What is Melasma, “The Mask of Pregnancy?”
Though melasma, commonly called the "mask of pregnancy," is typically seen in women, it may appear in men. Lesions are characterized by persistent grayish/brown pigmentation of the face, including the cheeks, chin and forehead. The skin appears "tan," but the tan does not fade when sun exposure is reduced. Though a strong association exists between the appearance of melasma due to pregnancy and the use of birth control pills, it may also appear spontaneously in other patients, especially those in their 30s and 40s.
Treatment: Includes four percent hydroquinone skin bleaches, matched with high-block sunscreens, can yield good results in some patients. Others may require multiple modalities including topical Retin-A and glycolic acid peels. The Fraxel laser, which is available at Dr. Humeniuk's main office, has demonstrated improvement even in the most resistant cases.
Hives/Urticaria
Hives, or urticaria, present as pink/red, well-defined, itchy swellings on the skin. In many cases, though not all, a definitive cause such as a reaction to foods, drugs or medications may trigger the response. Spontaneous cases may arise from viruses and environmental factors, such as pollen and mold. Individual lesions may resolve within 24 hours, but others can persist for days or even weeks. Most cases resolve within six weeks.
Treatment: Includes a combination of antihistamines and occasionally oral steroids. In cases lasting more than six weeks, medical investigation is warranted to look for other underlying causes or medical conditions. Access to a good patient history, including timing of onset and activities within 24-48 hours of onset, is helpful. Elimination of certain foods in the diet may be necessary to determine the cause.
Atypical or Dysplastic Moles
Dysplastic moles are notable for having somewhat irregular borders and an uneven internal pattern that may include bright red and brown spots or patches. These moles may appear to mimic, or in some cases may actually be, precursors to melanoma. While many atypical moles are benign or safe, it is important to have any moles evaluated that fit such a description. Several tools are available to the physician for use, such as a dermatoscope, which uses high-power magnification and polarized light to penetrate the mole, thus getting a thorough picture. If the mole appears questionable, it may be removed and sent to a pathologist to examine the cellular patterns.
Treatment: Dysplastic moles that do not exhibit an abnormality are often left alone, but continued self-examination by the patient is recommended. Moles that indicate signs of early progression toward melanoma after being examined by a pathologist will require a wider excision of the skin surrounding the initial site. Even if that particular mole is determined to be benign, monthly self-examination by the patient or a family member is important.
Actinic Keratosis
Actinic keratoses appear as persistent, rough, sometimes red and tender dry patches on the skin on the face, head, hands, arms or other body parts that typically have experienced long-term and frequent exposure to the sun. Up to 10 percent of actinic keratoses may progress to skin cancers, such as squamous cell or basal cell carcinoma. Many lesions are benign and remain unchanged for many years. Some may appear and progress rapidly. Also, old stable lesions can suddenly change and begin to grow. Unfortunately, it is impossible to predict which lesions will remain stable and which will grow.
Treatment: Cryotherapy, or liquid nitrogen freezing, is the most effective treatment for individual lesions. Extensive areas may be treated with topical creams, such as 5-fluorouracil, Efudex, Carac and Solaraze. Aldara is a new treatment that stimulates the immune system to fight pre-cancers in the skin. Some resistant actinic keratoses may need to be surgically removed.
