Melasma is a skin condition that mostly causes brown patches on the face. The parts of the face usually affected are the cheeks, upper lip, and central forehead. Women with darker skin tones are most commonly affected.
It is a combination of sun and genetic predisposition that causes melasma; although, the exact reason some people get it and others don’t, is not fully understood.
Treatment of melasma consists of two steps – 1) preventing darkening via sun protection, and 2) removing existing pigmentation. Melasma is often a chronic condition, so treatment usually consists of two stages: clearance and maintenance.
To clear melasma, there are a variety of options available including bleaching creams, chemical peels, and lasers. The most important step in treating melasma, though, is sun protection. No matter what treatment is used, very strict sun protection using a high quality sunscreen, sun avoidance, and sun protective clothing is critical.
The Best Sunscreen for Melasma
UV exposure plays a key role in the development of melasma, so wearing the right sunscreen is vital. The sunscreen you choose should block all rays of the sun. Zinc oxide based sunscreens of SPF 30+ can provide such protection. Applying enough sunscreen to thoroughly protect the area and re-applying every 2 hours, or more frequently if active, is also just as important as selecting the right product.
Bleaching creams are often the first line of treatment after sun protection. The primary ingredient used in most is hydroquinone. Over-the-counter creams can legally only contain up to 2% of hydroquinone which is not often strong enough. Concentrations of 4-6% mixed with other active ingredients are often needed.
A prescription “triple bleach” containing hydroquinone, tretinoin, and a steroid is often an effective cream.
Chemical peels can be an excellent adjunct to bleaching creams and can get resutls all by themselves. There are many types of peels including glycolic acid, salicylic acid, Jessner’s solution, TCA, and various proprietary blends including the ViPeel and Perfect Peel.
There is no best peel. Choosing the right peel often comes down to selecting the one best suited for the skin type and the degree of recovery one is willing to accept. Most peels other than trichloracetic acid (TCA) have 2-3 days of downtime.
Similar to chemical peels, microdermabrasion works by lifting off the outer layers of skin. While chemical peels chemically exfoliate the skin, microdermabrasion uses mechanical action to lift off the outer layers. A series of treatments is needed.
IPL and Laser
One of the most effective type of lasers for removing melasma are fractional resurfacing lasers. These include brands such as Fraxel, Clear + Brilliant, and ProFractional. Many other types of laser and IPL devices can also be effective at removing the pigment of melasma, but they have all been reported to occasionally cause darkening of the pigment. For this reason, they are often reserved as treatments of last resort.
Mask of Pregnancy
The “mask of pregnancy” refers to melasma that develops during pregnancy. Some cases of melasma appear in association with a change in hormone status such as during pregnancy or while taking birth control pills. For some of these pateints, their melasma resolves when the underlying change in hormones goes away.
Untortunately for most people suffering with melasma, it is a chronic condition requiring treatments to clear it followed by ongoin efforts to maintain it.