The Truth About Melasma and How to Treat It
By now, you’re probably very familiar with your face. You’ve lived with it for this long so you pick up on every new freckle, zit and dry patch. If you’ve noticed a diffusion of brown spots speckling your cheeks, nose and maybe chin, you may assume it’s hyperpigmentation. Hold off on that self-diagnosis because it could actually be melasma.
It’s common to mix up hyperpigmentation and melasma, especially when people aren’t familiar with the latter. It’s important to recognize the difference between the two because it impacts treatment. Of course, visiting a dermatologist or other reputable skin care expert is the only way to know for sure whether you have melasma. Still, it can be helpful to have some background information to know what you could be dealing with. We asked experts about the common skin care condition and how to treat it.
What Is Melasma?
Melasma is a form of hyperpigmentation, according to Park Avenue plastic surgeon Dr. Melissa Doft. “[It] is not only triggered by sun exposure, but by hormonal change,” she explains. That can include pregnancy, thyroid dysfunction, oral contraceptives, menopause and hormone replacement therapy, says Kerry Benjamin, founder of StackedSkincare.
Basically, melasma is the result of color-making cells in the skin producing too much color. It appears as flat brown to gray-brown patches typically on the face, explains Clarisonic co-founder and skin care expert Dr. Robb Akridge. It commonly appears on the cheeks, the bridge of the nose and upper lips. Melasma can also occur on the body on areas exposed to sun. Eileen Feighny, founder of Tulura, says it can sometimes occur on the neck and forearms.
Given that melasma is triggered by hormonal changes, it’s more common in females. Founder and CEO of Shiffa Dr. Lamees Hamdan points out that 90 percent of people who have it are women. What’s more, it’s usually hereditary (thanks, mom). Doft points out that melasma is more common in people of color, especially those from Asia, Latin America, Africa and the Middle East.
If you have it, know that you’re not alone. There are an estimated 6 million people in the United States alone with melasma, reports Feighny.
Hyperpigmentation vs. Melasma
Distinguishing between hyperpigmentation and melasma is important. So we’re clear, hyperpigmentation is used to describe any darkening. There are three forms of hyperpigmentation Benjamin says and melasma is one of them. UV damage and post-inflammatory hyperpigmentation (PIH) caused by acne/waxing/other traumas are the others.
Because the causes are different, treatment is different, so it’s important to know which one you have. Akridge adds melasma is much harder to resolve than typical hyperpigmentation.
Melasma and Pregnancy
Melasma can get worse with pregnancy because of the vast hormonal changes occurring in the body. In fact, melasma is referred to as “pregnancy mask,” Feighny says. Hamdan points out that pregnancy melasma “can clear spontaneously.” If it doesn’t, patients will have to wait until after pregnancy to get their hormones balanced.
Those dealing with pregnancy mask can still take action now. “If you are pregnant, PLEASE wear sunscreen every day,” states New York City-based dermatologist Dr. Dhaval Bhanusali. “Your skin may be more sensitive to UV exposure…UV damage and hormonal influences can make for a lifelong problem.” He recommends Aveeno Positively Radiant Daily Moisturizer SPF 30 ($18.99) as a morning moisturizer because it has SPF and soy, which is a natural lightener.
Feighny states there is no “final answer” on whether melasma will fade or get worse with time. There are so many factors to consider and each person is different.
The first order of business is trying to figure out what’s causing melasma and whether anything is exacerbating the problem. For instance, sun exposure and heat can make the problem worse. Doft explains “as hormones and sun exposure change, the pigmentation will vacillate.” Hamdan adds that some people may see their melasma change with the seasons with it darkening in summer and lightening in winter.
There can be a temporary increase in the appearance of melasma when exercising, explains Benjamin. When the body temperature returns to normal, skin should, too.
Having a strong sun protection game and balanced hormones are two major factors. “If you are staying out of the sun, have checked your hormonal and thyroid levels with your doctor, are getting proper treatment from your dermatologist and esthetician and not overusing chemical exfoliating ingredients at home, you should see your melasma fade within a few months,” says Feighny.
How to Treat It
Akridge warns against self-diagnosing. “Many people self-diagnose, but they really should check with a dermatologist before moving forward with any treatments. Melasma can look like another skin condition, in which case a dermatologist may need to take a skin biopsy to determine the correct form of treatment.”
The biggest thing is protecting with a high SPF, UVA/UVB sunscreen to prevent melasma from getting worse. Hamdan suggests using a sunscreen in compact powder form as opposed to a loose powder version because the former offers full coverage. She recommends versions by Jane Iredale and Shiseido. “I believe it is a waste of money treating melasma without first making sure your sun protection is stellar,” she warns. “Because you will be effectively undoing all the treatment with constant sun exposure.” Doft suggests using hats and umbrellas whenever possible for added protection.
For hormonal melasma, consult an expert like a gynecologist or endocrinologist. “They may be able to pinpoint your hormonal imbalance and eliminate whatever is causing the flare-up,” says Benjamin.
At-Home Skin Care Regimen
In terms of a good melasma skin care regimen, Doft suggests starting out with brightening creams. Look for ingredients like vitamin C, licorice root, kojic acid and niacinamide. They all have been shown to decrease the amount of melanin in skin.
Hydroquinone is something that melasma suffers will likely come across. Akridge says it’s “an amazing agent for decreasing pigmentation if used at the right concentration and on the right skin type.” Getting it right is essential because too high of a concentration can exacerbate melasma in some skin types and ethnicities. That’s why it’s important to consult the pros. Additionally, he says professionals may prescribe topical medicines that include azelaic acid or kojic acid to help lighten melasma.
In terms of in-office procedures, Doft says laser treatments can benefit some, but they can worsen melasma in others. Benjamin says “the safest ways” to treat melasma are medium-depth peels, microneedling, dermaplaning and microdermabrasion. These treatments gently exfoliate without causing trauma to skin and infuse it with a potent blend of active ingredients that inhibit melanin production.
But think beyond skin care products. Hamdan suggests boosting green tea consumption because it can help skin fend off the damaging effects of UV exposure from the inside out. So order that matcha latte.
We’ve said it before, but it’s worth repeating: sun protection is paramount. As with any other form of hyperpigmentation, not wearing sunscreen will make dark areas worse, cautions Doft. She states it’s important to wear SPF 50 sunscreen and reapply throughout the day. She suggests a physical sunscreen that contains zinc oxide or titanium oxide to block rays.
Another no-no when it comes to treating melasma is overdoing acids. Joanna Vargas, celebrity facialist and founder of Joanna Vargas Salon and Skincare Collection, warns that overusing glycolic acid can lead to inflammation, which can, in turn, worsen melasma. Hamdan cautions against “thinking the higher the concentration, the faster and better the results — not so.”
Laser treatments are also something to be careful of, according to the experts. Benjamin considers getting a laser treatment to be the biggest mistake people with melasma make because the procedure can cause a lot of trauma to skin and produces heat, resulting in the production of more melanin — and that makes the problem worse. She says there are newer versions of lasers that claim to be safe, but suggests sticking with microneedling, dermaplaning, microdermabrasion and medium-depth peels.
Two surprising things to watch out for are birth control pills and waxing. Doft points out that some patients have to change their birth control because of an increase in melasma. In terms of waxing, it can exacerbate skin, leading to problems. Benjamin says to remove fuzz with dermaplaning, shaving or threading.