Melasma is a brown patch on the face. The color is usually homogenous however it can be blotchy at times. It results from exposure to sunlight and not wearing sunscreen. It is also associated with patients taking oral contraceptive pills and pregnancy. Common treatment options include topical bleaching creams like Triluma, Obagi or Hydroquinone, chemical peels or even lasers. Sunscreen with physical blocking agents like zinc oxide or titanium dioxide is imperative to prevent worsening or future recurrence of melasma.
What is melasma?
Melasma is a brown patch that typically occurs on the forehead, temples, cheeks and upper lips. Sun is the most common trigger for melasma. Melasma is more common in females than males and is also very common to occur during pregnancy and in those patients who are on birth control pills.
How does melasma look clinically?
Melasma clinically presents as a blotchy pigmentation on the face. The most common areas for melasma include the chin, the bridge of the nose, the upper lip, the cheeks and forehead.
What is the actual cause of melasma?
The actual etiology of melasma is not really known. However, it is proposed that the UV rays from the sun stimulate the pigmented cells within the skin, inducing them to deposit pigmentation into the skin. This is why melasma is typically worse in the summer (because of all the sun exposure). This is also why patients with melasma get it over and over again because they do not protect themselves from the sun. In addition, it has been proposed that a change in hormones may also induce melasma and this is why patients on birth control pills as well as those who are pregnant also develop melasma.
Are melasma common in men?
Only 10% of all melasma patients are men. Melasma most commonly occurs in females.
How is melasma diagnosed?
Melasma is diagnosed clinically. It clinically appears as a blotchy patch of pigmentation on sun exposed areas.
Are there carious forms of melasmas?
There are 2 forms of melasma, superficial and deep. This could be distinguished by using a Wood’s light. The reason why dermatologist distinguish between the two is that superficial forms of melasma typically does respond to the most common form of treatment such as chemical peels and bleaching creams whereas deeper forms do not respond.
Is melasma difficult to treat?
The deeper form of melasma can be stubborn and could be hard to treat. Dr. Behnam typically recommends first using a combination of bleaching creams along with chemical peels. If there is no improvement, then lasers such as Fraxel is the choice of therapy.
How to treat melasma?
- Chemical Peels and Hydroquinone: Combination of chemical peels and bleaching creams are very effective in treating melasma. Chemical peels that may help include Jessner’s peels, GLycolic peels and ViPeel. Bleaching creams include hydroquinone 4% (prescrition strenght) to be used on a nightly basis, Obagi NuDerm system, and TriLuma.
- Lasers: Fraxel may help with melasma. Multiple sessions are required.
- Sunscreen: The most important trigger for melasma is the sun. Thus protection from the sun is the most important way of keeping melasma away. Sunscreens with SPF 35 and above with zinc oxide are very important. One must put on sunscreen everyday and also wear a hat.
- Birth Control Pills: If a patient is on a birth control pill, it might be a good idea to go off of it, if possible, as the birth control pill will induce melasma on the face.
What topical creams may help melasma?
The standard of care for treating melasma is hydroquinone. Hydroquinone 4% is a bleaching lightening cream that is used once a day at night. In addition to the bleaching cream, topical tretinoin cream may be used along with the topical bleaching cream. The combination of hydroquinone and tretinoin used once a day will help significantly reduce the pigmentation of melasma.
Besides hydroquinone bleaching creams, what are the other topical creams that might be applied?
kojic acid and azeliec acid are also sometimes used in combination with bleaching creams in order to treat melasma. Again please remember that the use of topical sunscreen is imperative in order to prevent the melasma from getting worse and preventing it from returning.
Are chemical peels recommended for melasma? Is ViPeel good for melasma?
Absolutely yes. In general, Dr. Behnam usually starts his patients on a combination of topical bleaching creams and in-office chemical peels. Patients use the bleaching cream on nightly basis. Once a month, patients return to Dr. Behnam’s clinic for a chemical peel. Typically glycolic peels or Vi-peel are used. The Vi-peel chemical peel is becoming a very popular procedure. It is a self-neutralizing chemical peel that is applied on the face and then left on for a minimum of 4 hours. ViPeel is performed once a month. It is a safe procedure and is typically done in all skin colors with a low risk of side effects. The combination of bleaching creams and chemical peels significantly help improve melasma.
What are the other options for melasma treatment besides chemical peels and topical bleaching creams?
Fraxel was introduced years ago with the hopes of improving melasma on the face. In most patients, a Fraxel will help with the pigmentation of melasma.
Is IPL Photofacial beneficial for melasma?
No, IPL photofacial is not recommended to be used for melasma because it could in fact worsen it in some patients. The standard of care is to use combination of bleaching creams along with topical chemical peels such as the Vi-peel. Only in cases where these two fail then the Fraxel laser may be used. Dr. Behnam does not recommend IPL or intense pulsed light or photo facial laser for treatment of melasma.
What are some of the side effects of using chemical peels on the face?
As with any other procedure there are always side effects and these could include skin irritation, redness, and pigmentation on the face. Under good doctor care and regular visits these side effects are minimal.
What is the prognosis for melasma?
Most melasma have very good prognoses. However if the melasma fades and the patient does not use very good sunscreen then melasma may return, so it is very important to use a sunscreen that has zinc oxide on a daily basis.
Is the sunscreen in my makeup enough?
No. The sunscreen in makeup is not enough to provide a good sun protection for the face. Sunscreen SPF 35 with zinc oxide or titanium oxide is recommended.
Tips for managing melasma:
- Apply sunscreens on daily basis after every 2 hours
- Wearing a hat
- Stay out of the sun
- Discontinue birth control pills (if possible)