Brown discoloration on the face. A mask that never leaves. It’s the reason you slather on sunscreen and hide out under a hat. Melasma is a common skin condition found in many females and a small percentage of males. Its presence is characterized by brown and tan patches that occur on many parts of the face. It is thought that melasma occurs when the cells responsible for making color in our skin (melanocytes) become hyperactive and produce an abnormally high level of skin color (melanin). Melasma is most often seen in darker skin types such as Latinos, Asians, African Americans, and Indians. Many times you may hear it referred to as the ‘mask of pregnancy.’ Although we typically do see melasma occur in pregnant women, we also find that it may sometimes be inherited, or as a side effect of hormone or oral contraceptive use.
Finding the exact trigger for melasma may be difficult to pinpoint. The condition’s unpredictable nature makes it hard to prevent; however, there are ways to treat and blend melasma into the surrounding skin. The depth of the melasma in the skin can sometimes dictate which treatments will be most beneficial and how stubborn it may be to respond. The first step in melasma treatment typically consists of a topical regimen aimed at blocking melanocytes from the process of producing extra color in the skin. A regimen for melasma may consist of hydroquinone and/or non-hydroquinone blending products, retinols, and sometimes gentle low strength topical steroids. Hydroquinone based products such as Obagi’s Clear® and Blender® work to block an enzyme responsible for allowing melanin to be produced. A non-hydroquinone product such as SkinMedica’s Lytera® works by blocking all four pathways of melanin production through the combination of antioxidants and natural ingredients such as licorice root. These creams and lotions help to prevent the production of new melasma in the skin. Topical retinols are also important to help increase cellular turnover on the skin’s surface. This allows for the pigment already present in the top layer of the skin to be sloughed off at a faster than normal rate. In addition to the topical regimen, your provider may suggest exfoliating washes such as Obagi’s Exfoderm® or SkinMedica’s AHA/BHA Exfoliating Cleanser®. Retinol and exfoliation use also allows for hydroquinone and steroid products to penetrate deeper and more efficiently into the skin.
Melasma Pre treatment
Melasma Post treatment
Many services may be combined with topical treatments for melasma. Chemical peels work similarly to retinols and can help to decrease the amount of time it takes to remove pigment present on the skin surface. Sometimes a laser may be employed to treat melasma as well. Q-Switched Alexandrite lasers may be used to target brown discoloration in the skin. These lasers may help to break apart the pigment and allow it to be reabsorbed. Intense pulsed light, or IPL, is sometimes used by practitioners as a modality to treat melasma. Unfortunately, not all lasers work for melasma. While it may temporarily decrease the discoloration, melasma has been known to sometimes recur after laser or light has been performed.
The key to keeping your melasma away after an intensive treatment program, is to slather on that sunscreen and wear your hat! Sun exposure has been known to deepen the color of the melasma and can sometimes make the condition worse. In addition, discontinuing or changing hormones or oral contraceptives (with your doctor’s permission of course) may help control melasma.
It is most important for a patient with melasma to consult with a provider in order to discuss treatment options most suitable for their condition. If melasma is a concern for you, stop by the USF Cosmetic & Laser Center, and allow us to develop a personalized treatment plan for you!
By: Erika Dare, ARNP-C Dermatology and Cosmetic Practioner, USF Health Department of Dermatology and Cutaneous Surgery, USF Health Cosmetic and Laser Center
Erika Dare, ARNP-C