One of the most frustrating skin conditions that I have helped my clients treat is melasma. This is because it is so incredibly stubborn and takes a very consistent treatment plan to be reduced, and hopefully completely eliminated. However, there are things that you can do, and if you are anything like my clients you are frustrated and desperate to do whatever it takes in order to get rid of your melasma. Here is what you should know about melasma and my top recommendations for treating it.

What is Melasma?

Melasma is a hypermelanotic skin disorder that occurs mainly in women and mainly on the face. Melasma is identified by dark hyper-pigmented spots or blotches on the skin. The pigmentation is often symmetrical or patterned and usually occurs on the cheeks, upper lip, nose, forehead, and/or around the eyes. Although melasma can be troubling for many on a psychological or emotional level, it is just hyperpigmentation and is harmless.

Another name for melasma is pregnancy mask, as 70% of pregnant women experience melasma due to the hormonal changes of pregnancy.  It is thought that melasma is triggered by the estrogen receptors on melanocytes (the cells in charge of producing melanin or pigment). These melanocytes are triggered to produce excess pigment in certain areas of the skin due to hormonal shifts, especially increased estrogen.  

Melasma Triggers

It is common for women on birth control to experience melasma. A necessary component of treatment may be discontinuing or changing birth control. Other medications have been linked to melasma as well. Pregnancy is the most common trigger for melasma, but pregnant women should wait until after pregnancy to treat their melasma. Melasma may go away on its own after delivery and many treatments for melasma are unsafe for pregnancy. It is also thought that it is best to stay away from irritating ingredients such as fragrance if you have melasma. The trigger you want to be most aware of is UV radiation. Sun exposure exacerbates melasma making it more visible. It is also said that heat can worsen melasma; this means it is normally more visible in the sunnier and warmer months like summer. 

Sun Protection

Since sun exposure worsens melasma, it is extremely crucial to wear a broad-spectrum SPF 30 on a daily basis, even if you are not spending time outdoors. This is always my recommendation but especially if you are trying to treat melasma. There is no way to cure melasma entirely, and in order to treat or reduce it, you must be diligent in protecting your skin from the sun. Your best bet is to stay out of the sun as much as possible, carrying hats and umbrellas with you when outdoors is another great way to protect your skin. Not to mention, although melasma is harmless, skin cancer is not and sun protection is a necessity in preventing both.

Skincare for Treating Melasma

It is important to remember that melasma is very stubborn and whatever treatment or products you use you must be patient and consistent in using them. It is also a good idea to save the more active products for fall and winter months when you are staying out of the sun. Active ingredients make your skin more susceptible to darkening hyperpigmentation and of course sun damage when exposed to the sun.

Some at-home skincare ingredients that have been found to help reduce the appearance of melasma include…

• Vitamin C (l-ascorbic acid or MAP)

• Licorice root

• Azelaic acid

• Glycolic acid

• Kojic acid

• Retinoid

• Niacinamide

• Arbutin

Professional Treatment

The other alternative you have is to consult with a Dermatologist. The most common and effective treatment used for melasma in dermatology is known as the triple combination, which includes Hydroquinone (HQ), retinoic acid, and corticosteroids. Although effective, HQ is not best for long term treatments as it eventually damages the skin’s melanocytes. Other potential ingredients for treating melasma long-term are under study and will hopefully be available in time. 

Professional treatments performed by either a medical esthetician or dermatologist, have been effective in combination with topical treatment. Procedures such as regular chemical peels, regular micro-needling sessions, and certain lasers can help in reducing the appearance of melasma. There are also some treatments that can make melasma worse, such as Intense Pulse Light (IPL) because both heat and light darken melasma. It is important to consult with a board-certified esthetician or dermatologist regarding your melasma to understand the most effective and safest treatment for you.