more bothered by the discoloration than the acne itself. Treatments may include topical skin lightening creams for dark spots, sunscreen and topical, prescription acne medications.

2. Dermatosis Papulosa Nigra – These brown or black raised spots, which commonly affect African American women and people of Asian descent, may look like moles or flattened warts. They are always benign, never lead to skin cancer and are not harmful. However, some people do have them removed for cosmetic reasons. Typically, up to 50 percent of Dermatosis Papulosa Nigra patients have a family history of the condition, and up to 35 percent of adult blacks in the United States have it. They are easily removed with minimal to no marks.

3. Eczema – Very common among those with brown skin, eczema is an itchy, irritating rash that can occur in skin of any type or color. However, according to the National Eczema Society, it is found twice as often in black skin. When it does occur, differences in the structure of black from Caucasian skin can cause related problems including excessive pigmentation and a thickening of the skin that can also cause changes in skin color. “Because eczema is harder to identify in dark skin, and is often confused with psoriasis or fungal infections, getting the right diagnosis and treatment can be difficult,” Dr. Fox says. “Once the correct diagnosis has been made, topical medicines are quite helpful.”

4. Keloids – Scar tissue caused by abnormal healing of the skin occurs frequently in individuals with brown skin. Any time dark skin is injured, the risk of keloids is dramatically increased. According to Skin & Aging magazine, up to 16% of black and Asian people suffer from keloids. Keloids can develop immediately following an injury or take a long time to grow. Sometimes they itch, are painful and burning or feel tender to the touch. Treatments include cortisone and other injections, radiation therapy, pressure dressings, silicone gel applications and several types of lasers are extremely helpful. Keloids can also be removed via traditional or laser surgery.

5. Traction Alopecia – This hair loss condition is caused by damage to the hair follicle from constant pulling or tension over a long period of time. It is most common in African Americans who braid their hair tightly, but can also be caused by over processing of the hair through dyes, bleaches or straighteners. According to the National Institutes of Health, some 17% of African-American schoolgirls (6-21 years) and more than 30% of women (18-86 years) suffer from traction alopecia. While this condition can be reversed if diagnosed early, it can lead to permanent hair loss if it is undetected for a long period. These people – mainly women – should change to looser, gentler hair styles and should see a dermatologist. Unfortunately, no medical treatment is available to reverse late-stage traction alopecia; hair grafts, transplants or wigs have been identified as the only practical solution.

6. Melanoma — Those with brown skin often have a false sense of security when it comes to skin cancer. “While increased skin pigmentation offers some protection against the sun’s harmful UV rays,” Dr. Fox says, “melanoma can and does occur,” unlike in the lighter-skinned individual, it occurs especially on the palms, soles, fingers and toes, nails and mucous membranes (such as the mouth or nose). “A new dark mark or a mark that changes in size, shape or color in these areas should be seen by a dermatologist immediately. Even people with dark skin should always use a sunscreen when spending extensive time in the sun,” he says.

7. Pigmentation – Women with brown skin, particularly those of African and Latino descent, have a high incidence of hypertension, diabetes and heart disease and thus take medications for those medical problems. These, as well as other commonly used medications (LIST MEDICATIONS THAT CAN CAUSE PROBLEMS) can cause various types of allergic reactions that frequently lead to hyperpigmentation, or dark patches. While the dark spots can fade over time, women should seek treatment early. Procedures such as chemical peels and skin bleaching, designed to lighten the darkened areas, can help, as can diligent use of sunscreen. The new Fraxel™ is the first laser approved for treatment of melasma – a type of pigmentation disorder of the face.

8. Vitiligo – Skin gets its color from pigment cells. When those cells are damaged or destroyed, they no longer produce pigment, causing white or colorless spots to appear. The spots can grow larger over time and eventually blend together so that large portions of the skin have no color at all. While no one knows why this occurs, many suspect it is related to problems within the autoimmune system. Vitiligo also may be hereditary. While people of any skin color can develop Vitiligo, it is most obvious and therefore debilitating on dark skin. One common treatment is PUVA — a repigmentation therapy involving the drug psoralen combined with exposure to UV light. A simpler, newer and equally efficacious treatment is narrowband UVB light treatment. The newest laser treatment though is that of the Excimer laser 308nm which markedly shortens the number to treatments and spares unwanted streaks. This process help increase the amount of pigment cells at the skin’s surface. Other treatments include prescription-strength corticosteroid cream, light/laser treatments and, in rare instances, skin grafting.

Fractional Laser Revolutionizes Melasma Treatment

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Fractional Laser Revolutionizes Melasma Treatment

Many women are embarrassed and distressed by brown or grayish-brown patches on their faces, a common condition known as melasma. The condition, which affects about 5 to 6 million women annually, is benign, but difficult to treat. This past summer, the U.S. Food and Drug Administration approved a breakthrough treatment, the Fraxel™ laser, for the treatment of melasma.

Many women are embarrassed and distressed by brown or grayish-brown patches on their faces, a common condition known as melasma or the “mask of pregnancy.”

The condition, which affects about 5 to 6 million women annually, is benign, but difficult to treat. “Melasma is linked to hormonal changes that occur during pregnancy and when using birth-control pills, and is worsened by sun exposure,” according to Joshua Fox, MD, a leading dermatologist and founder of Advanced Dermatology and The Center for Laser and Cosmetic Surgery. Until recently, bleaching creams and other types of topical medications were the best hope for lightening the unsightly patches, but these products can take a long time to clear brown spots and don’t always work very well.

Now, there is a much better option particulary in cases unresponsive to cream. This past summer, the U.S. Food and Drug Administration approved a breakthrough treatment, the Fraxel™ laser, for the treatment of melasma. “With the Fraxel laser, we can gently treat portions of the skin and penetrate deeply enough to eliminate the pigment-producing cells or melanocytes that cause melasma,” says Dr. Fox. “There may be a little redness and swelling after the treatment, but it typically fades within a day or two and can be covered with makeup.” Three to five treatments spaced about a month apart may be required – some doctors do it on a weekly protocol. Each treatment takes about 30 minutes, but you should expect to be in the doctor’s office for over an hour, as a topical anesthetic needs to be applied and take effect before the laser is used.

Fraxel’s technology works on skin in much the same way a computer artist might manipulate a digital photograph. Just as the artist corrects “pixel by pixel” in a photograph, the laser works cell by cell on the skin. “Fraxel corrects a section of cells, called Micro Thermal Zones (MTZ), rather than the entire surface,” Dr. Fox explains. “This allows the healthy surrounding cells to promote faster healing to the entire area.” What’s more, Fraxel treatments are applied deeply into the skin, encouraging regeneration at the collagen level. “This is where we see the real benefits of the Fraxel laser treatment, in that it aids in the natural regrowth of healthier, younger-looking skin cells,” he adds. This is why it is also helpful for wrinkles, scars, phototherapy and many other problems.

In one study, improvement was seen in 7 of 10 women with melasma who received Fraxel treatment; in another that compared Fraxel treatment plus use of topical creams to topical products alone, significantly more fading of brown patches was seen with the laser. No serious adverse events were reported in either study. The Fraxel laser has also been approved by the FDA to treat wrinkles, fine lines, and other age-related changes on the body and face. However it is the first and only laser approved by the FDA for hte treatement of Melasma.

Other Treatment Options
A triple combination treatment called Tri-Luma cream, containing tretinoin (a vitamin A derivative often used to treat acne and wrinkles), hydroquinone (a bleaching cream), and fluccinolone acetaonide (cortisone) is also effective for melasma. Other compounds hydroquinone and vitamin C, HQ alone, HQ and AHA, Azalaic Acid or Kojic Acid can also be utilizied. Studies show it clears or almost clears melasma in 70% of patients who apply it nightly for 8 weeks or more. Side effects include redness, peeling, and dry skin.

Chemical peels and microdermabrasion, both of which exfoliate the outer layer of skin, may also be prescribed to treat melasma, but their results are inconsistent. “Whatever treatment you have, it is critical to use sunscreen regularly and avoid sun exposure, or melasma may return,” says Dr. Fox.

Who Gets Melasma?
Melasma occurs as the result of increased production of melanin, the substance our bodies make that gives color to the skin and hair. It affects women of all races (and a few men), but is more common among those with darker skin. It also runs in families. Typically the brown patches appear most commonly on the cheeks, upper lip, nose, chin, or forehead. They may sometimes fade on their own after pregnancy or stopping birth-control pills but often recur with subsequent pregnancy or use of the pill.