Melasma

I am getting worried. I have in the corner of my mouth on the outside tis growing dark spot. its circular and much darker than my regular pigmentation. I am brown skinned (dominican ethnicity if that helps). I have tried just about every lightening cream and steroid there is and nothing helps. It seems to be getting darker. Its not dry or itchy or anything but it looks kinda gross. I am not on the pill nor do i have any estrogen problems or any of the aforementioned causes. The dermatologist is trying to charge me $2,000 for laser treatements but there has to be another way. I would even pay for a stronger over the counter bleach product which i know insurance doesnt cover. Any suggestions would be highly appreciated. I am tired of hiding i would like to enjoy life again.  Thankyou and happy new year

[BhumikaMD]

Hi,

The treatment options available are -
'Topical depigmenting agents, such as hydroquinone (HQ) either in over-the-counter (2%) or prescription (4%) strength. HQ is a chemical that inhibits tyrosinase, an enzyme involved in the production of melanin.

Tretinoin, an acid that increases skin cell (keratinocyte) turnover. This treatment cannot be used during pregnancy.

Azelaic acid (20%), thought to decrease the activity of melanocytes.

Facial peel with alpha hydroxyacids or chemical peels with glycolic acid.'

'Laser treatment for melasma - A Wood's lamp test should be used to determine whether the melasma is epidermal or dermal. If the melasma is dermal, laser (or "IPL") will actually DARKEN and worsen the appearance of the spots. Dermal melasma is generally unresponsive to most treatments, and has only been found to lighten with products containing mandelic acid.

In all treatments for melasma the effects are gradual and a strict avoidance of sunlight is required. The use of broad-spectrum sunscreens with physical blockers, such as titanium dioxide and zinc dioxide is preferred over that with only chemical blockers. This is because UV-A, UV-B and visible lights are all capable of stimulating pigment production.'

You should consult your doctor about this and whether laser treatment would help in your case.

You could read more about this at the following links -

http://en.wikipedia.org/wiki/Melasma

and

http://www.emedicine.com/DERM/topic260.htm

Let us know if you need any further information.

Regards.