Melasma is patches of dark pigmentation often found on the cheeks, temples, upper lip, chin, bridge of nose and forehead. It is most commonly found in women but will occasionally affect men.
Skin of color is more likely to develop melasma simply because they have more melanocytes (pigment-producing cells). Having a family member with it may increase your chances of developing the skin issue.
We do not have a complete understanding of the causes. We do know that it is caused by the overproduction of melanin (pigment) in areas of the skin.
It does not cause symptoms but can be associated with social embarrassment.
Melasma Triggers include:
- Sun Exposure – The UV light from the sun or tanning beds will stimulate melanocytes to produce pigment and overproduce melanin in the areas of melasma. In our region of the country, most patients feel that it improves in the winter and worsens in the winter.
- Changes in Hormones – You will often hear melasma called the mask of pregnancy. Many women will notice it starts with one of their pregnancies. It is not always the first pregnancy. While pregnant it is important to protect your skin from sun exposure. It may also be triggered by birth control pills or hormone replacement therapy.
- Sun Protection –Lazaderm believes that the most important first line of defense is wearing sunblock every single day on sun-exposed body parts. Some physicians feel, that if you tan your legs it may affect the melasma on your face even with complete protection of your face from sun exposure. We recommend wearing a good sunblock daily such as EltaMD. Sunblocks should contain zinc oxide or titanium dioxide. We prefer a concentration of at least 7% zinc or titanium or a combination of the two.
- Topical Creams – The more common topical treatments will include hydroquinone, tretinoin and even corticosteroids. We prefer not to use corticosteroids because they can only be used for a short time and melasma is a long-term problem. We recommend either the Obagi NuDerm system or the ZO Skincare products.
- Laser / Light Treatments – It is very important to make sure those treating your melasma with lasers or light sources have a good understanding of the issue. Lasers and light treatment can make melasma worsen if not done correctly. We will always recommend that you pre-treat with topicals before any laser or light treatments. We have found that the Fraxel Laser, Halo Laser, BBL and the PicoSure Focused array treatments work best for the treatment of melasma.
Remember, there is no cure for melasma. It may improve over time especially with the removal of the inciting factor such as stopping birth control pills, delivery of the baby or hormone replacement therapy. Treatment is all about controlling it. If you have great control of your melasma and you stop protecting your skin from sun exposure or stop using your maintenance topicals, the melasma will likely reappear.