If you’ve developed large, irregular, brown patches on your skin, you may have melasma. This skin condition is very common among women, especially women with darker skin or who tan well.
Age spots, sun spots, and liver spots are not melasma, but they are very similar. Melasma patches are almost always larger. They often appear on facial skin, which can be very embarrassing. In fact, they most often develop on the face due to sunlight exposure.
Melasma patches and spots are harmless, and some fade after a few months -- while others seem to be permanent. Here’s the good news: We have great success with several treatments that promote fading of melasma.
What causes this skin condition?
Melasma is a form of hyperpigmentation believed to be caused intrinsically by hormones or stress. This condition has been called “mask of pregnancy” as it is common among pregnant women. In fact, this condition is more common during a woman’s reproductive years, and taking oral contraceptives can increase the risk. Women taking hormone replacement therapy are also at increased risk of melasma.
While melasma is initially triggered internally, sun can make the melasma worse or prevent it from fading. Some medications make skin sensitive to sunlight, increasing risk of melasma: antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), diuretics, retinoids, hypoglycemics, antipsychotics, and others. Tanning beds with UV light will damage skin and can worsen melasma.
The patches or spots typically develop where skin is exposed to the sun, including:
- Bridge of the nose
- Chin and neck
- Upper lip
Because melasma spots appear on sun-exposed areas, most people notice them worsening during summer months.
What Can You Do?
Some women find that melasma disappears on its own, especially if the condition is caused by pregnancy or birth control pills. Protecting the skin from sunlight and LED light exposure also helps diminish melasma.
Several treatments have been found to help diminish melasma by lightening the patches.
Topical skin lightening serums are often helpful. When these don’t work, chemical peels and microneedling are good treatment options. These treatments work by removing the top layers of skin, which helps to lighten dark patches.
Before we look at these treatments in more detail, it is important to note that any treatment that heats the skin will make melasma worse. One would never want to do laser, IPL or Photofacials for melasma as there is a very high probability that the pigmentation will get darker and not lighter.
Certain brands of chemical peels containing skin lightening ingredients such as Alzelaic acid and Vitamin A can reduce the appearance of age spots, freckles and melasma-- improving the skin's appearance. This treatment involves a chemical solution that when left on the skin will cause the top layer of skin to peel and will suppress the melanin overactivity that is causing the darkening. This reveals new skin that is smoother and dark patches that are significantly lighter, and melasma will be barely visible.
Microneedling with Topical Therapy
This procedure involves a dermaroller that applies small needles to prick the skin. The procedure generates new collagen and skin tissue for smoother, firmer, more toned skin. Microneedling is mostly used on the face to treat wrinkles, fine lines and scars, and has been successful in lightening melasma patches as well.
Hydroquinone is a topical skin-bleaching agent; when combined with prescription tretinoin (a topical retinoid) and a topical steroid cream, this can be effective in diminishing melasma.
Sun Protection Factor (SPF) in skin products indicates the amount of protection you will receive from solar energy (UV radiation). A high SPF value provides the greatest protection and can help prevent melasma from darkening. Wear sunscreen with iron oxides and an SPF of 30-50 applied every two hours, as well as a wide-brimmed hat.
Hormone-balancing supplements such as Chasteberry (Chaste Berry Vitex) may reduce estrogen; low doses of extract have decreased estrogen levels and increased progesterone and prolactin levels. The extract may inhibit the release of follicle-stimulating hormone (FSH) and stimulate luteinizing hormone (LH) levels -- which may help balance estrogen levels -- reducing risk of melasma.
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COMMONLY ASKED QUESTIONS
Chemical peels and microneedling have very little downtime, and only side effects may be sensitivity to sun (chemical peels).
Laser treatments are not appropriate for melasma, as some lasers can make the pigmentation darker. We do not use lasers for melasma so there are no potential risks.
Hydroquinone may cause itching and/or irritation, so discontinue using it when this happens. Test a small amount of the product on facial skin before using it as a treatment. Do not take the combination of hydroquinone, tretinoin and a moderate topical steroid during pregnancy.
Chasteberry may have side effects like acne, headache, rash, stomach upset, and menstrual bleeding. You should not take chasteberry if you are pregnant or breastfeeding, take birth control pills or hormone replacement, or have breast cancer.
These treatments generally help to lighten the melasma patch or spot, but they cannot remove it entirely.
There is no pain involved in any of these treatments, although you may have temporary discomfort with chemical peels and microneedling.
There is no guarantee with these procedures that melasma won’t return, and some melasma patches can’t be lightened completely. Follow-up visits are often helpful, and it’s necessary to protect skin to prevent return of melasma -- like reducing your sun exposure and wearing sunscreen daily.
You should have a dermatologist check any new or changing skin spots to determine exactly what they are. It’s important to ensure you don’t have skin cancer or another condition that requires treatment.
We can help diminish melasma patches and spots
If melasma patches or spots are bothersome, especially on facial skin, talk to us about treatments that will help diminish their appearance. We’ve had great success with chemical peels, microneedling, and specific topical creams.
Don’t put up with embarrassing melasma patches and spots that distract from your enjoyment of life. Give us a call- let’s talk -- and find solutions.