Todd Minars, M.D.
Dermatology |
This
is the first of a two part email about
treating “brown spots”.
This month we will discuss the treatment
of “brown spots” with bleaching
cream, and next month we will talk
about the treatment of “brown
spots” with lasers.
“Brown spots” is an intentionally
vague term. But most people do not
know the medical term for the type
of brown spots that they have. Some
people are familiar with the term melasma,
which is also called “the mask
of pregnancy” (though you do
not have to be pregnant to have it).
Another very common form of “brown
spots” is called post-inflammatory
hyperpigmentation. Acne patients with
darker skin are familiar with this
form of “brown spots”.
In these patients the inflammation
from their acne leaves them with brown
pigmentation on their face that can
last from months to years. Any type
of inflammation can leave this form
of pigmentation: burns, irritation
from shaving, plucking, or ingrown
hairs. Both of these conditions: melasma
and post-inflammatory hyperpigmentation
are notoriously difficult to treat.
In fact, they are even notoriously
resistant to laser therapy, so we turn
to bleaching creams.
Bleaching creams come in many varieties.
The most common ingredient is hydroquinone.
Over-the-counter preparations contain
up to 2% hydroquinone and prescription
creams contain up to 4% hydroquinone.
But most patients who I see have already
tried these creams, and they are coming
to see me because they have failed
to improve.
The most effective bleaching cream
was developed many years ago by a dermatologist
at the University of Pennsylvania named
Albert Kligman. His cream is a mixture
of three ingredients (one of them being
4% hydroquinone) and was used with
great success by dermatologists for
years.
|
|
The
only problem was that a pharmacist
had to compound (i.e. custom mix) the
cream, and the art of compounding has
been a dying art over the past few
years due big chain pharmacies, poor
insurance reimbursement, and the availability
of pre-packaged creams. For example,
Triluma came on the market a few years
ago as a pre-packaged/ pre-mixed, prescription
version of Kligman’s formula and is very
effective for the treatment of hyperpigmentation
(though also very expensive and usually
not covered by insurance). Again however,
being a specialist (and therefore often
the last resort for some difficult
cases) I will often see patients who
have already tried Triluma, and failed
to improve.
So the question is what kind of bleaching
creams do I prescribe for my patients?
As a specialist I have the unique opportunity
to treat many patients with the same
problem and I have tried just about
every version of bleaching cream and
(just as important) several pharmacies
who compound these creams, and I now
use one pharmacy to make my bleaching
cream compounds based on Kligman’s
formula, because they provide the following
advantages:
| • |
We can use stronger
concentrations than available in
pre-packaged prescription creams.
For example, Triluma has 4% hydroquinone,
and we often like to use 6, 8,
or 10% hydroquinone. |
| • |
We can use
any combination of those three
ingredients and can “fine
tune” it according to your
skin type or according to what
stage of treatment you are in.
For example, we may start with
high concentrations of all three
ingredients for two or three months
to achieve initial clearing of
the pigment, and then use lower
concentrations of only one or two
of the ingredients to maintain
the results. |
| • |
Finally, we
get all of these advantages at
a significantly lower cost. Triluma
usually costs about $90 to $100
for 30 grams. The pharmacy that
we use will compound the same cream
for $30 to $40. (please note: The
pharmacy bills you directly. We
in no way profit from this or any
other prescriptions we write.) |
For more information, call Dr. Todd Minars
at 954-987-7512. |
