This is a common question I get from all over the world…
“What is melasma, chloasma, mask of pregnancy and how can I fix it?”
As you know by now, I like to explain a bit of the how, what, why and who’s of each topic, so here goes…
What causes melasma is not yet clear, as there can be multiple factors. It occurs when the color-making cells in the skin (melanocytes) produce too much color. People with skin of color are more prone to melasma because they have more active melanocytes than those with light skin.
Common melasma triggers (what can instigate it) include:
- Sun exposure: Ultraviolet (UV) light from the sun stimulates the melanocytes. This is our natural protection kicking in, BUT, just a small amount of sun exposure can make melasma return after fading. Sun exposure is why melasma often is worse in summer. It also is the main reason why many people with melasma get it again and again.
- A change in hormones: Pregnant women often get melasma. When melasma appears in pregnant women, it is called chloasma or the mask of pregnancy. Birth control pills and hormone replacement medicine also can trigger melasma.
- Cosmetics: Skin care products that irritate the skin may worsen melasma. Exfoliation that is too aggressive, allergic reactions, treatment that is not consulted properly on, etc can all contribute.
Women are affected up to 90% more than men
Melasma appears on women’s skin much more often than men’s skin. Just 10% of people who get melasma are men. Obviously, this is directly related to our hormone load. Lucky us, we get ALL the bonuses (brains, beauty, curves) even the ones we do not want (dark spots, scars, stretch marks, cellulite).
People with darker skin, such as those of Latin/Hispanic, North African, African-American, Asian, Indian, Middle Eastern, and Mediterranean descent are more likely to get melasma. Mixed or Multi racial folks will also see a larger incidence.
NOTE: People who have a blood relative who had melasma also are much more likely to get melasma. Ahh genetics…
How is diagnosed?
Dermatologists, well trained aestheticians, and some general practioners can diagnose most patients by looking at their skin. To see how deeply the melasma penetrates the skin, your dermatologist or aesthetician may look at your skin under a device called a Wood’s lamp. This is a lamp that uses UV light to see if the dark patches are past the border between the epidermis and dermis. This helps in determining type of treatment, as does as your lifestyle, environment and philosophy.
How do dermatologists treat melasma?
Melasma can fade on its own. This often happens when a trigger is causing the melasma, such as a pregnancy or birth control pills, after a woman delivers the baby or stops taking the birth control pills, melasma can fade.
Some people, however, have melasma for years — or even a lifetime. If the melasma does not go away or a woman wants to keep taking birth control pills, melasma treatments are available. These include:
- Hydroquinone: This medicine is a common first treatment prescribed for melasma. It is applied to the skin and works by lightening the skin. You will find hydroquinone in OTC products as a cream, lotion, gel, or liquid. You can get these without a prescription, but note these products contain less hydroquinone than a product that your dermatologist can prescribe. I have seen great results with HQ, however, there are some safety concerns. It is a fat soluble ingredient which means it can linger in the liver (liver is a fatty organ that helps us with detoxification). It should be used as directed by your doc, but a general rule of thumb is 3 months on and 3 months off to allow HQ to completely leave the liver. It can also lead to rebound pigmentation (dark patches that come back darker) if not using daily SPF of 30 and gentle cleansing and exfoliation routine.
- Tretinoin and corticosteroids: (retin a, and all its forms; topical steroids) Enhancing skin lightening, your dermatologist may prescribe a second medicine. This medicine may be tretinoin or a corticosteroid. Sometimes a medicine contains 3 medicines (hydroquinone, tretinoin, and a corticosteroid) in 1 cream. This is often called a triple cream (it can have AHA’s, Retin A and corticosteroids). Retin A can be too strong for darker or multi racial skin tones. I prefer Azelaic Acid for darker skins, less irritating=less inflammation=less dark spots.
- Other topical (applied to the skin) medicines: Your dermatologist may prescribe azelaic acid or kojic acid to help lighten melasma. These are great options for darker skins as they are less irritating. Your aesthetician will recommend Vitamin C based serums, anti-inflammatory ingredients like oat beta glucan, allantoin, licorice extract, and many others that reduce the cascade of effects that result in more dark patches, or spots on your skin.
- Procedures: If a topical medicine does not get rid of your melasma, a procedure may succeed. Procedures for melasma include a chemical peel (such as glycolic acid, TCA), microdermabrasion, and intense pulsed light. A dermatologist/or a well trained aesthetician should perform these procedures. New skin problems can occur when the person who gives the treatment does not tailor it to the patient’s skin type and color.
Ask your dermatologist about possible side effects (health problems that can result from the treatment).
If you notice any of the following after treating melasma, be sure to call your dermatologist:
- Skin irritation
- Darkening of the skin
- Other problems
So now what…
Under a dermatologist’s/ well trained aesthetician’s care, many people with melasma have a good outcome. Melasma can be stubborn, though. Patience is key as it may take a few months of treatment to see improvement. It is crucial to follow your dermatologist’s/aesthetician’s advice. This ensures that you get the most benefit from treatment. It also can help avoid skin irritation and other side effects.
After your melasma clears, you may need to keep treating your skin. Your dermatologist/aesthetician will call this maintenance therapy. Maintenance therapy can prevent melasma from returning.
You can help prevent your melasma from returning by wearing sunscreen, sunglasses and a wide-brimmed hat every day.