What is Melasma and How is it Treated?

Do you have dark patches on your cheeks, forehead or upper lip?

Have you recently experienced a hormonal shift, such as pregnancy or starting birth control pills?

Have you been out in the sun?

It could be melasma.

Melasma is a common skin condition where an excess of melanocytes (the cells that give skin pigment) create dark patches on the skin. These areas are usually brown or grayish and typically occur on the face. Melasma is overwhelmingly more common in women than men, and although it does not cause any discomfort or damage, many people find it distressing and look for ways to minimize its appearance.

What Causes Melasma?

Doctors aren’t sure why some people develop melasma. It is associated with hormones, often appearing during pregnancy (in fact, it is often referred to as “the mask of pregnancy”) or while taking birth control pills. Melasma tends to run in families and occurs more often in people with darker skin. Sun exposure is a major cause of the skin changes associated with melasma. Certain cosmetics can also trigger it. Less commonly, melasma can be due to stress or thyroid disease.

What to do about it?

If you are prone to melasma, there are things you can do to minimize it. If the melasma is associated with pregnancy, it should go away on its own after the baby is born. If it is due to birth control pills, your doctor may be able to change your prescription to one that doesn’t have the same effect.

If your melasma is chronic, your best defense is to avoid its triggers. That means staying out of the sun and using appropriate sun protection and gentle skin care products.

  • Use a sunscreen with an SPF of 30 or more every day, preferably a mineral-based sunscreen (zinc oxide or titanium dioxide) that provides a physical barrier between your skin and sunlight. Apply it 15 minutes before going outside and reapply every two hours or more if you are sweating or going in the water.
  • Seek shade when outdoors and wear a wide-brimmed hat to keep sun off your face.
  • Stay away from harsh skin care products that sting or burn. Products that irritate the skin can trigger melasma.
  • Avoid waxing the areas of your skin that are melasma-prone (for example the upper lip). A dermatologist can discuss other options for hair removal that won’t trigger your condition.

Should I see a dermatologist about my Melasma?

Melasma can be persistent and distressing. If your melasma is bothering you, there are things we can do to treat it. Before we make recommendations, however, we will want to make sure that your skin changes are due to melasma and not something else. This may involve a Wood Lamp examination, a painless diagnostic procedure that uses black light to illuminate skin irregularities. It is important that you not use any skin products (i.e. moisturizer, cosmetics, perfumes) on the affected areas prior to coming to your appointment or the results may not be accurate. In rare cases, the doctor may need to take a biopsy to confirm the diagnosis.

Treatments for Melasma

Once a diagnosis of melasma is confirmed, we can offer appropriate measures to help minimize it. In addition to addressing triggers, which is the most important factor in controlling melasma, treatment may include medications and/or skin procedures such as chemical peels or microdermabrasion. In many cases, a combination of therapies are necessary to get this persistent condition under control.

A dermatologist is your best bet for reducing the look of melasma since the wrong type of treatment for your skin type can make melasma worse.

Medications for Melasma

Hydroquinone. Hydroquinone is a common skin-lightening medication that can be used to reduce the look of melasma. While products containing hydroquinone are available over-the-counter, the concentration of active ingredient is far lower than in the hydroquinone your dermatologist can prescribe.

Tretinoin and corticosteroids. These medications are often prescribed in addition to hydroquinone to further lighten dark patches of skin caused by melasma. All three medications together are available in a product commonly referred to as “triple cream.”

Azelaic acid. This medication targets hyperactive melanocytes without affecting normal cells and is safe to use during pregnancy.

Kojic acid. This ancient antioxidant is a by-product of the rice fermentation process used to make sake. It is increasing in popularity with dermatologists as a treatment for melasma as it interrupts the cellular process of producing melanin.

Skin Procedures to Treat Melasma

Several in-office dermatological procedures have been proven effective in the treatment of melasma.

Chemical peels. Chemical peels can be an effective treatment for melasma, however, the type of chemical, concentration, and duration of the peel are all factors that play into how well a peel will work against melasma. For this reason, it is important to avoid at-home or spa peels and get your chemical peel done under a dermatologist’s supervision. Peels done improperly can cause iflammation or hyperpigmentation and make melasma worse.

Microdermabrasion. This procedure uses abrasive tools to exfoliate the skin, effectively removing the epidermal layer where melasma is present. Patients are typically very pleased with the results of microdermabrasion, especially since the procedure causes very little discomfort and downtime.

Laser and light treatments. While laser and light treatments are not the first line of attack against melasma, in resistant cases they may be appropriate. Your dermatologist will talk to you in depth about whether laser or light treatments could help your melasma.

You don’t have to “just live” with melasma. If skin discoloration is bothering you, give Arizona Dermatology a call today.