By Casey Watkins, MD
Melasma is a common skin problem that usually affects women and people with darker skin tones. Brown to gray-brown patches appear on the cheeks, forehead, chin, nose, and above the upper lip. The exact causes of melasma are unclear, but there are several well-known triggers including sun exposure, pregnancy, and birth control pills.
Melasma is often a relapsing condition and can be very frustrating for those affected. A thorough history can help identify melasma triggers. During the summer months, melasma often becomes more prominent. Wearing wide brimmed hats, protective sunglasses, and sunscreen is very important for treatment and prevention. Avoiding exposure to unsuspected UV sources such as computer screens, sunroofs, and windows is also important. UVA light is capable of travelling through windows, so daily sun protective measures—even when you don’t plan to be outdoors—is recommended. Heat can also trigger or worsen melasma. One of the most well-known triggers is pregnancy which is why melasma is also referred to as the “mask of pregnancy.” Oral contraceptive pills can also induce melasma in some individuals.
Melasma is one of the most difficult forms of hyperpigmentation to treat. Common topical treatments available include 2-4% hydroquinone, retinol, and use of daily broad-spectrum sunscreen that is SPF 30 or higher. The sunscreen should contain either zinc oxide or titanium dioxide, ingredients which will physically block the sun. Using sunscreen daily is the most important step in treating and preventing melasma. Hydroquinone cream bleaches the dark skin and should be applied only to the dark areas. Consistent use of a retinoid cream, such as retinol or Retin-A, helps by increasing cell turnover which aids in shedding the top layer of darkened skin. Prescription Retin-A or non-prescription retinols are available and work best when used regularly. AveneRetrinal is a great option for those with more sensitive skin as some retinoid creams can be irritating. Products containing vitamin-C offer antioxidant protection to the skin and can also be beneficial (available products include SkinCeuticals C E Ferulic or Phloretin). If you have more sensitive skin, either Avene AntiOxidant Serum or Water Cream would be a good alternative.
In conjunction with topical treatments, superficial chemical peels containing salicylic acid and glycolic acid will often enhance results and improve the skin’s appearance. Certain lasers may also be used alone or in combination with topical therapies to selectively target dark spots. The Lumenis PiQo4 is a hybrid laser that is safe for the treatment of melasma in most skin types and tones. This laser treatment is available at our Johnson City Cosmetic Center and consists of a series of four treatments spaced four to six weeks apart with annual maintenance visits.
Check with your dermatologist about the common melasma triggers such as hormonal triggers, including birth control pills, hormone-releasing intrauterine devices, hormone therapy, and vitamin supplements such as those used for pregnancy, nursing, and perimenopausal symptoms.
Less common triggers include scented or deodorant soaps, toiletries, cosmetics, or fragrances that may cause phototoxic reactions. Rarely, autoimmune thyroid disorders, chronic stress, or adrenal dysfunction can cause or worsen melasma.
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Melasma. (n.d.) Retrieved February 09, 2018, from https://www.aad.org/public/diseases/color-problems/melasma#treatment
17, 2. P., & Lily Talakoub, MD Naissan Wesley, MD. (2017, August 17). Why you should use sunscreen indoors. Retrieved February 09, 2018, from https://mdedge.com/