While the name is perhaps unfamiliar, many women (and some men!) are well acquainted with this pigmentary disorder that manifests as brown or gray-brown patches on the face. Melasma is not inherently harmful or dangerous but it can be a cause of significant distress. Women, individuals with darker skin types, high sun exposure, and pregnancy are some of the most common risk factors for the development of melasma. 

What causes melasma?

There are many underlying changes in the body and skin leading to the appearance of Melasma. Melanocyte hyperactivity (cells in the skin that create pigment go into overdrive), melanophage activity (immune cells that ingest melanin and store it in the deeper layer of skin called the dermis), blood vessel changes in the skin (which fuel melanocytes boosting melanin production), light UV triggers, hormonal influences from estrogen and progesterone, and low grade inflammation are some of the chief culprits. Because of the multifactorial nature of melasma, the best treatment is multimodal and consists of a combination of topicals as well as procedures. 

Treatment for melasma

1. SUNSCREEN - Sun protection is of utmost importance and foundational for the prevention and treatment of melasma. In addition to applying sunscreen, avoid peak sun hours, wear a wide brimmed hat and sunglasses, and stay in the shade to limit UV exposure. When choosing a sunscreen look for SPF 50 or higher, mineral based (zinc oxide, titanium dioxide), and iron dioxide (which protects against visible light). See Dr. Andy’s recommendations here.

2. TOPICAL TREATMENTS - work to lighten the pigment include prescription based treatments such as hydroquinone, tretinoin, and a mild steroid like fluocinolone acetonide. There are also over the counter options such as azelaic acid, kojic acid, niacinamide, vitamin C, and topical tranexamic acid. Keep in mind that these treatments take weeks to months to fade the pigment in the skin so it requires patience and perseverance. At Smooth Skin Laser, your physician will come up with a topical treatment plan tailored to you and your skin’s needs. 

3. ORAL SUPPLEMENTS - Pycnogenol is an over the counter oral supplement that has evidence to suggest it may be useful as an add-on treatment thanks to its anti-inflammatory effects and antioxidant activity. It also helps reduce melanin production and may make the skin more resistant to UV damage. Another option is the prescription pill version of tranexamic acid which helps melasma by decreasing inflammation, vascular activity, and melanocyte activity.  It cannot be used in women who are pregnant or breastfeeding, with certain medications (blood thinners and some birth control), or in those with a history of blood clots. 

4. PICOSURE LASER TREATMENT - Office procedures can be used when topical and oral treatments aren’t enough. Options include chemical peels, microneedling, and careful use of lasers. Because these procedures tend to be more aggressive and can elicit an inflammatory response in the skin (which can worsen melasma), they must be used cautiously. At Smooth Skin Laser, we use the Picosure laser to treat melasma. Because the picosure delivers very short pulses of energy, heat damage is minimized - making this an excellent option for treating stubborn melasma which is sensitive to inflammation.