Help Please: Melasma (?)+ Redness around Nose and Mouth Area

[pinkskyinthecity]

I've been suffering with raised beige-y "freckles" on my Chinese skin for the past 5 years, but it's got worse recently. The GP stated there's nothing they can do as it's a "cosmetic" issue and I'd have to go private and have laser treatment. I've tried "brightening" creams like Dermalogica, Fade Out, Shiseido in the past etc. but they weren't effective. As there's more and more brand targeting this area of skincare, I'm overwhelmed by it all.

Also, the reddening of my nose/mouth areas is more prominent nowadays. I don't have a proper skincare regime other than using:

Moisturiser with SPF usually 25-30 (currently, it's Aldi's Caviar Illumination Day Cream SPF 15 and L'Oreal Revitalise Night Cream.
Nuxe Eye Serum
Clinique Facial Soap (morning)
a herbal (v. astringent) soap from Thailand (brand?) - but works to keep the adult acne at bay

I wear minimal make-up without foundation. Very occasionally, the foundation I use is something by No. 7 but the coverage is that great as some of the freckles still show through. (Additionally, I have 2 moles, and they've both have got bigger as I got older, but not malignant. Still not happy with one of them as it's prominent enough to show up in photos now.)

I've read a beauty article recently (The Times/Observer?) that anything SPF 30 and over is not going to be effective, so it's money-wasting. What do you lot think?

If anyone has anything to comment on this whether it's their experience or knowledge, then I'd be most grateful. Thanks.

Oh, btw, I've had one child 20 years ago and have had long-term use of the pill. Since reading about melasma, I recently stopped taking it as it's one of the causes of the condition. I didn't get melasma until 5 years ago, so I don't think it's linked to the pregnancy all those years ago.

MSM sulfur as a supplement is supposed to eradicate melasma. Are you sure you don't have rosacea?

My understanding of melasma is that once you have it, you have it and from then on you have to be obsessional about SPF.

With SPF you need broad spectrum - both UVA and UVB protection. The articles saying that over SPF 30 is pointless are kind of right in that SPF 30 blocks 97% of UVB so with SPF 50 you aren't really getting much more than 97%!

However there are 2 problems here:

1. SPF only refers to UVB protection. You need to have made sure your sunprotection is protecting against UVA as well - usually indicated by ++++ or broad spectrum as UVB causes skin cancer and burning but UVA causes melasma. So you absolutely need to check you have very high UVA protection.

2. Almost nobody applies sun protection in the quantities you are supposed to get the protection described on the bottle. Especially if you also wear makeup as you are supposed to reapply your sun protection frequently throughout the day. This is the main reason most people buy a higher SPF in hopes that if you buy SPF 50 you may be ending up with SPF 30 on your face IYSWIM.

Does that help?

Also if you have reddening are you sure you don't have rosacea?

In which case, wearing high factor SPF is very important again but chemical sun block may trigger your rosacea and you should try to stick to physical sun block only.

I have Melasma. Its has lessened a little during winter, but during last summer the emergence was quite upsetting. It's not massively noticeable to everyone, but I am at the point where I won't go out without makeup.

I use facial sunblock every single day. I use a Paula's choice one, sf 35 and a Clinique City Block sf 40 as a minimum.

I use some chemical exfoliants in my skincare that have helped a little, but you also have to be careful and avoid sun exposure/use SPF whilst using them, so it's easy to make it worse if you aren't careful.

Makeupwise, I use Nars Creamy concealer over the affected areas. It's really good, so if there is a shade to match your skin, it's worth a look.

There is a good video online somewhere with Caroline Hirons and (I think) Sali Hughes that talks about it.

Also - I may be wrong about this - but I think it can sometimes have a hormonal trigger, so maybe get your thyroid checked?

I've had some areas of pigmentation for a few years now and although have not eradicated them have managed to fade them to barely noticeable but it's been a long hard slog through the use of chemical exfoliants, vit C serum and other products designed to combat this (serum, essences, sleeping packs etc) - Ingredients to look out for are Niacimide, arbutin, azaelic acid, liquorice root and retinol among others. It's very much a question of trial and error as everyone's skin is different but would definitely recommend using glycolic acid and vitamin c serum as a starter. Also take a look at the korean beauty thread as there are some excellent korean products designed to help combat this.
I'm also fanatical about using sunblock every day and basically any treatment you decide to try will not work if you are not protecting your skin from UVA. Don't rely on spf from foundation or moisturiser as this isn't sufficient.

I've had melasma for the past few years and finally seem to have beaten it!

In my case, it was caused by a hormonal inbalance (oestrogen dominance)! This is common in perimenopause and can be treated with progesterone supplementation. After several years of progesterone treatment (first the mini-pill and then natural progesterone capsules), I ended up having a hysterectomy, as the high oestrogen levels were causing other problems, too.

The hormonal treatment stopped the melasma from developing further and I managed to reduce the existing patches to virtually invisible using a serum and a cream from Laroche-Posay, called Pigmentclar. I've used the moisturiser cream each morning after a moisturising serum and the pigmentclar serum each evening, followed by a heavy-duty moisturiser, for the past few years and it really has made a huge difference!

I mentioned it to a couple of my colleagues a few months ago and they were shocked because they'd never noticed the melasma until I pointed it out to them, as it's barely visible these days.

Hey All,

It's really heartening to hear your shared experiences of this and various advice you have given me. I shall look into finding specific treatment for this, but I have never been convinced that separate applications of various creams, SPF block etc. would work together; wouldn't they counteract their efficacy? Or are you meant to apply each layer of treatment and leave for some minutes so that it absorbs into the skin properly?

(Sorry for sounding so dumb)

Oh, and one other thing, I've got lots of bumps in my neck like spots? I can't see them but they're annoying like hell? Is this usual?

Wolpertinger: I have often thought about whether the redness is rosacea but the GP never said anything about this. It's red most of the time. In photos it doesn't show up but if you're right in front of me, you can see it. I've got the usual open pores with oiliness around the nose, and dry cheeks and around the mouth area. It's not a good look at my age (40s)

Fancy posting pics? The difference between melasma and rosacea is quite visible to someone who's had it.

If it's melasma you'll need very high ppd rating sun protection (la Roche posay anthelios xl is a good place to start). Every day including rainy winter ones in the UK.

Next layer treatments depend on whether it's surface or deep level.

If you don't want to post pics I'd suggest see a dermapologist. Unfortunately it sounds dermal which is more difficult to treat, but can be vastly improved and maintained with fanatical sun protection. Think chemical peels and heavy supplementationight can work for some. Obagi Nu skin protocol is popular but lots of people get bounce back when they stop.

Good luck.

Agree with all the sound advice from others. But, I think you need to see a dermatologist. He or she will be able to give you a diagnosis and therefore more tailored and appropriate advice. Expensive, but better than spending £££ on over the counter products (or laser treatments) which aren't necessarily suitable. FWIW, I was diagnosed with Melasma a few years ago. I saw a derm and was prescribed hydroquinone, Retin A, vicamin C seum and spf 50 (using the Obagi Nu Derm system). It improved but did not eradicate my patches. I now maintain/protect my skin with vitamin C, azelaic acid, SPf 50 each day and Retin A at night.

Here's a close-up pic of mine. It's only visible close up now and only in my upper lip area. Before, it was much darker and around an inch wide, all around my mouth and chin!

The La roche posay Pigmentclar I use is spf 30 btw. It's made a huge difference!

Well, here it goes... (took awhile to get someone to take a photo for me, though, it's not a very clear pic, sorry)

The redness isn't showing as the flash wasn't disabled, but it's definitely there. The freckles are raised as you can see, but having read about this melasma doesn't have this, is that true for you guys?

I'll look into all the suggestions, particularly about seeing a dermatologist, but I wouldn't want anyone overcharging me ridiculous amounts (I'm not very well-paid). If anyone can recommend anyone from the East Midlands, then that'll be great. Thanks for your input everyone as I do feel quite alone on this matter. (My sisters don't have this; one of them suffer with milia).

I think it's worth asking your GP to refer you to a dermatologist. That's if you don't mind a bit of a wait. i was referred to one for hair loss and was surprised that the wait wasn't as long as I thought it would be.

I think if you try and diagnose/treat it yourself it might be tricky. There's a lot to take into account - hormones, any previous skin issues and in your family etc.

I was so glad when I did see a specialist. She really helped where the GP and all the supplements and products I chucked at the problem, were making no difference.

My melasma marks aren't raised. They're like freckles that joined together to form splodges/darker patches. I agree with timemaychangeme about asking your GP for a referral. I'm sorry that I don't have any recommendations in the E Midlands. Worth researching/hanging on for one though, as you could then ask you GP to be referred to him or her. Good luck.

PS, my experience (in London) is that the GP said it was a cosmetic issue and I'd have to go private. I think if you have had this for 5 years and it is causing you real anxiety, it is worth emphasising this and pushing for a referral. I have found over the years that it pays to be reasonable but firm with my requests for referrals (not that I've made many) as the default answer seems to be "no", as GPs are now in effect the gatekeepers when it comes to referrals.

Op. Don't want to worry you, but given this is a developing condition, raised, not responding to topically etc. I think you need to rule out if this is actually actinic keratosis (which in all honesty, looks like it could be to me). If you can't get referral to a derm, asking for a skin cancer specialist might prompt your gp to sort it...else please do cough up the cash yourself.

Please don't delay (and report back!).

Thelwell,

Hm...Actinic keratosis is definitely not what I have as I don't have any kind crusting or scaling on the freckles (having checked out those awful images on Google!) They're just as they are with no alteration in its form (as depicted in the pic). I've got a GP appt. tomorrow so shall be asking them about a referral as it's caused me a great deal of internal upset for some time. I will reconsider using a higher SPF, but as I've said in the previous post about how to use one product after another (SPF and moisturiser blending into one another, thus cancelling out each other's effectiveness, maybe?) Can someone advise me on this, please?

Thanks for all concerned, and I shall update in due course...
Have a lovely w/end!

Pinksky how did you get on with your skin?

suzib and others -

Well, the referral I've asked about to my GP back then was honoured but it wasn't till mid-June, but only last week, the derm. dept. at the hospital rang to ask if I wanted a 'telederma' appt. instead which is where they photograph your skin and the doctors will look at it rather than see the patient in person. They'll respond by letter to confirm what they diagnose and treatment to advise. If they wanted to see you, your original appt. would still stand. So lo and behold, a few pics were taken and they said it'll be a week before I'll get a letter. What the GP said originally was that there would be nothing on the NHS, but if I wanted to go privately then I'll get some recommendations for those working for both sectors should I want to consider laser treatment (or whatever) route.

Now that the sun's really bright these days, I'm going to buy a separate sunblock and am thinking the LPR Pigmentlar might be a possible purchase, though I'm wondering if it absorbs well as I wouldn't like a white cast or a greasy sheen...

Well, I've had my diagnosis and it's seborrhoeic keratosis, and there's nothing on offer from the NHS to help it. Do you think a brightening cream might lighten it as there's so many products on the UK atm to even out skin tone?

Unfortunately, I bought the LRP Anthelios XL SPF 30 instead of 50 by mistake but it gives me a white cast. Is there another I can use instead?

Pinksky - you need to look up advanced cosmetic procedures for this. Where are you based?