Combating Melasma 101
Hyperpigmentation is one of those topics that I get questions about on a daily basis. As someone who struggles with it myself (in the form of both melasma and postinflammatory hyperpigmentation), I completely understand how stubborn and frustrating it can be. First and foremost, with any skin condition I always suggest seeing your derm provider to provide a detailed analysis and plan of action for your specific diagnosis. It may, after all, require prescription options. However, here is a general guide to my thoughts and tips when it comes to melasma (these also apply to other types of hyperpigmentation as well)
What is Melasma?
Melasma is characterized by chronic hyperpigmentation predominantly on sun-exposed areas of the skin. It most commonly appears as brown or gray patches on the face, particularly the cheeks, bridge of the nose, forehead, chin, and above the upper lip. I think it’s also worth mentioning that the condition is more common in women and particularly prevalent among those with deeper skin tones.
Difference Between Melasma and Hyperpigmentation
This is a question I receive consistently. While I completely understand how people use these terms interchangeably, it’s important to understand the difference between the two. Melasma is a specific type of hyperpigmentation driven by several factors, including hormonal changes and UV radiation. Unlike general hyperpigmentation, which can result from various causes such as inflammation, melasma is particularly tied to hormonal fluctuations and sun exposure, making it more persistent and often recurrent. However, many of the treatments and recommendations remain the same.
Causes & Risk Factors of Melasma
I want to start off by saying that when it comes to melasma, there are several factors that can put you at risk. There are also several variables that can cause your melasma to flare. Let’s cover them:
UV Rays: To nobody's surprise, sun exposure is going to lead the pack for causing melasma flares. UV rays increase melanin production by stimulating melanocytes, the pigment-producing cells in the skin.
Hormonal Influences: Ever heard of the “mask of pregnancy” when it comes to melasma? Well there’s a reason for that. Increased estrogen and progesterone levels (common during pregnancy) are believed to exacerbate melanocyte activity.
Heat Exposure: Not just UV light but also heat can exacerbate melasma. Heat from a hot fitness class, hot car, and other sources can induce melasma.
Stress: This one is a little less directly linked than other factors, but stress can influence hormone levels and, in some studies, has been shown to exacerbate skin conditions including melasma. This may be related to increased cortisol levels which can affect other hormone balances in the body.
Inflammation & Irritation: Ever noticed your melasma became worse after your rosacea flared or a product irritated your skin? We know now that there is a link between melasma and inflammation.
Treatments for Melasma Management
Managing melasma effectively truly involves a dual approach: prevention and correction. While no treatment can completely reverse melasma, significant improvements can typically be made. Before anything else, it's crucial to understand that once melasma develops, it often becomes a chronic condition that requires ongoing management. While the products and treatments I recommend help, the absolute best strategy I can emphasize is prevention. To nobody’s surprise, this looks like wearing sunscreen everyday (& reapplying consistently). As an added layer of protection, I recommend sun protection apparel (I actually talked about this with Dr. Mary Alice Mina on a recent podcast episode).
Now that we have covered the topic of prevention, let’s cover some of the topical agents I recommend to combat hyperpigmentation in general. Note this is not medical advice, please see your Derm provider for tailored recommendations
Hydroquinone: This ingredient is widely used in skincare to lighten areas of pigmented skin. It works by inhibiting an enzyme called tyrosinase, which is essential for the production of melanin. By slowing down melanin production, hydroquinone can effectively reduce the dark patches characteristic of melasma, making them less noticeable over time. It is safe and highly effective when used under the guidance of a Dermatology Provider.
Non-Hydroquinone Skin Brighteners: Great because they can safely be used all over the face, not just on affected skin, I love non-HQ skin brighteners for anyone battling hyperpigmentation.
Retinoids: Promote epidermal turnover, facilitating pigment dispersion and removal.
Vitamin C: An actual powerhouse. This antioxidant helps brighten the skin by inhibiting tyrosinase activity, similar to hydroquinone, but it also offers additional benefits. Vitamin C helps protect the skin from UV damage and improves overall skin integrity by promoting collagen production.
Tinted Sunscreen: I know I already mentioned spf in the prevention part, but it’s just that important! I do want to use this as an opportunity to highlight the use of tinted sunscreen when it comes to melasma. Sunscreens that are tinted contain iron oxides, which not only protect against UV light but also visible light. These sunscreens pretty much work double duty by preventing new melasma patches from forming while also subtly covering existing discolorations.
In-Office Treatments for Melasma
I go into a little more detail on all the treatments I mention in my recent blog post on treatments I love (& swear by), but here is a brief synopsis on the ones I love when battling melasma.
Chemical Peels: Substances like glycolic acid and trichloroacetic acid are used to remove the outer skin layers, encouraging regeneration and reducing pigmentation.
Laser Treatments: Lasers should be used with CAUTION when it comes to melasma as the condition often flares months post laser, often worse than before.
Microneedling: Enhances the delivery and efficacy of topical treatments by creating microchannels in the skin.
If you are struggling with hyperpigmentation, I hope you know that you are far from alone. While I know firsthand how much of a challenge it can be, there are ways it can be effectively managed. DM me any questions or any other topics you want me to cover. I want to finish this by reminding you that if you think you are experiencing melasma, please go see your derm provider. They will be able to tailor a treatment plan specific to your diagnosis!
Hungry for more? Check out my Comprehensive Skincare Guide in the Skinthusiast Shop!
**Disclaimer: This post does not constitute medical advice. Please speak to your Dermatology provider before adding any at home procedures or products into your routine!
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