Last Updated on November 20, 2020 by Alice Pien, MD & Asher Milgrom, PhD
Melasma is one of the most prominent skin problems in the world. Nearly 6 million Americans suffer from melasma. The problem reveals itself in the form of dark spots on skin including the nose, cheeks, forehead, upper lip and chin. However, the dark spots of melasma can be found in other areas that are exposed to the sun. Other less-common areas include the neck and forearms.
Who Gets Melasma?
Melasma can affect a wide variety of people but women are the most likely candidates. Only 10 percent of affected patients are men.
This skin problem is particularly prominent during pregnancy and is commonly referred to as the “pregnancy mask”. The pregnancy hormones are one of the main causes of melasma.
Some women are so sensitive to hormonal changes, that going on the birth control pill or even changing brands of birth control pills can exacerbate their melasma.
Darker Skin Types
Melasma is also more common in people with darker skin including people of North African, African-American, Middle Eastern, Latin or Hispanic decent. The said skin condition can be genetic.
Melasma does not cause people to feel any different. The most common complaint about this condition is in regards to the appearance of the skin.
What Causes Melasma?
The major cause of melasma is not known. Experts do know that the skins color-producing cells can over produce, which results in the said dark spots on skin. People with darker skin are predisposed to this melasma because their melanocytes (color-producing cells) are more active than those with lighter skin tones. However, the darker the surrounding skin is, the harder it is to see the melasma.
Watch the video : A deep dive into the cause and treatment of melasma
No Direct Cause is Know
Researchers have still not identified a direct cause of melasma. However, most experts agree that pregnancy, hormone replacement therapy, family history, birth control, anti-seizure meds and sun exposure can all prompt the onset of melasma.
Sun Exposure can Cause Melasma
Sun exposure is known as the principal cause of the dark spots as evidence suggests melasma peaks during the summer months when exposure to the sun is the highest. During the winter, patients with melasma report a fade in their dark spots.
Pregnancy can Cause Melasma
Pregnancy melasma is known in the medical field as Chloasma, but commonly referred to as the “pregnancy mask”. During the final two stages of pregnancy expecting mothers face an increase in hormones such as estrogen, melanocyte-stimulating hormones and progesterone. Researchers believe the “pregnancy mask” is caused by the boost in progesterone not the melanocyte-stimulating hormone.
In addition, menopausal women who used hormone replacements with progesterone were prone to melasma while those who used estrogen were less likely to have the dark spots on their skin.
Common Causes of Melasma
The most common causes of the dark spots of melasma include: sun exposure, hormone changes such as pregnancy and treatments such as birth control. An over exposure to sun is extremely common among melasma patients. Pregnant women of Asian or Latin descent are especially prone to melasma. Sunscreen is the best defense against melasma.
- A sudden change in hormones often brought on by pregnancy. Melasma that is caused by pregnancy hormones is often referred to as the “pregnancy mask” or Chloasma. Hormone replacements or birth control can also spur the skin problem.
- Sun exposure is the most common melasma causes. Ultraviolet rays spur melanocyte cells to produce melanin (pigment) which produces dark spots on skin. In addition to the initial onset of the melasma, the sun can spark the dark spots on skin to return after fading.
- For people with very hyper-sensitive melanocytes, almost anything that causes irritation to the skin can also stimulate the production of extra melanin. Even cosmetics can trigger the onset of the condition. Irritating makeup or lotion can worsen the condition.
- Irritating cosmetic products can also boost color-producing cells causing the dark spots on skin. Those with a family history of melasma should be especially careful with cosmetic products. To prevent against these threats avoid extra sun exposure and pigment stimulating products.
If you believe you are especially susceptible to melasma, talk with your medical provider before taking birth control pills.
The Signs of Melasma
Melasma appears in three distinct patterns on the face.
- Melasma appears on the center of the face, known as Centro-facial. This is the most common occurrence of the dark skin spots as it appears on the upper lip, chin, forehead, cheeks and nose.
- The malar pattern is identified by melasma on the upper cheeks.
- Dark spots on the jaw are known as the mandibular pattern.
Melasma may also be found on other parts of the body including the upper sides of the neck and the forearms.
Treating the Cause of Melasma
Perhaps the best way to treat melasma is with prevention. Sun protection, such as sunscreen, is the best defense against this skin problem. Experts recommend applying sunscreen on a daily basis. If sun exposure is extreme, sunscreen should be applied every 2 hours to prevent against the dark spots of melasma. However, sunscreen alone may not completely prevent against the severe sun damage. Visit your skincare specialist for stronger treatments.
It is not uncommon for melasma to naturally clear without any form of treatment. Many patients report a decrease in the spots after simply avoiding the sun. Others, who have hormonal melasma, report that their symptoms relinquished after the birth of their child or they stopped taking hormone therapies.
There are several options for treating melasma.
Hydroquinone creams, such as Estoerica or Porcelana, can be purchased over-the-counter if they contain 2 percent hydroquinone. If the cream contains 4 percent hydroquinone, such as Obagi Clear and Solaquin, a prescription is required. Research indicates that even the over-the-counter products can effectively lighten the dark spots of melasma when applied twice a day.
In addition to the cream, sunscreen should be applied daily to prevent against future melasma outbreaks. The over-the-counter products have also proven to be less irritating to the skin. The epidermal type of melasma responds best to these types of creams as it is primarily found on the surface of the dermis.
Hydroquinone + A Form of Acid
In severe cases doctors may prescribe higher doses of hydroquinone with a form of acid in order to reduce the appearance of melasma. These acids include: azelaic, retinoic, tazarotene, adapalene, kojic, lactic and glycolic.
Temporary skin irritation is a common side effect of the melasma medications. Those who require long-term hydroquinone treatments have an increased risk of ochronosis, which is a permanent discoloration of the skin. Ochronosis is rare in the U.S. and is more prominent in countries where doctors prescribe higher concentrations of hydroquinones. In areas such as Africa, doctors may prescribe concentrations of hydroquinones as high as 20 percent. Hydroquinone medications should be discontinued if you suspect that you have ochronosis.
Chemical peels, laser treatments and microdermabrasion are different ways of treating melasma.
A wide variety of chemical peels are available at your doctor’s office and should be tailored to your specific type of melasma. Various combinations of both HQ creams and glycolic acid peels are also used to treat Melasma.
Vacuum suctions, aluminum crystals and diamond chips are all used to reduce the dark spots of melasma during the microdermabrasion treatment. The pressure of the suction can be adjusted to fit your skin type. Microdermabrasion treatments can last anywhere from five minutes to an hour and do not require any recovery time. However, in order to see dramatic results, several microdermabrasion treatments are required. Remember to apply sunscreen daily for best results. Microdermabrasion treatments are considered cosmetic and will not be covered by insurance.
How to treat Melasma? My experience with Laser Melasma Treatment
Laser treatments are also used to treat melasma. These procedures should be used with caution as they can worsen the dark spots on skin if done incorrectly. Multiple treatments are often required in order to see dramatic results.
Like any melasma treatment, it is best to continue a daily sunscreen regimen to ensure the best results.
The Most Effective Way to Treat the Cause of Melasma
By far the most effective melasma treatments will be laser treatments combined with topical creams, and anything else that helps reduce the production of melanin.
There are a number of different kinds of lasers that work in reducing melasma. A real laser specialist might even combine different kinds of lasers to customize the most effective treatment specifically for your skin.
Research indicates that those who effectively treat their melasma feel better about themselves and their appearance. Before experimenting with any over-the-counter products be sure to consult with your skin care professional. Nursing or pregnant women should be especially cautious of strong melasma treatments.
About the Authors
Doctors Alice Pien, MD and Asher Milgrom, Phd are established pioneers in the fields of Regenerative Medicine and Skincare. Their expertise ranges from advanced laser systems to HCT/P – Stem Cell medicine. Their medical education and advanced certifications span from medical schools of NY State University, the University of Chicago, to Johns Hopkins, Harvard and UCLA. They approach medicine with the clinical expertise of over 85,000 successful treatments over the past 20 years and significant scientific research resulting in proprietary protocols that they customize for each individual patient.