Dr. Alai is an actively practicing medical and surgical dermatologist in south Orange County, California. She has been a professor of dermatology and family medicine at the University of California, Irvine since 2000. She is U.S. board-certified in dermatology, a 10-year-certified fellow of the American Academy of Dermatology, and Fellow of the American Society of Mohs Surgery.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melasma is a very common patchy brown, tan, or blue-gray facial skin
discoloration, almost entirely seen in women in the reproductive years. It
typically appears on the upper cheeks, upper lip, forehead, and chin of women
20-50 years of age. Although possible, it is uncommon in males. It is thought to be
primarily related to external sun exposure, external hormones like birth control
pills, and internal hormonal changes as seen in pregnancy. Most people with
melasma have a history of daily or intermittent sun exposure. Melasma is most
common among pregnant women, especially those of Latin and Asian descents.
People with olive or darker skin, like Hispanic, Asian, and Middle Eastern
individuals, have
higher incidences of melasma.
An estimated 6 million women are living in the U.S. with melasma and 45-50
million women worldwide live with melasma; over 90% of all cases are women.
Prevention is primarily aimed at facial sun protection and sun avoidance.
Treatment requires regular sunscreen application and fading creams.
What causes melasma?
The exact cause of melasma remains unknown. Experts believe that the dark
patches in melasma could be triggered by several factors, including pregnancy,
birth control pills, hormone replacement therapy (HRT and progesterone), family
history of melasma, race, antiseizure medications, and other medications that
make the skin more prone to pigmentation after exposure to ultraviolet (UV) light.
Uncontrolled sunlight exposure is considered the leading cause of melasma,
especially in individuals with a genetic predisposition to this condition.
Clinical studies have shown that individuals typically develop melasma in the
summer months, when the sun is most intense. In the winter, the
hyperpigmentation in melasma tends to be less visible or lighter.
When melasma occurs during pregnancy, it is also called chloasma, or "the mask
of pregnancy." Pregnant women experience increased estrogen, progesterone, and
melanocyte-stimulating hormone (MSH) levels during the second and third
trimesters of pregnancy. However, it is thought that pregnancy-related melasma
is caused by the presence of increased levels of progesterone and not due to
estrogen and MSH. Studies have shown that postmenopausal women who receive
progesterone hormone replacement therapy are more likely to develop melasma.
Postmenopausal women receiving estrogen alone seem less likely to develop
melasma.
In addition, products or treatments that irritate the skin may cause an
increase in melanin production and accelerate melasma symptoms.
People with a genetic predisposition or known family history of melasma are
at an increased risk of developing melasma. Important prevention methods for
these individuals include sun avoidance and application of extra sunblock to
avoid stimulating pigment production. These individuals may also consider
discussing their concerns with their doctor and avoiding birth control pills and
hormone replacement therapy (HRT) if possible.
There are many symptoms involved in the 1st, 2nd and 3rd trimesters of pregnancy. The first early pregnancy symptom is typically a missed period, but others include breast swelling and tenderness, nausea and sometimes vomiting, fatigue and bloating. Second trimester symptoms include backache, weight gain, itching, and possible stretch marks. Third trimester symptoms are additional weight gain, heartburn, hemorrhoids, swelling of the ankles, fingers, and face, breast tenderness, and trouble sleeping. Read more to learn about recommended procedures and tests for each stage of a healthy pregnancy.
Birthmarks and other abnormal skin pigmentation is caused by the body's inability to produce enough melanin. Abnormal skin pigmentation can cause conditions such as vitiligo, pigmentation loss, melasma, albinism, port wine stains, macular stains and hemangioma.
There are a number of different methods of birth control to include: barrier methods, IUDs, hormonal methods, natural methods, and surgical sterilization. Birth control methods can be reversible or permanent. In simple terms, all methods of birth control are based on either preventing a man's sperm from reaching and entering a woman's egg (fertilization) or preventing the fertilized egg from implanting in the woman's uterus (her womb) and starting to grow.
Women's health is an important topic area to guide a woman through the stages of her life, as well as knowing the conditions and diseases that may occur. Educating yourself so that the transitions into different phases of life is key to a healthy, happy, and productive life.
Sunscreens are crucial for sun protection. Sun damage to the skin from exposure to ultraviolet rays is a risk factor for skin cancer and melanoma. To avoid sunburn, people should limit sun exposure during the peak hours of 10 a.m. to 3 p.m., wear protective clothing, and use a sunscreen. People with sensitive skin should use a sunscreen with an SPF of 30 or more.
Chemical peels are performed on the face, neck or hands. They can be used to:
Reduce fine lines under the eyes and around the mouth
Treat wrinkles caused by sun damage, aging and hereditary factors
Improve the appearance of mild scarring
Treat certain types of acne
Reduce age spots, freckles and dark patches due to pregnancy or taking birth control pills (melasma)
Improve the look and feel of skin that is dull in
texture and color
Areas of sun damage, which may contain pre-cancerous keratoses that appear as scaly spots, may improve after chemical peeling. Following treatment, new pre-cancerous lesions are less likely to appear.
However, sags, bulges and more severe wrinkles do not respond well to chemical peels. They may require other kinds of cosmetic surgical procedures, such as carbon dioxide laser resurfacing , a facelift , brow lif...
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