Last summer, Jen* noticed something odd about her appearance. “Out of nowhere, dark splotches had appeared beneath my eyes…and they were clearly not dirt.” Because they were symmetric and discrete, and because Jen had a busy work and academic schedule, she simply brushed the lesions off, until she noticed a similar discoloration above her upper lip. Bothered by this more noticeable change, Jen scheduled a dermatologist’s appointment for that winter.
Jen’s dermatologist diagnosed her with melasma, a skin condition characterized by the development of flat, tan/brown spots upon the face. The spots are usually symmetric, and they tend to appear on the cheeks, forehead, upper lip, and jawline. Hormonal factors seem to be involved, as melasma has been associated with both pregnancy and birth control pills. It is also exacerbated by sun exposure.
Jen’s dermatologist recommended that she discontinue her birth control pills, but Jen did not wish to do so. Instead, her gynecologist switched her to a low-estrogen pill, but Jen did not see much of a difference. “My dermatologist also gave me a prescription for TriLuma cream [a combination of fluocinolone – a mid-potency topical corticosteroid, hydroquinone – a bleaching agent, and tretinoin – a vitamin A derivative] but it was absurdly expensive and not covered by insurance, so I did not fill it right away.” However, when the switch to a low-estrogen pill did not help, Jen purchased the $160 cream at Target (it cost $180 at Duane Reade), with the help of a $40 coupon provided by her dermatologist.
Despite the cost, Jen is happy that she filled the prescription. “The cream really helped the spots fade – I am glad that I splurged on it!” Jen also switched to wearing Neutrogena Ultra-Sheer Dry Block Sunblock SPF 70 every day, which she believes has made a difference. Today, the spots have completely faded from her upper lip, and are very faint below her eyes.
*name has been changed to protect confidentiality
Editor’s Note: Although Tri-Luma and sunscreen worked for this reader, other (some less expensive) options exist for the treatment of melasma. If you have this condition, you should consult a dermatologist to explore the variety of treatment options.