Melasma (also called the “pregnancy mask”) can be stubborn and very frustrating for so many women. To address the questions I’ve been getting about melasma, I shared a series of posts covering this topic, including Melasma 101, 102, and 103.

Now, I’m sharing some brand new information. It’s not very often that we see new meaningful developments when it comes to treating melasma, so I am excited to share these new developments with you guys.

New Studies re: Antihistamine Use and Melasma:

If you have melasma, you might want to consider taking a daily antihistamine, like Claritin or Zyrtec. Why?

New studies are showing that there is an increase in mast cells in melasma.  Mast cells are cells that release histamine and other molecules that make you itchy and red – we usually think about mast cells when we think about allergies, but now we are seeing they play a role in melasma as well!

These mast cells can actually break down a type of collagen, collagen 4, which is found in the basement membrane of our skin. In melasma, the extra mast cells found in the skin release substances that chew away the membrane that separates the top layer of our skin from the bottom layer, called the dermis. When that happens, the pigment in our upper layers can drop down into the deeper layers, and that is NOT a good thing.

If you have melasma, your doctor might have told you that your pigment is DEEP, in the deeper layers of your skin, and that could be a reason why it’s so stubborn and not responding to therapy. So what if we could prevent the mast cells from destroying the basement membrane?  And, what if we could keep that pigment in the upper layers, where it’s easier to treat?

Well, there are ongoing studies looking at just that! They are looking at whether taking a daily oral antihistamine (like Allegra, Zyrtec, Claritin) might actually help with melasma. It’s worth considering if you have a very stubborn case. I will share more on this as the science develops!

Tranexamic Acid and Melasma

Another very new development in treating melasma is called tranexamic acid. It works as part of the clotting cascade, so it is FDA approved for conditions like heavy menstrual bleeding, or to help prevent bleeding in people with hemophilia, say when they’re getting a tooth extracted. In melasma, it works by basically dialing down the inflammation that leads to pigment production in the skin. It’s not FDA approved for melasma, so when it’s used for melasma, it’s considered “off label use.” With that said, we are starting to see very promising studies in connection with treating melasma.

Like any other treatment, this is something to raise with your doctor. This is not meant to be a first line treatment. It’s complimentary to all of the other tools used in melasma like brightening creams, sunscreen, Heliocare, and chemical peels. Also, it’s important to note that people who have a history of blood clots, dvt (deep vein thrombosis), are pregnant or nursing, or on birth control should not be taking prescription strength tranexamic acid by mouth. The topical, OTC form of tranexamic acid is newer (so we have less data at this point) and an option for people who are more comfortable using a topical cream vs an oral prescription drug, or for those who are not candidates for the oral form. Again, something to consider and to discuss with your doctor if you have very stubborn melasma.

Dr. Whitney

 

When I was a little kid, my hair was a very white-blonde color. My mom loved to squeeze lemon juice into my hair to lighten it even more when we were at the beach. Little did she know that she was exposing her skin to a condition called phytophotodermatitis, which can result in severe chemical burns on your skin. All you need is the juice of a lemon or a lime, a bergamot orange – all seemingly innocuous citrus fruits – and sunlight. The juice reacts with sunlight and can seriously burn your skin, ranging from redness and blisters all the way to second degree burns. Even if your skin does not burn, you may wind up with substantial, lasting, skin discoloration which presents as darkened patches on the skin.

4 Ingredients that Can Cause Severe Sun Damage

So, if you use a hair lightener at the beach – like Sun In or  Sun Bum Hair Lightener, these typically include lemon juice or extract. Be careful not to leave any of this spray on your skin if you are using it on your hair.

If your child has a lemonade stand, be mindful of whether she is squeezing lemons and then exposing her skin to the sun. This is something very few parents think about, but the rashes and burns which can result are actually very real.

Other products which cause photosensitivity which can result in irritation, redness, dark spots, burns, and sun damage include:

These Essential Oils are Photosensitive

 

Certain Essential Oils: So many of my patients swear by their essential oils. They can be energizing, relaxing, and everything in between. But, if you’re going to spend the day in the sun, don’t expose your skin to: bergamot, bitter orange, grapefruit, lemon, lime, verbena, and several others. Be sure to check the information which accompanies your essential oils, as many are labeled photosensitive!

Reminder: Why Retinol Invites Burning

Retinol: I always recommend that my patients use their skin renewing retinol products at night. If you use retinol in the morning and head out into the bright sunshine, you will not have happy, healthy skin. This is a nighttime product because it makes your skin more sensitive to the sun.

Have you Heard of Hydroquinone?

Hydroquinone: This skin brightening ingredient — which helps limit the skin from producing an excess amount of melanin (which is what gives our skin its pigment and, in cases of excess production, causes brown patches and hyperpigmentation) — is also a common culprit in terms of photosensitivity. Check your labels before you use your skin cream and head out to the beach or pool!

Have a wonderful time in the sun, wear your sunscreen, and watch out for those sneaky citrus fruits!

Dr. Whitney

 

@DrWhitneyBowe

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