Melasma – causes and cures

June 12, 2020

What is Melasma?

By now, you’re probably aware of the dark marks that are left on  your skin after your pimples heal and go away. For most, these dark marks will fade with be very small and short- lived, for others, they will linger for months. The pigment in the skin is the determining factor when determining how dark the marks will be and how long the marks will take to fade. Typically, no additional treatment is needed to address these marks.

There is another type of skin darkening condition that is called melasma. Melasma is a pigmentation disorder that results in grey or dark brown patches that appear on the skin, commonly on the face. Ninety percent of all melasma cases affect women. Most spots are found on the upper lips, bridge of the nose, cheeks, and forehead.

There does not seem to be a single cause of melasma, however it is caused by several factors: sun exposure (sunburns, suntans), hormones (estrogen and progesterone primarily) and of course genetics. It has been noted that melasma lightens as women age and hormones decrease in the body. Some birth control pills will make melasma darken as well.  

What are the treatments for melasma?

There are topical bleaching agents that contain hydroquinone and kojic acid. When consistently applied to the skin, these active ingredients work by blocking the enzyme tyrosine, which is needed to make skin pigment or melanin. Consistent use of these agents has been shown to lighten darker patches on the skin. There are caveats on using these products. For some skin types, hydroquinone is irritating or may cause blackheads. Kojic acid, while effective, is not as strong as hydroquinone and may take longer to see results. An important factor to know when using these products is that you must not wear them when in the sun, since they will actually cause your skin to tan darker! Therefore only use these products at night. Another important consideration when using these is that it’s best to use topical bleaching products in the fall and winter when the sun is not as strong, since one time out in the sun without sunscreen or a wide brimmed hat will reverse the fading that has occurred up to that point. 

Which brings us to the next very important tip – you must wear a sunscreen every single day. AND if you are in the sun at all, you must wear a wide brimmed hat to avoid all UV radiation to the skin. As we say, nothing beats shade on your skin!

For the super motivated, there are laser treatments available to address melasma. This works when the laser scatters the melanin cells in the dermal layer at the skin. If you do this, make sure the skin care professional you are seeing has done this treatment many times before and do a test patch on your skin before treating your entire face. If your skin becomes damaged by this laser process, your skin will produce more melanin, which just causes more melasma to form. And if you do a successful laser treatment, your skin will be more sensitive to the sun for years to come, so you must be very diligent with daily sunscreen application and wear a wide brimmed hat when in the sun.

Finally, there is another treatment to fade melasma – wear your sunscreen daily and to stay in the shade (or supply your own shade with a wide brimmed hat) and practice really good sun hygiene. The good news is that melasma will fade with time.