The Mask of Melasma

Melasma, also known as the mask of pregnancy, it’s a hyperpigmentation condition that can manifest in women (and some men) in all stages of life, resulting in darker patches of skin on the face and neck.  It’s a word in dermatology that’s always come with a lot of baggage—frustration from patients and head-scratching from doctors.  As scientific research continues to hone in on what causes it and how to manage it, we’re staying abreast of the latest and greatest. Let’s break it down.

What Is Melasma?

Melasma is a pigmentation disorder that results from the hyperactivity of melanocytes, the pigment producing cells of our skin. While it often appears on the face, it can manifest on the neck and arms. Unlike freckles, melasma patches are larger and peskier, being resistant to fade long after summer is over.

The most common areas we find melasma are: the forehead, chin, cheekbones and upper lip.

What Causes Melasma?

Researchers are still learning the intricacies of what stimulates melanocytes to go into overdrive and what makes some people more susceptible than others, but there are some common triggers. These include:

Sun Exposure: It’s known that ultraviolet light (UV) light activates melanocytes, causing skin to tan, but UV light can also induce certain melanocytes to over-react, causing the characteristic grayish-brown patches of melasma.

Heat: Extreme heat has been shown to cause a melasma flare, making the summer months particularly difficult to those most at risk. Hot yoga studios, saunas and steam rooms are high-heat areas that can exacerbate existing hyperpigmentation.

Hormonal Changes: Melasma is often seen for the first time in some women during pregnancy as their hormones fluctuate. In pregnant women, melasma is referred to as “chloasma” or the mask of pregnancy. Other hormonal triggers include birth control and hormone replacement pills.

Genetics: There is evidence to suggest that there is a genetic component to melasma, so look to see if other women in your family have gotten it to anticipate whether you’ll be at greater risk.

Irritating Skincare Products / Aggressive Skin Care Treatments: Harsh products and more invasive skincare treatments, such as intense laser and light therapies, can aggravate melanocytes, causing them to be over-produce. My team at Greenwich Point Dermatology and I work closely with you to manage both in-office and at-home therapies to lighten existing patches and suppress future melanin production.

Who Gets Melasma?

Women of darker skin tones are most likely to get melasma. In fact, 90% of melasma patients are women. While people with fairer skin are less likely to get it, their patches are often more visible due to the contrasting skin tones. Of women, those who are pregnant are at higher risk because of their extreme hormonal changes.

What Are My Treatment Options for Melasma?

Treating melasma implies total removal of it, so we prefer to think of it as managing melasma, as this is where the scientific research is right now.

The goal of managing melasma is two-fold. We want to lighten the existing melasma patches, and we want to prevent future patches from forming. Melasma treatment is a marathon, not a sprint, as too aggressive a treatment can actually be counterproductive and cause overstimulation of the melanocytes. I employ multiple modalities to strike an effective balance, some of which include:

Sun Protection: We’re big advocates of limiting sun exposure for a variety of reasons, but UV rays are the #1 culprit in making existing melasma even worse. Prevention is key here so be sure to apply SPF on the face daily and wear a hat and sunglasses for outdoor adventures. Neocutis Journee Bio-Restorative Day Cream SPF 30* is my go-to.

Topical Retinols/ Retinoids: Retinol creams like Tretinoin speed up cell turnover, helping dark patches clear more quickly, but they aren’t safe to use when pregnant. Too high of doses used too frequently can cause skin sensitivity, so proper application is essential for the best results. I recommend prescription-strength formulations for best results, prescribing retinoids tailored to suit your skin’s tolerability.

Vitamin C Serums: Vitamin C serums are safe to use when pregnant or trying to conceive and have a natural lightening effect. I love ISDIN Vitamin C Capsules for its potent antioxidant profile.

Hydroquinone: One of the most popular bleaching agents, hydroquinone use is best managed by a dermatologist as it can cause hypopigmentation, or extreme lightening of the skin when not titrated correctly.

Chemical Peels: The VI Peel Precision contains a combinations of acids and vitamins that are gentle enough so they don’t risk making pigment darker but effective at helping brighten skin. We see the best results with a series of 2-4 treatments over the course of 3 months.

Clear + Brilliant Permea Laser: Our most gentle laser, Clear + Brilliant Permea stimulates the production of new cells to brighten the skin—with no real downtime. It has an added benefit of boosting collagen production and enhancing the skin’s surface. The most successful transformations occur after 3-5 treatments, each about 6 weeks apart.

Lumecca Photofacial (IPL): Intense-Pulsed Light (IPL) treatment uses light energy to target melanocytes and destroy melanin to brighten skin with minimal downtime. By controlling the intensity of the light, I use IPL carefully to target the hyperpigmentation without inducing a hyperactive response from the surrounding melanocytes.

Other options may include discussing other lifestyle changes that may help such as modifying your birth control method (i.e. switching from the pill to an IUD).

So I Think I Have Melasma, What Are My Next Steps?

Here at Greenwich Point Dermatology, I take a personalized approach to treating your melasma. During your consultation, I will assess your pattern of discoloration, its intensity, and other personal factors that could affect the treatment plan, like whether you’re pregnant or trying to conceive. I work with you to manage expectations and find the best option for you whether that’s a serum, cream, in-office treatment or combination of modalities.

If you’d like to find a solution for your melasma, call Greenwich Point Dermatology to schedule an appointment today or make an appointment online here.

Stay bright,

Dr. Dolder

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