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Q: I have been struggling with melasma for two years. I've been on oral contraceptives for seven years, but only in the past two years has this problem occurred. My doctor prescribed Lustra, but there have been no visible changes. I also changed my birth control pills from Ortho Cyclen to Alesse, but still with no visible changes.

I'm getting very frustrated. Will taking the Alesse eventually cure the problem? If not, should I try the Depo Provera shot? Is the only way to get rid of the melasma to stop taking birth control pills for a while and wait until it goes away and start again?

-- A.L.
A: Melasma (also called chloasma) is a skin pigment disorder in which blotchy, patterned dark brown patches appear on the face -- usually the forehead, cheeks, temples and jaws. The patches typically have sharp lines of distinction from the surrounding normal skin.

Melasma is a direct effect of hormonal change, and the condition often occurs during pregnancy (it's sometimes called the mask of pregnancy) or when taking oral contraceptives. It is a common condition, affecting 30 percent to 50 percent of women on the pill. Asian women are especially at risk.

As you note, melasma is a frustrating condition, but not a serious health problem. The pigmentation will usually fade after the pregnant woman gives birth or when the woman stops taking oral contraceptives.

Otherwise, several topical (applied to the skin) "treatments" are available, but none is very satisfactory. Melasma can be resistant to topical therapy.

A topical cream containing 10 percent glycolic acid and 2 percent hydroquinone (Neostrata AHA Age Spot and Skin Lightening Gel) has been reported to be as effective as any for depigmenting the dark patches.

However, this treatment and most others require regular application for a long time.

For example, in a recent preliminary study, 10 Asian women received twice-daily applications of this topical cream to both sides of the face for six months. One side of the face was also treated with glycolic acid peels every three weeks. This cream was found to improve the melasma, and the glycolic acid peel appeared to increase that improvement.

The medication your doctor prescribed, Lustra, contains 4 percent hydroquinone. Care should be taken with these depigmenting agents. Unwanted cosmetic side effects may result if the agents are not used as directed.

The pigmentation tends to be increased by exposure to sunlight, so exposure should be avoided to keep the condition from getting worse. Use of sunscreens on the pigmented areas should also help.

I don't know of any research on the difference between Alesse and other oral contraceptives in terms of production of melasma.

But you may be on the right track in considering Depo Provera shots. The manufacturers say that less than 1 percent of women taking the shots experience melasma. Check with your gynecologist.

For the time being, I suggest you have a little more patience -- it takes time for the pigmentation to go away.

Update on erectile dysfunction: More than 30 million men in North America have some degree of erectile dysfunction, i.e., impotence.

For many, Viagra has been helpful. But for all men with erectile dysfunction, the mass marketing campaign for this drug has brought the subject out of the closet and probably helped them feel less negative about themselves.

Now many more men can be helped by the new use of an older drug. Alprostadil (brand name Topiglan) has been somewhat successful in treating impotence in men, especially those with problems with their blood vessels. But until now it was thought that it had to be injected into the penis -- something many men were unable to do themselves.

However, a recent study has shown that alprostadil can be effective in almost half the men who used it simply by applying it as a topical cream directly onto the penis.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is

This column is for informational and educational purposes only.

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