Melasma refers to irregular patches of darker skin color , usually on cheeks, forehead and upper lip. It is often called “mask of pregnancy” because it is believed to related to hormone changes during pregnancy, birth control pills and other hormone treatments. It affects women predominantly, especially those with skin of color. Exposure to ultraviolet light is also both a cause and an aggravator. Melasma is one of the most frustrating conditions to have and to treat. Although total clearance can happen, it would never be fair to tell every patient that her melasma can be cured. Melasma has been notoriously resistant to many fancy therapeutic approaches such as picolasers, IPL, Fraxel Laser’s etc.
That being said, it is absolutely possible to significantly lighten it, as well as keeping it under control. Both the patient and the dermatologist must be committed.
- First and foremost: sun protection for those areas at all times. That means concealer 100%. DO NOT rely on sunscreen alone. MELASMA reacts to ALL wavelengths of light, not just the ones covered by sunscreens. Wear a 5’ wide rimmed hat.
- Botanical lightening agents
- Hydroquinone from 4 to 8% , especially in combination with a retinoids and an anti-inflammatory, has consistently outperformed every single other therapeutic approach. It is therefore still considered the mainstay of therapy.
- Very light peels can help with the penetration of your topicals.
- Microneedling followed by application of hydroquinone or tranexamic acid has been a welcome addition to our armamentarium.
- We avoid the use of orally taken tranexamic acid. It clears melasma in 80% of cases, but must be stopped after 3 months, at which time the melasma always recurs! There are also some serious side effects associated with it.
- Use prescribed medication
- wearing a wide-brimmed hat that shields or provides shade for your face