Skin Deep

Ask Dr. Sam: What Is Melasma And What Can I Do About It?

by Julia Gibson

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Skin Deep

Ask Dr. Sam: What Is Melasma And What Can I Do About It?

It’s not *quite* the same as hyperpigmentation.

It’s a fact of life: we’re going to see some changes on our faces as years go by. I still remember the birthday when I woke up and noticed that there were two hyper-pigmented spots under my eyes that I swear weren’t there before. Although aging can be a contributing factor, hyperpigmentation comes in many forms and has a variety of causes, like acne scarring, sun damage, or discoloration from eczema or psoriasis. But there’s one form of hyperpigmentation that’s unlike the rest, and that form is melasma. I talked with FACILE dermatology + boutique co-founder Nancy Samolitis, MD, FAAD all about this unique form of hyperpigmentation, why it shows up, and what you can do about it.

JG

What is melasma and how do I know that I have it?

NS

Melasma is a common skin condition characterized by patches of uneven skin pigmentation, usually seen on the face. The patches are darker than normal skin tone and may have lighter spots speckled within. It is often seen on the forehead, cheeks, and upper lip. The diagnosis can be confirmed by a dermatologist. 

JG

Is melasma the same as hyperpigmentation?

NS

Yes and no. The term hyperpigmentation is a generic descriptive word that can include types of excess pigment formation other than melasma (for example, it also references pigmented acne or traumatic scars).

JG

What causes melasma?

NS

Melasma is caused by a combination of factors, including sun exposure and hormones such as estrogen and progesterone. It is definitely more common in women and is known to be triggered by female hormones. It can occur during pregnancy and in women taking birth control pills, but often occurs in women who don’t fall into these categories. It is rarely seen in men. The exact mechanism of how and why hormones stimulate melasma is poorly understood scientifically.

JG

Is it possible to fade melasma completely? Does it ever just go away on its own?

NS

Melasma sometimes goes away on its own, but it can be chronic for many years or decades. In some cases, women who develop melasma during pregnancy or while on birth control pills may experience improvement in their condition when they are no longer pregnant or on the pill, but they often require treatment to clear more quickly. Although many of our treatments can fade melasma significantly, we don’t usually consider it “cured “because it often recurs with sun exposure and warmer temperatures.

JG

What can I do to treat my melasma?

NS

There are many great treatment options for melasma, and I usually recommend using a combination approach for optimal results. The first step is diligent sun protection. Sunscreens that contain zinc, titanium, and a tint are more effective for blocking a broader light spectrum. Reapplying, wearing a UV-protective hat, and avoiding any direct sun exposure during peak hours (typically 10-4) will enhance your protection. Heat can also cause melasma to worsen, so keep the skin cool and avoid saunas and hot yoga (I know, I’m sorry!). The second step is skin care that you use at home. There are several ingredients that can be found in medical grade skin care that can help to exfoliate skin, remove melasma, and then prevent new excess pigment from forming. Using these ingredients in combination will fight the melasma by attacking the different causes. Some of the most commonly used ingredients include retinol, alpha hydroxy acids, kojic acid, tranexamic acid, niacinamide, and vitamin C. For more severe or resistant cases, a prescription topical compound can be used. These topicals can speed up the results significantly.

JG

What in-office treatments can I have done to combat melasma?

NS

Some popular procedures that we perform at FACILE dermatology + boutique that are very effective for melasma include Clear and Brilliant Laser, Cosmelan Peel, and Microneedling. We also use treatment boosters to enhance the results. It is very important to see someone with a lot of experience treating melasma because a lot of medical procedures used to treat other types of sun-related pigmentation can actually worsen melasma (the classic example of this is the IPL/photofacial). There’s also a newer exciting treatment for severe melasma, which is an oral form of tranexamic acid. This is a relatively safe medication that melts melasma away more quickly than any treatment I have ever seen. It does require a prescription, and  we have to make sure that you are a good candidate by reviewing your health history prior to prescribing it. It is used for about 3-4 months, usually in combination with the other therapies discussed.

Heat can cause melasma to worsen, so keep the skin cool and avoid saunas and hot yoga (I know, I’m sorry!).”

JG

Are there any specific topical products that are your favorites for treating and preventing melasma?

NS

Some of my favorite recommended OTC skin care products are FACILE tinted SPF, FACILE Easy C serum, SkinMedica Lytera 2.0, IS Clinical ProHeal Serum, and Biologique Recherche lotion P50 1970.

JG

Is it possible to prevent melasma from worsening or even forming in the first place?

NS

Unfortunately, you can’t necessarily predict if you will develop melasma. Again, diligent sun protection is the best way to prevent formation and worsening of melasma.
drsam

Interview courtesy of Nancy Samolitis, MD, FAAD (@drsamolitis)

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