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El Dr. Timothy Jochen de antemano lo que le dirán algunas de sus pacientes cuando acudan a su consulta de Palm Springs. "Una mujer frustrada, generalmente de 30 años o más con

manchas

oscuras en el rostro, me pedirá que la ayude. Una situación sorprendentemente común,? afirmó el Dr. Jochen, "y es lamentable que muchas más no acudan a su dermatólogo para que les proporcione tratamiento. Me satisface ver la sonrisa de mi paciente cuando le hablo de la existencia de tratamientos disponibles que pueden ayudarla a reducir o eliminar esas manchas pardas y desagradables.? Las manchas faciales oscuras pueden aparecer por muchas causas, como la acción de los rayos solares, las cicatrices del acné o una inflamación. Cuando afloran esas manchas oscuras de color pardo grisáceo en las mejillas, labio superior o frente, estamos en presencia del trastorno llamado melasma, al cual también se le conoce como "paño,? máscara del embarazo o hipermelanosis. Pero independientemente de cómo quiera llamársele, dicho trastorno es provocado presumiblemente cuando las células de la piel producen cantidades adicionales de melanina, sustancia química responsable de la pigmentación. Numerosos médicos vinculan estos casos con una amplia variedad de factores desencadenantes como la exposición a los rayos solares, así como cambios hormonales en las mujeres como los que causa el embarazo y la menopausia, e incluso aquellas transformaciones hormonales asociadas con el uso de píldoras anticonceptivas. Cada día, millones de mujeres estadounidenses se enfrentan a las manchas oscuras cuando se miran al espejo, sobre todo las de origen hispano, caribeño y asiático, así como las afroamericanas. Aproximadamente el 80% de las hispanas reportan este tipo de manchas faciales oscuras, algo que también suele ocurrir en mujeres pertenecientes a una misma familia. Aunque esas manchas oscuras no producen enfermedades físicas, varias investigaciones han revelado que sí provocan trastornos psicológicos y emocionales, pues no sólo afectan la autoestima de muchas mujeres, sino que también transforman la manera en que las ven otras personas. Un informe publicado en la revista Evolution and Human Behavior demostró que las manchas oscuras en el rostro femenino son una de las señales que se usan para determinar la edad. A propósito de esta situación, la presencia de manchas en sí misma puede influir en la edad que una persona aparenta. "Sentía que los demás pensaban que estaba sucia,? aseguró Rebecca Brown, de 32 años, paciente a quien se le diagnosticó el melasma. Las manchas de la Sra. Brown aparecieron después de unas vacaciones en las playas de Cancún. "Mientras más tiempo permanecieron ?

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? Numerosas mujeres con

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faciales oscuras padecen trastornos emocionales... Los dermatólogos aseguran que hay esperanzas melasma La Crema Tri-Luma ® puede aclarar las manchas oscuras del melasma. PATIENT INFORMATION For External Use Only. Not for Ophthalmic Use. TRI-LUMA ® Cream (fluocinolone acetonide 0.01%, hydroquinone 4%, tretinoin 0.05%) Read this information carefully before you begin treatment. Read the information you get whenever you get more medicine. There may be new information. This information does not take the place of talking with your doctor about your medical condition or your treatment. If you have any questions about TRI-LUMA ® (try-LOOM-ah) Cream, ask your doctor. Only your doctor can determine if TRI-LUMA ® Cream is right for you. What is the most important information I should know about TRI-LUMA ® Cream? Use of TRI-LUMA ® Cream in pregnant women may carry the chance of having birth defects in the baby. Tell your doctor if you are pregnant, may be pregnant, or plan to become pregnant. Your doctor will talk with you about the benefits and risks of using TRI-LUMA ® Cream during pregnancy to help decide if the benefits for you are greater than the risks. You may decide to delay treatment until after your baby is born. If you become pregnant while taking TRI-LUMA ® Cream, tell your doctor right away. You should discuss the chances that your baby may be harmed. Using TRI-LUMA ® Cream early in pregnancy may be more likely to produce birth defects than using it later in pregnancy. What is TRI-LUMA ® Cream? TRI-LUMA ® Cream is a medicine with three active components. You put TRI-LUMA ® Cream on your face to treat a skin condition called melasma. Melasma consists of dark (hyperpigmented) spots on facial skin, especially on the cheeks and forehead. This condition usually happens with hormone changes. TRI-LUMA ® Cream is for short-term and intermittent long-term treatment of moderate to severe melasma of the face, in the presence of measures for sun avoidance, including the use of sunscreens. TRI-LUMA ® Cream showed a significantly favorable safety profile for the long-term treatment of melasma, up to 6 months. Milder forms of melasma may not need treatment with medicine. Melasma can also be managed by staying out of the sun or by stopping the use of birth control methods that involve hormones. In clinical studies, after 8 weeks of treatment with TRI-LUMA ® Cream, most patients had improvements, with 42 (26%) out of 161 patients experiencing complete clearing of their melasma. In most patients treated with TRI-LUMA ® Cream, melasma came back after treatment was stopped. If the underlying causes of melasma, such as the use of certain birth control pills or too much exposure to sunlight, are not removed, melasma will come back when you stop treatment. In the long-term studies, patients were treated with TRI-LUMA ® Cream on and off, whenever their

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viento o el frío extremos. www.triluma.com melasma came back until it cleared. About 300 patients used TRI- LUMA ® Cream intermittently (not continuously) for 180 days, and the majority of the side effects were mild in severity. TRI-LUMA ® Cream may improve your melasma, but it is NOT a cure. Who should not use TRI-LUMA ® Cream?Do not use TRI- LUMA ® Cream if you are allergic to the medicine or any of its ingredients. See the end of this leaflet for a list of ingredients. What should I tell my doctor before using TRI-LUMA ® Cream? If you are pregnant, think you are pregnant, plan to be pregnant or are nursing an infant, tell your doctor. Your doctor will decide with you whether the benefits in using TRI-LUMA ® Cream will be greater than the risks. If possible, delay treatment with TRI-LUMA ® Cream until after the baby is born. Tell your doctor about all the other medicines and skin care products you use, including prescription and non-prescription medicines, cosmetics, and supplements. They may make your skin more sensitive to sunlight. How should I use TRI-LUMA ® Cream?TRI-LUMA ® Cream should be used as instructed by your doctor.To help you use the medicine correctly, follow these steps: ?

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® Cream at night, at least 30 minutes before bedtime. ?

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? affected area. After you have used the medicine for a while, you may find that you need slightly less to do the job. ?

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mouth, eyes and open wounds. Spread it away from those areas when applying it. ? Do not use more TRI-LUMA ® Cream or apply it more often than recommended by your doctor. Too much TRI-LUMA ® Cream

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the treated areas. It requires only a small amount of sunlight to

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? sunburn. Only your doctor knows which other medicines may be helpful

JUEVES 17 DE JULIO, 2008

during treatment, and will tell you about them if needed. Do not use other medicines unless your doctor approves them. If you get sunburned, stop using TRI-LUMA ® Cream until your skin is healed. After stopping TRI-LUMA ® Cream treatment, continue to protect your skin from sunlight. What should I avoid while using TRI-LUMA ® Cream? Sunlight or ultraviolet light. Too much natural sunlight or artificial sunlight from a sunlamp can cause sunburn. Dark skin patches may become darker when the skin is exposed to sunlight. You

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TRI-LUMA ® Cream can make your skin more likely to get sunburn

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from natural sunlight as much as possible to help prevent further darkening of existing dark patches and formation of new ones. Staying out of the sun is especially important for women who take birth control pills or hormone replacement therapy, and for people who have had dark patches in the past. Use an effective sunscreen any time you are outside, even on

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? of 30 or more. Use sunscreen year-round on areas of the skin that are regularly exposed to sunlight, such as your face and hands. If possible, protect the treated area from sunlight exposure. If you spend a lot of time outside, be especially careful of sunlight.

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level of protection. If you will be outside, wear protective clothing, including a hat. Do not use sunlamps while you use TRI-LUMA ® Cream. Heat, wind and cold. Heat and cold tend to dry or irritate normal skin. Skin treated with TRI-LUMA ® Cream may be more likely to react to heat and cold. Your doctor can recommend ways to manage your melasma under these conditions. Other skin care products and medicines. Avoid products that may dry or irritate your skin. These may include soaps and cleansers that are rough or cause drying; certain astringents, such as alcohol-containing products, soaps and toiletries containing alcohol, spices, or lime; or certain medicated soaps, shampoos, and hair permanent products. Do not use any other medicines with TRI-LUMA ® Cream unless you have consulted your doctor. The medicines and products you have used in the past may cause redness or peeling when used with TRI-LUMA ® Cream. What are the possible side effects of TRI-LUMA ® Cream? A very few patients may get severe allergic reactions from TRI-LUMA ® Cream. This includes people allergic to sulfites. They may have trouble breathing or severe asthma attacks, which can be life-threatening. While you use TRI- LUMA ® Cream, your skin may develop mild-to-moderate redness, peeling, burning, dryness, or itching. TRI-LUMA ® Cream contains a corticosteroid medicine as one of its active components. The following side effects have been reported with application of corticosteroid medicines to the skin: itching, irritation, dryness, las manchas, más vergüenza me daban,? añadió la Sra. Brown. "Intenté ocultarlas con maquillaje, y luego probé con algunos de los tratamientos que venden en el supermercado.? Pero ninguno de esos tratamientos le sirvió, por lo que finalmente decidió consultar con su médico. "Los tratamientos con receta funcionan de forma diferente, y con frecuencia resultan mucho más exitosos,? explicó el Dr. Jochen. Al cabo de dos meses de su primera visita al dermatólogo, según la Sra. Brown, su piel estuvo totalmente libre de manchas. "Básicamente había renunciado a toda esperanza,? dijo la paciente. "Y no fue hasta la desaparición total de las manchas que me di cuenta de lo mal que me hacían sentir.? Para obtener más información acerca de este trastorno de la piel, visite el sitio Web www.darkpatches.com, o consulte con su dermatólogo. La Crema Tri-Luma® es el único producto tópico aprobado por la FDA como tratamiento para el melasma moderado a

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? Tri-Luma®. No es de sorprender que sea el producto más recetado para tratar el melasma.2 También puede obtener una lista gratuita de dermatólogos en su área que ofrecen tratamiento para esta condición. Simplemente vaya a www.triluma.com y seleccione el enlace DermFinder® para encontrar el nombre de un dermatólogo que le puede ayudar a iniciar el tratamiento con la Crema Tri-Luma® de inmediato. Mientras más pronto empiece, más pronto podrá controlar su melasma. Pregunte a su dermatólogo de DermFinder ® dsobre la Crema Tri-Luma ®. La más recetada por dermatólogos para el melasma 2 infection of the hair follicles, acne, change in skin color, inflammation around the mouth, allergic skin reaction, skin infection, skin thinning, stretch marks, and sweat problems. Stop using TRI-LUMA ® Cream and contact your doctor if you have ?

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crusting; severe burning or swelling of your skin; irritation of your eyes, nose, and mouth Some patients using TRI-LUMA ® Cream develop dark spots on their skin (hyperpigmentation), tingling, increased skin sensitivity, rash, acne, skin redness caused by a condition called rosacea, skin bumps, blisters, or tiny red lines or blood vessels showing through the skin (telangiectasia). If you are concerned about how your skin is reacting to the medicine, call your doctor. General information about prescription medicines Medicines are sometimes prescribed for conditions that are not mentioned in patient information leaflets. Do not use TRI-LUMA ® Cream for a condition for which it was not prescribed. Do not give TRI-LUMA ® Cream to other people, even if they have the same

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the most important information about TRI-LUMA ® Cream. If you would like more information, talk with your doctor. You can ask your pharmacist or doctor for information about TRI-LUMA ® Cream that is written for health professionals. Ingredients: TRI-LUMA ® Un control del melasma que permanecerá en usted. Cream contains fluocinolone acetonide, hydroquinone, and tretinoin as active ingredients, as well as the following in the cream base: butylated hydroxytoluene, cetyl alcohol, citric acid, glycerin, glyceryl stearate, magnesium aluminum

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