What is causing these brown spots? Why can’t I get rid of them?

At age 55 I developed brown spots on my cheeks. I started the Obagi skin care regimen. About three years later, a large splotchy brown patch appeared on my cheek as well as patches on my jaws and brown spots on my forehead. I tried IPL and CO2 laser but they did not help. I went off the hydroquinone and went back on. Initially there is marked improvement but at about 7-8 weeks, the dark spot on the cheek starts to come back. I use a hat and sunscreen with 18 % zinc anytime I step out. I have never had HRT, never used oral contraceptives and have no family history of melasma. Despite following the doctor’s advice, I can’t seem to control the melasma. Should I use sunscreen even when I am indoors and not sitting in direct sunlight? Thank you for any advice that you can provide.

I recently returned from the IMCAS European conference on skin that was in Paris.  There were excellent talks on pigmentation problems.  There were several good points that were made.  One point had to do with the importance of considering a small biopsy for accurate diagnosis in a situation where pigment is not responding or is getting worse. 

One problem with hydroquinone based skin care systems (like some Obaji systems) that are used for years and not just months, is that the hydroquinone itself can cause more pigment.  This is called exogenous ochronosis.  Is your diagnosis really melasma?  You don’t really know if a biopsy has not been done.   Please see a really good board certified Dermatologist and get help with this key question.    Dr. I

Dr. Brandith Irwin, MD

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