Treating Melasma

Melasma is a very common skin pigmentation issue that is caused by two factors: hormones/genetics or external damage (mainly through chemical burns, extreme sun exposure). All forms of melasma have a similar look in that they are localized patches of darker skin usually around the mouth area, chin, cheeks and forehead.

The root of melasma (whether it is hormonal or externally acquired) is the result of an abnormal increase of melanocytes. The pigmentation builds up in a specific spot (generally the areas I mentioned above) and can darken even more when exposed to the sun. The hormonal aspect of melasma is what seperates it from regular hyperpigmentation. While all cases of hyperpigmentation are caused by external stressors (inflammatory irritation, cumulative sun exposure), melasma can be the cause of estrogen dominance.

Treatment of melasma is approached differently than other skin lightening concerns. Often times, melasma is almost 'imprinted' into the skin - meaning it is very difficult to treat, because many people aren't treating the underlying cause (or they don't know if it's from a chemical-induced trauma or abnormal hormonal activity).

I've read many cases and had people e-mail me about a recoccurence in their melasma. The best advice I can give is start out with a plan. Figure it out what is the cause of the melasma, because if you don't you will just end up wasting your time, money and even worsening the situation (melasma is notorious for returning the second time darker than the original outbreak).

90% of the time, melasma is a hormonal issue. The first thing I always tell people who message me about their melasma, is know where you stand with your estrogen levels.  There are many things that can balance endogenous estrogen levels. Birth control pills (Spiro etc.) can sometimes help with the sudden onset of melasma. If the melasma is acquired from pregnancy (also a hormonal issue) than once the baby is born, you can stick with topical treatments to remove it.

Some small steps you can take to balance excessive estrogen levels is to cut down on your body fat. Studies prove that women with excess body fat have irregular estrogen levels. Directly related to that, you should excercise regularily (particularily lifting weights, they don't have to be too high, but this is important regardless) since it can balance out the testosterone and estrogen within the body (to an extent, nothing incredibly drastic but it can help).

Dietary alterations can help as well - load up on dark greens, produce, lots of antioxidant rich foods like blueberries, strawberries, pomengranates etc. Increasing antioxidant levels help all skin pigmentation issues. That is a fact.

Once the underlying hormonal cause is taken care of, you can work on the topical. People with melasma really need to wear good high PPD sunscreens everyday. A tip I can give is to look for sunscreens with mexyoryl or tinsorb - very good at blocking UVA rays. A lot of European brands like La Roche Posay, Vichy, Avene have these ingredients as well as Japanese sunscreens. Also, on that note make sure you are wearing sunscreen properly.

Hydroquinone works very well at treating melasma. This is one of the only (aside from other localized regions of hyperpigmented skin) valid reasons to use hydroquinone. Particularily with a retinoid like Retin-A gel. There are numerous articles and studies proving that hydroquinone + tretinoin = powerful skin bleaching results. Probably one of the most potent combinations out there, it is very effective. Obagi Clear actually utilizes these ingredients in their product.

Another effective option can be azealic acid. Finacea Gel is the top prescription strength azealic topical treatment out there. It is a great hypopigmenting agent that can break up melanin and suppress its activity. You can get Finacea gel through a prescription or online without one.

Regular skin lighteners that have arbutin, mulberry extract, bearberry, licorice, and other plant based botanicals can work as well, especially in combination with Finacea or Retin-A. Topical antioxidants like Vitamin C can help as well.

Intensed Pulse Light (IPL) lasers can work, but those can be costly and I would rather advise the other topical suggestions I mentioned above.

Remember: use hydroquinone only on the melasma NOT the entire face (like Obagi suggests). My tip is to apply the retinoid first, and then apply the hydroquinone on the melasma very sparingly.

Topical treatments of melasma are effective at removing the imprint. Because once the real cause (which is always hormonal in most cases) is taken care of, the melasma won't return but the dark patches that it caused will remain unless you treat it topically.

=D