What is Melasma?

Melasma is a skin condition that causes gray-brown patches on the face.  It is a form of pigmentation, sometimes mistaken for a tan and often referred to as ‘pregnancy mask’.  Melasma is most common among women of childbearing age.  Only 10% of men will be afflicted with Melasma.

Melasma is not a harmful skin condition, although it can be difficult to treat.  Most people get Melasma on the cheeks, forehead, chin, bridge of the nose and above the upper lip, although it can appear on other parts of the body such as the arms and neck, although this is quite rare.

Causes of Melasma

The cause of Melasma is not know, although it is believed that an increase in the production of cells that release the pigment called melanin is responsible for the dark patches.  What causes the release of increased melanin is not fully understood, but there are some factors that are considered triggers:

• Pregnant women often present with Melasma (sometimes called ‘pregnancy mask’) due to hormone fluctuation.  The condition usually fades after pregnancy.
• Prolonged exposure to the sun
• Birth control pills
• Heredity factors
• Medications such as tetracycline, anti-malaria drugs and anti-seizure drugs
• Skin inflammation and allergic reactions
• Waxing can trigger Melasma on the upper lip

Preventing Melasma

While there is no known cure for Melasma, there are steps you can take to prevent the onset of the condition and minimize the visual effects.  The best treatment for Melasma is prevention, and the best prevention is to avoid overexposure to the sun – not only the summer sun but winter sun too – most people fail to protect their skin from sun exposure in the winter months.

Use a mineral based sunscreen – one that contains zinc or titanium – and select a sunscreen with SPF 30 or higher. Wearing protective clothing and a hat will help.  Even if Melasma is already present, these precautions should still be taken to prevent Melasma from worsening.

Treating Melasma

Melasma is considered a transient condition (one that can come and go).  For that reason, it can resolve itself (as in the case of pregnant women).    However, since there is no known cure for Melasma, treating the condition with lightening agents or cosmetic procedures offers some degree of resolution.    It is important to understand that even after treatment, discoloration may not completely disappear and NO treatment for Melasma will be successful without the ongoing use of an effective sunscreen.

Cover up with makeup – mineral makeup can help protect the skin and cover the discoloration.  However, mineral makeup is not a substitute for sunscreen.  Most makeups use inorganic pigments and can look flat on the skin.  New formulations, such as those from Colortration, provide lighting technologies add organic pigments, resulting in color properties similar to real skin.

Skin Lightening Creams – Currently the FDA only recognizes hydroquinone as a “bleaching agent”.  Products are available in 2% and 4% strength, however, darker skinned suffers may require 6% or 10% concentrations of hyrdoquinone.    Other effective key ingredients include tretinoin, azelaic acid, and kojic acid. Skin lightening agents should only be applied to pigmented skin, avoiding the surrounding, unaffected skin.  These treatments can be harsh and irritating to the skin.   They should be continually applied to maintain results and must be combined with an effective sunscreen.

There are a number of natural skin lightening products available at herbal stores that, when applied daily, can be as effective without being so irritating to the skin.  Examples include Mitracarpus Scaber Extract and Arctostaphylos Uva Ursi Leaf Extract, more commonly referred to as Bearberry Extract.

Microdermabrasion - is a method by which very fine crystals are used to abrade the skin – the crystals and damaged skin cells are vacuumed away with a tiny vacuum-cleaner-like tip. The newer systems use tiny diamond chips embedded in the tip to provide the abrasion.   Other new procedures offer the ability to infuse therapeutic agents such as a solution of salicylic acid to help clean the pores at the same.  Depending on how much pigment you have and how sensitive your skin is, approximately five microdermabrasions are done two to four weeks apart, followed by a maintenance treatment about every four to eight weeks.  Optimally, a combination of treatments including glycolic acid peels, fading creams like hydroquinone 4%, and daily zinc-based sunscreens will help yield the best results.

Chemical Peels – Light peels, such as Glycolic Acid peels, are applied in different strengths (depending on skin type and condition), and must be done by a licensed skincare professional or in a doctor’s office.   There are also light peels that contain a beta-hydroxy acid like salicylic acid. These peels take off a few layers of dead skin, and also help to clean out pores.  A series of light peels may be required to achieve optimum results.

Trichloroacetic acid (TCA) peels – Used by skincare professionals for more than 20 years, some dermatologists prefer TCA peels to any other method for treating Melasma, particularly severe Melasma. The treatment is more effective when used combination with prescription creams.  Stronger peeling agents like TCA have a higher effectiveness than light peels, but they carry a higher risk of side effects such as burning, scarring, or discoloration.

Laser Skin Resurfacing – Before considering laser treatment for Melasma, you should know that some laser therapies may actually make the condition worse.   One laser system that is effective in treating a wide range of skin types with Melasma is the fractional laser.  One of the first brands approved by the FDA for treatment of Melasma, is the Fraxel system.  The fractional lasers deliver smaller pixels that can provide a deeper and more effective treatment without the burning.  Fractional lasers treatments are expensive and you will probably need 3-4 treatments over 3-6 months.

DID YOU KNOW….

There is exciting news from the medical community for Melasma suffers – a new peptide treatment that provides excellent results.

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• Intense Pulsed Light Therapy(healthyskinsolutions.com)
• Skin Lightening (healthyskinsolutions.com)
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 Resources: 

American Academy of Dermatology; Dermatology A-Z, Melasma.

National Center for Biotechnology Information, U.S. National Library of Medicine; Melasma; Chloasma; Mask of pregnancy; Pregnancy Mask.

Sood A, Tomecki KJ. Pigmentary Disorders. In: Carey WD, ed. Cleveland Clinic: Current Clinical Medicine 2010. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2010.