Hormonal Pigmentation /Melasma

Frequently Asked Questions

• 1

  What is the cause of increased pigmentation and darkening of the skin?

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  There are many possible causes of pigmentation disorders, which are marked by changes in melanin, the pigment in skin.These may include progesterone (the Mirena), photosensitizing medications, thyroid dysfunction, stress and dysbiosis.

  There's overwhelming evidence that certain medical conditions are key players in your overall health and are the root cause of your pigmentation problems. Failure to address these conditions will lead to failure of your Hormonal Pigment treatment plan and ALSO lead to chronic disease.

  Melasma is more prevalent in darker-complexioned individuals though persons of any race can be affected due to the intense sun exposure in South Africa. This condition is seen most frequently in young women from the age of 28 years but can also be seen in men.

  At Skin, Body, Health Renewal, we treat all our patients holistically by dealing with all the issues that may be responsible for their initial presentation of hormonal pigmentation/ melasma at Skin Renewal. After obtaining a thorough history from our patients to exclude medical conditions that could be aggravating the hormonal pigmentation, we include ESSENTIAL supplements into our Hormonal Pigmentation treatment packages for optimal pigmentation treatments and health.

• 2

  How is skin colour produced?

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  The short answer is that melanin-its amount, quality, and distribution- creates human skin colour. The slightly longer answer is that melanin is produced within melanosomes, organelles located in the cytoplasm of melanocytes (skin cells in the basal layer of your epidermis). The number of melanocytes in human skin is the same in people of all races; in darker-skinned individuals, though, the melanosomes are larger and contain more melanin. Once melanin is produced, melanosomes migrate to the melanocytes' dendrite tips, where they come into contact with keratinocytes, skin cells closer to the surface of the epidermis. The final stage of the pigmentation process, however, wherein melanin is transferred from the melanocytes to keratinocytes, is still poorly understood.

• 3

  What is hormonal pigmentation, also known as melasma?

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  Melasma, also known as hormonal pigmentation, is a considerable problem for South African women. It is a chronic skin condition that occurs on the face in the form of brown patches and is a dynamic (active) condition that needs lifelong management. Its incidence is much higher in Asian and darker-skinned individuals than in fair-skinned people.

• 4

  What is the cause of Hormonal pigmentation/Melasma?

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  • In many cases, a direct relationship with female hormonal activity appears to be present because it occurs with pregnancy and with the use of oral contraceptive pills and HRT/ hormone replacement therapy. However, unopposed oestrogen may also be an underlying factor and thus it is essential that the cause of this unopposed oestrogen is identified. If these underlying conditions are not addressed, any pigmentation treatments are doomed for failure and the pigmentation will return. At Skin Renewal, all consultations are holistic and get to the root cause of the problem be it acne, Rosacea or hormonal pigmentation. Even our anti aging consultations are treated holistically.
  • The pathophysiology of melasma is uncertain. In many cases, a direct relationship with female hormonal activity appears to be present because it occurs with pregnancy and with the use of oral contraceptive pills and HRT/ hormone replacement therapy.
  • After pregnancy Melasma (chloasma) or pigmentation usually clears within a few months of delivery but may persist indefinitely.
  • Any change in hormonal status with higher levels of estrogen is thought to trigger and aggravate the condition (i.e. birth control pills and pregnancy).Discontinuing the use of contraceptives rarely clears the pigmentation and it may last for many years after discontinuation.
  • However many women without these risk factors also develop.
  • Other factors that may be implicated are progesterone (the Mirena),
  • photosensitizing medications such as tetracyclines or anti psychotic medication or medical conditions such as mild ovarian or thyroid dysfunction and dysbiosis, thus it is important to consult with a Skin Renewal doctor to diagnose the cause of Hormonal pigmentation/ Melasma.
  • Other possible causes could probably include genetic predisposition and exposure to ultraviolet light. visible light which emits infra red A ( sunlight , TVs, computer screens, fluorescent lights, hair dryers, clay ovens) and excessive heat which causes inflammation ( such as saunas and steam baths).
  • Stress may also produce certain hormones that worsen melasma.
  • UVA rays are a stimulant for melanin (brown pigmentation) to develop on the skin, and unfortunately can even penetrate through car window glass.
  • Any activities that cause intense heat to the face ( from steam showers, hot closed environments, sitting on the beach even under cover and with full sun protection, etc) causes inflammation which is a powerful stimulator of melanin.
  • Melasma is more prevalent in darker-complexioned individuals though persons of any race can be affected due to the intense sun exposure in South Africa.
• 5

  What appearance does Hormonal pigmentation/Melasma have?

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  Pigmentation disorders such as melasma or chloasma (during pregnancy) arise from increased melanin in the lower layers of the skin and increased free melanin in the skin. Hormonal pigmentation is usually brown with a non-distinct border, and is usually found symmetrically on the face or jawline . Melasma can appear on the central facial areas such as the cheeks, moustache, and forehead areas. Melasma affects both men and women, though it is more frequent in women (up to 30% may be affected) and usually starts to appear from the age of 28 years onwards.

• 6

  Where does Melasma appear on the face?

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  • Centro Facial (forehead),
  • Malar (cheekbones) and
  • Mandibular (jawline).
• 7

  ​What are the different types of Melasma? (This describes how deep the pigment is in the skin and how to treat it)

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  • Epidermal melasma is the most common form and is easily treated with a combination of superficial chemical peels, Limelight or Photo Genesis procedures.
  • Dermal melasma: If the melanin has leached into the dermis, this is known as dermal melasma. The deeper the pigment is and the more difficult it is to treat. Dermal melasmas not treated with superficial peels and is best treated with mid dermal peels such as a Skin Renewal's 3 D peel, Cosmelan, Dermamelan or injected mesotherapy with Tranexamic acid to penetrate into the dermis to reach the pigment.
  • Mixed Epidermal-Dermal melasma is a combination of the above and is treated the same way as dermal melasma.
• 8

  ​How do I get started?

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  Make an appointment to consult with your Skin Renewal Doctor and he/ she will assist you in determining your risk factors for pigmentation and how best to prevent any problems or conditions that you may be susceptible to.

• 9

  Why should one consult with a Skin Renewal doctor to assess your pigmentation?

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  At Skin, Body, Health Renewal, we treat all our patients holistically by dealing with all the issues that may be responsible for their initial presentation. One should consult with Skin Renewal doctor to rule out the possibility of an underlying systemic health disorder that requires medical treatment. There's overwhelming evidence that certain medical conditions are key players in your overall health and are the root cause of your pigmentation problems. Failure to address these conditions may lead to failure of your Hormonal Pigment treatment plan and ALSO lead to chronic disease.

  Your Skin Renewal doctor will conduct a physical examination, examining the location, distribution, color, and appearance of the areas of increased pigmentation. Ask your Skin Renewal doctor to look at your skin with a Wood's light- a type of black light -which is available at all Skin Renewal clinics - or the Visia Complexion analyser

  Your Skin Renewal doctor will also evaluate whether external factors, such as hormones, medications, chemical exposure, or other environmental influences could have contributed to the increased deposition of pigment in the skin. Furthermore, the practitioner will make note of any prior history of pigmentation disorder and its treatment.

  We also include ESSENTIAL supplements into our Hormonal Pigmentation treatment packages for optimal pigmentation treatments and health. Schedule an appointment with one of our experienced Skin Renewal doctors to find out what underlying medical condition/ s could be aggravating your melasma/ hormonal pigmentation

• 10

  What can you expect during your consultation for pigmentation at Skin Renewal?

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  The initial medical consultation at Skin Renewal will be approximately 30 minutes. A thorough evaluation will be done by your Skin Renewal doctor, who will identify underlying conditions and lifestyle habits that may be aggravating your condition.

  If you think you are not affected by pigmentation, ask your Skin Renewal doctor to look at your skin with a Wood's light - a type of black light -which is available at all Skin Renewal clinics - or the Visia Complexion analyser. Our patients are always shocked by the as-yet-invisible dark spots that these lamps reveal. The Skin Renewal doctor will decide on a treatment plan or depending on:

  • how long you have had hormonal pigmentation?
  • If the Hormonal pigmentation/ melasma has been present or more than 2 years it may be more difficult to improve
  • what medications you are taking
  • previous treatment failures or successes
  • whether dermal pigment is present.
  • After the Woods lamp analysis, deeper dermal pigment can be identified and an appropriate treatment schedule can be prescribed
  • your Skin type. Deeper/more aggressive skin peels and IPL/Lime Light procedures cannot be done on darker skin types 5 and 6
  • your expectations and budget restraints
  • your occupation/sporting/recreational activities
• 11

  How is hormonal pigmentation/melasma managed at Skin Renewal?

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  • A thorough evaluation will be done by your Skin Renewal doctor, who will identify conditions and lifestyle habits that may be aggravating your condition.
  • Hormonal pigmentation/ Melasma is a dynamic, chronic condition which has to have ongoing management by applying a pigment inhibitor daily. We have numerous Prescription and non prescription topical Brightening / pigmentation products at Skin Renewal.
  • Without the strict avoidance of sunlight and the continued use of home topicals mentioned above to downregulate the enzymes responsible for making pigment , potentially successful treatments for melasma and pigmentation are doomed to fail.
  • To prevent increased Hormonal Pigmentation and PIH (Post inflammatory Hyperpigmentation) before and after any peel or IPL procedure, pretreatment for a period of 2 to 4 weeks is recommended to downregulate the enzymes responsible for making pigment
  • Our superficial peeling treatment of choice at Skin Renewal is the Beta Melanostop peel which is a 4 peeling combination of salicylic acid, rescorcinol, phytic and azelaic acid combined with a transdermal brightening mesotherapy
  • Prescription skin-bleaching agents are extremely helpful in brightening melasma and maintaining skin-brightening improvements and may be prescribed by our Skin Renewal doctors
  • In addition, THE CONTINUED USE OF RECOMMENDED PIGMENTATION PRODUCTS IS MANDATORY AFTER ANY PEEL / IPL procedure .
  • SPF of 50 MUST be applied twice daily
  • Any laser procedure such as fractional laser that causes excessive redness and inflammation should be avoided as there may be aggressive rebound hormonal pigmentation a few weeks/ months later especially if NO post treatment depigmentation products are prescribed
  • At Skin Renewal we recommend that you avoid hot baths, Bikram Yoga, steam saunas, tanning beds and dry saunas as they can cause excessive inflammation and may aggravate hormonal pigmentation
  • At Skin Renewal we are pleased to introduce Skin Brightening IV infusions for pigmentation. See below
• 12

  What other Skin Renewal Brightening agents may be prescribed for you by the Skin Renewal doctors?

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  Many all-natural, topical skin-brightening agents have been found to be quite beneficial in brightening hyperpigmented areas of the skin. These include alpha arbutin, as well as kojic acid, azelaic acid nicotinamide and Liquorice root (Glycyrrhiza glabra).

  Topical applications of natural, fruit-derived alpha-hydroxy acids, including glycolic acid, have been extremely beneficial in combination with the aforementioned bleaching agents. For enhanced results, these products should be used in conjunction with exfoliation treatments such as peels and transdermal pigment brightening Mesotherapy.

  The following is a list of skin care ingredients to AVOID due to worsening melasma pigmentation and dark spots.

  oestradiol, oestrogen, genistein ,black cohosh, chasteberry, hops, red clever, soy, wild yams.

• 13

  ​Why are certain hormonal pigmentation conditions so difficult to resolve?

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  • If the underlying condition is not identified and managed, then the pigmentation will return and suboptimal treatment can be expected. That is why it is important to,attend a skin clinic that treats you holistically.
  • Pigmentation present for more than 2 years may be more resistant to treatment as dermal pigment may be present and this may need transdermal therapy with TA (Tranexamic acid) or deeper peels Cosmelan or Dermamelan depigmentation treatments which are suitable on all Skin Renewal types.
  • Dermal pigment is caused by the melanocyte distributing pigment/ melanin into the dermis instead of the epidermis.
  • This dermal pigment may take longer to resolve than epidermal pigment . The source of the dermal pigment is the epidermis so if the epidermis can be prevented from making melanin for long periods with home topicals and peel/ depigmentation treatments such as a series of superficial peels, Cosmelan and Dermamelan, the dermal pigment will not replenish and will slowly resolve..but this may take months.
  • Normal SPF sunblock protect against UVA and UVB but NOT AGAINST infra red A.
  • Without the strict avoidance of sunlight and the continued use of home topicals mentioned above to downregulate the enzymes responsible for making pigment , potentially successful treatments for melasma and pigmentation are doomed to fail.
• 14

  What is infra red A ?

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  • infra red A , a relatively new discovery, is a deep dermal ray which causes accelerated ageing
  • Infra red A is found in ANY visible light that emits heat such as sunlight, computer screens, fluorescent lights, heaters and even hair dryers
  • Normal SPF 50 sunblock protects against UVA and UVB but does NOT protect AGAINST infra red A.
  • One is only 56 % protected with a good SPF 50 sunblock
  • If one applies a topical anti oxidant such a Vit C, Vit E , Ferulic and Phloretin, 96 % sun protection can be achieved
  • Only topical antioxidants such as Vit C, Vit E , Ferulic and Phloretin can protect against infra red A
• 15

  ​How do the oral anti oxidants such as Ovelle and Heliocare protect one's Skin internally?

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  • For continued sun protection and to maintain results, oral supplements such as Ovelle( Pycnogenol®) or Heliocare( Polypodium Leucotomas ) together with MSM with Vit C can be taken orally to increase ones resistance to the sun
  • In addition Pycnogenol and Polypodium Leucotomas are powerful anti oxidants that stop the enzyme that breaks down collagen( MMP) and protect against infra red A, which is present in the light from sun exposure, computer screens, fluorescent lights etc
• 16

  How do we manage resistant Hormonal pigmentation/ Melasma at Skin Renewal?

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  • A thorough evaluation / medical history will be taken at the initial consultation to ensure that all causes of Melasma are addressed.
  • After a series of 4 to 6 in office medical peel treatments combined with home topicals, the topical products need to be applied indefinitely and one of the above mentioned topicals is recommended. These can be alternated over time.
  • If there no improvement after the 6th treatment then we usually recommend that a Health Renewal consult with one of our integrative doctors to exclude medical causes of pigmentation. This may also include a course of Skin Renewal brightening intra venous infusions with Glutathione .. See below
  • In addition, if there no improvement after the 6th treatment of superficial peels and topical products, Cosmelan or Dermamelan or Injected Tranexamic acid mesotherapy treatments are recommended to treat dermal melasma and PIH which has been present for more than 2 yrs
  • If the melanin has leached into the dermis, this is known as dermal melasma
  • The Laser Genesis procedure can be done in all skin types as it targets dermal pigment by heating up the melanophage ( which contains the melanin) trapped in the and aids the "release" of the trapped dermal pigment so it can move up to the epidermis where it can be exfoliated with normal epidermal renewal. Laser genesis also "polishes" the skin and improves fine lines, wrinkles , pores and texture.
  • For all peels prescription creams such as Retin A or retinols must be stopped stop 3 days before each treatment and restarted 3 days after the peeling process.
• 17

  ​What new innovative skin brightening INFUSIONS are available at Skin Renewal Renewal?

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  At Skin Renewal we are pleased to announce our new breakthrough in skin brightening and Cellular Defense: An intra venous infusion of a combination of powerful anti-oxidants such as glutathione delivered with vitamins and fluids to hydrate the skin and reduce melanin production in all our pigmentation afflicted patients. After a series of treatments a lighter fairer skin tone may result. Glutathione is an extremely effective antioxidant comprised of three essential amino acids. It plays a major role in helping your liver detoxify harmful chemicals by binding to the toxins, facilitating their easy elimination. The body produces glutathione naturally, and research has shown healthy intake of Vitamin C boosts its production. If glutathione levels are normal, the body’s ability to fight neurological disorders like Parkinson’s disease is strong. If they are low, you are susceptible to a revolving door of conditions.

• 18

  Why is Glutathione called the "master anti oxidant" as every system in the body is affected by the Glutathione system, including

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  • the immune system,
  • the gastrointestinal system
  • the nervous system

  Glutathione is a tripeptide (made of 3 amino acids) that is produced in the body in small amounts. Glutathione is an extremely effective antioxidant, which as we know means that it reduces free radicals in the body reactive oxygen compounds. It has also been shown to bind to toxic substances in the body and assist in flushing them out of the system. Glutathione is also an important player in the synthesis and repair of DNA, protein synthesis, and enzyme activation.

  As you can see, glutathione should be an important part of any supplementation regimen. These benefits can be received through fairly reasonable dosages of Glutathione, making it an excellent addition to any supplementation regimen. At higher dosages, glutathione may also be effective at brightening skin.

  There are few other factors which are predictive of our life expectancy as is our level of cellular glutathione. Glutathione levels in our cells are predictive of how long we will live. Glutathione is called the “Master Antioxidant” without it other important anti-oxidants such as Vitamin C and E cannot do their job adequately to protect your body against disease. No other anti-oxidant is as important to overall health as glutathione. It is the regulator and regenerator of immune cells and the most valuable detoxifying agent in the human body. Low levels are associated with hepatic dysfunction, immune dysfunction, cardiac disease, premature aging, and death. Glutathione is water soluble, and easily destroyed by the body systems.

• 19

  Why are intra venous infusions Glutathione better than oral supplementation for Skin Brightening?

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  The only downside to glutathione supplementation is that when taken orally, the gastrointestinal system breaks much of the glutathione down into its 3 component amino acids before it can be absorbed into the system. This means that you must take much more glutathione than the effective dose to make sure that you are getting a sufficient amount into the system. This is where IV Glutathione supplementation comes into play. By taking glutathione intravenously it is possible to get the supplement directly into the body in its original form, bypassing any of the degrading processes associated with oral supplementation.

  For skin Brightening, this would seem to be the only reasonable method. Attempting to take a sufficient amount of glutathione for skin whitening through oral supplementation is wasteful and may be ineffective due to the breakdown of the digestive system. IV Glutathione for skin whitening has been used in China and Japan for many years to assist women with brightening their skin.

• 20

  ​How often should one have an IV glutathione Multivitamin Therapy?

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  For skin Brightening, it is recommended to have IV infusions twice a week in the first month in order to get the full benefit. After this period, infusions can be done weekly until your desired skin tone and results are achieved. Thereafter a session every month to maintain results

• 21

  ​How does MSM benefit Melasma, Skin, Nails, Hair and Connective issue?

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  MSM is a powerful activator of the powerful anti oxidant Glutathione . MSM may facilitate the break up of pigmentation in the skin/ dermis as it a natural detoxifier of the lipofuscin / lipopolysaccharides/ brown pigment in the skin .

  MSM contains sulphur which is necessary for the production of new cells and plays an essential part in the synthesis of collagen and keratin, vital protein substances that are needed to make and maintain hair, nails and skin. Hair and nails grow faster and stronger with good levels of sulphur. This compound is also responsible for the flexible bonds between cells and helps to block the cross-linking of collagen, an effect responsible for the appearance of wrinkles and aging skin.

  Sulfur helps the body to form keratin, the protein that makes up the main part of the outermost layers of your hair and nails. It is a tough, fibrous protein that is very resilient to the effects of damaging chemicals and other harmful agents. Each strand of hair has its own keratin supply, which is stored in the root. Sulfur is also contained in biotin, a B vitamin that is essential for shiny hair and strong nails. You may be interested to know that the natural inclination of hair to be straight or curly is maintained in part by the sulfur amino acids. MSM benefits dry scalp and hair and improves nail growth and benefits your cuticles and nails.

  Acne, including rosacea has been shown to respond favourably to MSM in studies, sulphur has also been found to enhance wound repair. MSM acts to keep the skin's cells and the tissue soft. Keeping the skin soft ensures that it remains elastic enough to allow stretching and movement without damage. Smooth, flexible skin is less prone to wrinkles and dry flakiness. It even helps stretch marks. MSM benefits the skin and internal organs.

• 22

  ​What are new pigmentation peptides developments in the treatment of Melasma/ Hormonal pigmentation?

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  1. Lamelle's Luminesce, an advanced pigmentation program which addresses hyper-pigmentation by reducing melanin at several points in its production, as opposed to just one point as with other treatments. Luminesce uses groundbreaking peptide technology (Oligopeptide 34) for treating pigmentation .

  2. Brighter Concentrate by Lamelle has Oligopeptide 34 plus 3 new novel pigmentation peptides added to the formula which offers excellent results in combating epidermal and post inflammatory hyper- pigmentation ( PIH).

  An added benefit is that the combination of peptides used in the range offers anti-ageing benefits to the skin as they stimulate collagen producing cells. By adding the supplement Ovelle or Heliocare, the melasma will be reduced further by 37% within 4 to 6 weeks of use.

  3. Lumixyl Brightening System is a revolutionary multi-faceted system that dramatically improves the appearance of hyperpigmentation tolerably and without the side effects associated with prescription Hydroquinone or retinoids. An innovation in skin brightening technology, Lumixyl Brightening System uses a decapeptide to target existing hyperpigmentation and to prevent its recurrence. Lumixyl products are proven to be powerful but gentle on skin. Lumixyl is ideal for all skin types.

  The following is a list of skin care ingredients to USE if you have Melasma;

  arbutin, bearberry, cucumber extract, hydroquinone, kojic acid, licorice extract, magnesium ascorbyl phosphate, mulberry extract, niacinamide, retinol, resorcinol, beta hydroxyl acid, vitamin c, oligopeptide 34,

• 23

  What other forms of pigmentation conditions are there ?

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  • The most common localized pigmentation disorder affecting the skin are ephelides, more commonly known as freckles. Freckles appear as flat brown pigmentation in sun-exposed areas, usually on the face. They are much more common in fair-skinned individuals, and a propensity to have freckles is an inheritable condition. The degree of pigmentation in the skin changes according to the amount of ultraviolet light exposure, so that freckles usually darken in the summer and lighten in the winter.
  • Another very common skin disorder is known Post Inflammatory Hyperpigmentation PIH . The underlying mechanism is unclear, but may involve inflammatory mediators such as prostaglandins and leukotrienes. While the causes and clinical presentation of post-inflammatory hyperpigmentation can vary, they are usually secondary to a traumatic incident to the affected area of the skin such as acne, dermatitis, eczema or any form of inflammation of the skin. Sun exposure can worsen this condition. Topical therapies and treatments as mentioned above in combination with sunblock may help this condition
  • Solar lentigos/sun spots appear as brown lesions (about 1 centimeter in diameter), typically on the face and hands. Both acute and chronic UV exposure can cause lentigos. While they rarely appear on patients under fifty, they are not caused by age -- sun-protected skin is not affected, even in elderly patients. Solar lentigos are completely preventable with sun avoidance and daily sunscreen use. Finally, whether solar lentigos are treated or untreated, patients should undergo routine skin exams, as they may be at greater risk for skin cancer.