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Interview with Dermatologist Dr. Jeanine Downie, M.D. About Melasma

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Recently I was honored with the privilege to interview Dr. Jeanine Downie, M.D., about the treatment and prevention of melasma.  Although Dr. Downie is an expert in many realms of dermatology, she specializes in pigmentary disorders, and is particularly passionate about the topic, having been personally diagnosed with melasma in her early twenties.

Dr. Downie is a practicing board-certified dermatologist of Image Dermatology in Montclair, New Jersey; author of Beautiful Skin Of Color: A Comprehensive Guide for Asian, Olive and Dark Skin; as well as a professional lecturer, wife, and mother. Dr. Downie has been featured in numerous sectors of the public arena as well, including onThe ViewGood Morning AmericaThe Rachael Ray Show, and In Style andO magazines, amongst many others.  Thank you for taking the time to talk toFutureDerm.com, Dr. Downie!

Nicki Zevola:  How common is melasma in your patients?

Dr. Jeanine Downie:   Melasma is very common amongst patients, and I have seen numerous patients with it lately.  One type I have seen a lot of recently is intense heat fluctuation melasma.  […]It is upsetting, how common melasma is amongst patients.

NZ:  What can be done to prevent or eliminate melasma?

Dr. D:  To prevent or eliminate melasma, don’t necessarily get off of hormonal contraceptives.  Put sunscreen on, reapply every 2 hours, and watch heat.  Patients don’t often consider how much heat aggravates melasma.  Even waxing the upper lip can exacerbate the condition.

NZ:  What can be done to treat melasma?

Dr. D.:   Three major factors:  sunscreen, Tri-Luma, and chemical peels/Fraxel.  

To treat melasma, first use sunscreen.  The prescription Tri-Luma is the only FDA-approved treatment for melasma.  With the Tri-Luma, you may also wish to do chemical peels to help to even the skin out.  Also, laser treatments like Fraxel are useful if the patient has had very deep-seated melasma for many years.  In summary, sunscreen, treatment cream (with Tri-Luma being the best, but a cosmeceutical may be used) and chemical peels or Fraxel.  

NZ:  A lot of attention has been drawn to potential safety issues [i.e., ochronosis] with Tri-Luma, particularly for patients of darker skin tones.  Has this been an issue for you in your practice?

Dr. D:  My practice consists of approximately 60% white patients, 40% black/Latino/Asian, in that order.  Regardless of race, I advise my patients to only putTri-Luma on the dark patches themselves.  I tell them not to put Tri-Luma all over the face, or else patches may evolve that look like a bull’s eye!  Of course, these bull’s eye-like patches may not be a problem, but as a safety precaution, I do not advise puttingTri-Luma all over the face.

Recently, I was giving a lecture at the Cosmetic Boot Camp in Aspen, CO, where approximately 250 dermatologists, plastic surgeons, and facial plastic surgeons attended to learn about cosmetics.  I happen to specialize in pigmentary disorders, especially melasma.  And when a question about Tri-Luma was raised, I explained this:  the tretinoin in Tri-Luma thickens collagen and elastin over time, and the tiny drop of steroid is balanced by the retinoid in the product.  In addition, it has been proven that there is no problem with using Tri-Luma for an extended period of time. The product has been FDA approved for seven years.  

NZ:  Is there a difference between treatments for melasma, dark spots from acne scars, and sunspots?

Dr. D:  Yes.  For dark spots from acne, I advise use of fade creams, the laser treatmentsFraxel or Lyra, and sunscreen.  Sunspots are solar lentigines – I say these are like the ones that appear on Grandma’s hands – are best treated with the laser Gentle-Laze.  Sunspots are an entirely different modality from melasma – don’t use Tri-Luma for sunspots!  In fact, Tri-Luma doesn’t work swimmingly well for sunspots.

NZ:  Melasma often develops during a woman’s pregnancy.  Is there any way to prevent melasma from occurring during pregnancy?

Dr.D:  In terms of being preventative during pregnancy, melasma can occur anywhere – even the arms – particularly if the patient has a family history.  The patient must be very stringent about sun protection, must use sunscreen every 2 hours [for sunscreens that are permissible during pregnancy, please click here].  A patient can also receive peels all through her pregnancy, which can be helpful.  However, I absolutely do not give Tri-Luma to pregnant or nursing women [due to tretinoin/retinol/vitamin A].  

NZ:  In summary, what is the best advice you can give to patients regarding melasma?

Dr. D:  The bottom line is that people need to realize that they should get their irregular spots checked.  Patients need to get melasma diagnosed by a board-certified dermatologist.  Often patients with dark spots cannot tell the difference between melasma, sunspots, dark acne spots, and even skin cancer, so it is vital to have a board-certified dermatologist make the proper diagnosis – it could save your life! In addition, avoid too much sun exposure.  While the sun is not a statistically significant factor in the development of melasma, it makes already-developed melasma patches worse, and can aggravate acne spots and worsen sunspots.  

Have a skin care regime….once you are diagnosed with melasma, sunscreen, Tri-Luma, chemical peels, and/or Fraxel lasers are the best!  Even after [dermatological] surgery, I tell patients they can keep the area covered, use Fraxel, and then use Tri-Luma to help eliminate scarring.  

NZ:  Thank you very much, Dr. Downie, for taking the time to do this interview!  It was very useful and I feel privileged to have learned so much directly from you.

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