Melasma

Melasma is a common, yet very challenging pigmentary disorder seen most commonly on the face, although it can rarely involve the forearms and neck. It is seen more frequently in women and in people with darker skin types. It is thought to be associated with excess light exposure, a hormonal imbalance, and a family history. 

Melasma is characterized by increased pigmentation, especially in the deeper layers of the skin, in addition to an increased number of small blood vessels and inflammation. This is helpful to understand how we treat the condition. The longer melasma has been present, the more difficult it can be to treat, so early intervention is important. 

There are various topical, oral and procedural therapies which can be used to treat melasma, and combining therapies often leads to better results. It is very important to understand that melasma is not a one-time issue that will go away overnight. This is a chronic condition that can take months to respond to therapy and requires a strict life-long regimen. 

We know that both UV, visible and infrared light can aggravate melasma, therefore protection from all these forms of light are an essential part of the treatment of melasma. If you are not actively protecting, then you will not see good results from the other recommended therapies. 

Sun protection recommendations:

  • Sunscreen with SPF 30 or above must be applied every morning, and then reapplied every 2 hours, regardless if you are outside 

  • Try to find a mineral (zinc or titanium) sunscreen that also has tint, which helps protect your skin from visible light

  • Wear a wide brimmed hat and sunglasses whenever you are outside. 

We usually begin treatment with what we call a “triple cream,” which typically contains a bleach (hydroquinone), a corticosteroid, and a retinoid (tretinoin). The bleach (hydroquinone) has been known to very rarely cause darkening of the skin (paradoxical ochronosis). In order to prevent this rare side effect, it is essential that you take a break from this medication. Typically we recommend using it for 3 months, since that is about how long it takes to see an improvement, and then taking at least a 3 month break from it. During the 3 month break, we may recommend other medications to help prevent the condition from worsening, but you should always continue your sun protection habits. 

Sometimes we recommend procedural therapies (i.e. lasers, chemical peels, microneedling) to help with melasma, but these must be done very carefully and only under the supervision of a dermatologist. Procedures, or even irritating skin practices such as waxing or shaving, can cause trauma to the skin and can result in worsening of the discoloration. 

Recommended sunscreens:

Any Elta MD tinted, SkinCeuticals Physical Fusion UV Defense, Alastin HydraTint Pro Mineral, La Roche-Posay Anthelios Mineral tinted.