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Melasma

What is melasma?

Melasma is a common skin disorder that presents with the development of light to dark brown irregular patches over the face. Less common sites of involvement include the forearms and chest. It is caused by overactive pigment producing cells, known as melanocytes, which are stimulated by ultraviolet light exposure and hormones (most often estrogen).

Who is affected by melasma?

Approximately 90% of those with melasma are female, suggesting a hormonal influence. Exacerbating factors include pregnancy (hence the condition is also known as the “mask of pregnancy”), hormonal birth control, and sun exposure. Those of Hispanic, Asian, and African descent are at higher risk for the development of melasma.

How is melasma treated?

Melasma treatment requires a combination of therapies to achieve the best results. Therapy focuses on the use of topical medications or procedures to brighten the skin along with strict sun protection to minimize stimulation of the melanocytes. Below are key steps to follow to lighten the skin:

  • Sun Protection:
    • Wear a broad-spectrum sunscreen daily with a minimum SPF of 30. Only minimal sun exposure is enough to trigger melasma. The best sunscreens to use are those containing physical blockers (zinc oxide or titanium dioxide), such as EltaMD®.
    • Wear a wide-brimmed hat when outdoors. Facial masks have been worn for those with severe cases.
  • Topical Therapies:
    • Studies have shown that the best topical medication for melasma is a combination therapy known as Tri-Luma®, consisting of hydroquinone, tretinoin, and a steroid.
      • Use: apply a thin layer nightly to the dark spots for no longer than 8 weeks
      • Side Effects: irritation, flaking, ochronosis (darkening with long-term hydroquinone use)
    • Other topical agents containing azeleic acid, kojic acid, or glycolic acid can be used to lighten the skin. These agents are most effective as maintenance and continued therapy after Tri-Luma® use. A recommended product is VI DermTM Clear HQ Free that contains azeleic acid, kojic acid, licorice root, and retinol.
      • Use: apply twice daily to the dark spots
  • Cosmetic Procedures:
    • For more resistant cases of melasma, medium depth chemical peels or microdermabrasion are effective therapies. Repeated sessions are often needed for optimal results.
    • Laser therapy still remains controversial as a therapeutic option since studies have shown that it may either improve or worsen melasma.
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