Melasma: Treatment and the Unknown

Written by Gianna Barry, Licensed Esthetician & CIE, Inc. Instructor

As a practicing esthetician, I have had a large percentage of clientele who are afflicted with Melasma, also sometimes referred to as Chloasma. It has been my experience that even men can suffer from this “pregnancy mask”. After having read several sources on Melasma, I have determined that there are a lot of unknowns and many factors that can cause Melasma.

Factors that can cause Melasma are a blood relative who is suffering from Melasma, excess sun exposure, and UV rays, all of which stimulate the melanocytes and may make the condition worse in the summer time. Darker skin tones have more melanocytes and therefore more pigment. These individuals are more susceptible to Melasma. Anything that irritates the skin can also worsen the condition (Perricone, 2014).

Melasma affects an estimated six million people in the United States. In fact, 90% of those afflicted are women, according to the American Academy of Dermatology (Joshua L. Fox, 2013). Melasma most often affects those with so called olive or brownish skin tone. The condition is characterized by skin discoloration typically located on areas of the body more exposed to the sun, such as the cheeks, nose, forehead and chin and to a lesser extent, the neck and arms.

Other common triggers include estrogen supplements and birth control pills. Joshua Fox, MD, a board certified dermatologist and medical director of Advanced Dermatology PC in Roslyn Heights, New York, cautions that patients should consult a dermatologist before trying any at-home remedies for Melasma. “Some household remedies and over-the-counter treatments involve scrubbing and/or chemicals that can aggravate the skin and make the condition worse,” he says (Joshua L. Fox, 2013).

The good news for patients is that technologies are evolving to better treat Melasma. The Fraxel laser (a type of fractional laser) is a tool that is increasingly used to treat Melasma, especially in severe cases and in cases where it doesn’t respond to other treatments. The Dual 1550/1927 Fraxel laser received new FDA approval specifically to treat skin pigmentation problems such as Melasma in June 2013. The benefit of the Fraxel laser is that it can safely treat the cells producing pigment yet it protects the outer layer of skin at the same time (Joshua L. Fox, 2013). Patients who go this route must be vigilant about avoiding the sun and must wear a high grade UVA/UVB sunscreen at all times.

While Melasma does not cause any physical discomfort, managing the psychological stress associated with the appearance can be a challenge. “Melasma can rarely fade on its own but most women prefer to treat it because it’s not only unsightly but it also causes some degree of embarrassment,” (Joshua L. Fox, 2013)”Appropriate treatment can significantly improve quality of life and restore self-confidence.”

Fortunately, there are many treatment options to help manage Melasma. “Dermatologists are excited about the FDA’s approval of Fraxel for treating Melasma. And while there is no magic bullet for the problem, we have additional therapies at our disposal that are safe and effective,” (Joshua L. Fox, 2013). These include:

The first line of defense is a broad spectrum sunscreen, which will help prevent further skin discoloration.

One of the first-line treatments is often a hydroquinone (HQ) cream, lotion or gel to lighten skin, which is available over-the-counter and in prescription doses. A dermatologist may also prescribe other topical medicines to lighten skin such as Tretinoin, corticosteroids, Azelaic acid, retinol, and Kojic acid. Several new products have been developed without HQ to treat the condition.

Products with Vitamin C Esters help brighten skin and encourage healthy collagen and elastin production.

Procedures for Melasma include chemical peels, microdermabrasion, Fraxel Dual 1550/1927, Q-switched Nd-YAG, and Ruby Lasers.

Doctor Perricone reinforces the importance of sun avoidance and sunscreen to help prevent Melasma and recommends everyone applies sunscreen 20 minutes prior to going out in the sun (Perricone, 2014). This is particularly important for people aiming to prevent or minimize Melasma. In addition, reasonable efforts to reduce sun exposure such as wearing a wide-brimmed hat and large sunglasses can also be helpful in avoiding the sun and aiding in the prevention of Melasma.

While it is commonly accepted knowledge that Melasma is caused by hormones, new research has suggested that there are other indirect influencers. Additionally, the approach to treating this skin condition varies from aggressive with the use of lasers and peels, to a more holistic approach with the use of topical vitamins, etc. One thing everyone can agree on is that a broad spectrum sunscreen is of the utmost importance to prevent further darkening of the afflicted skin and to prevent the condition from presenting all together.