Welcome to our Skin Concerns Series where our wonderful community asks skin-related questions and Dr. Kademian answers! Today we’re discussing prevention and treatment for melasma.
This article breaks down both at-home and in-office treatment options that are highly effective in the prevention and treatment of this pigment + discoloration. We also include our favorite in-office peels and lasers, plus skincare lines designed to specifically target hyperpigmentation.
Keep reading to learn what you can do to prevent and treat melasma and get your best skin yet!
What is Melasma?
Melasma is hyperpigmentation (discoloration) of the skin. There are different types of melasma that you can have based on where the pigmentation is living.
- Epidermal melasma is when the pigmentation is living in the skin’s top layer. This type of melasma is easier to treat and improvement can be seen more quickly.
- Dermal melasma is that in which the pigmentation is occurring in the skin’s lower layer (the dermis). While these cases can be more stubborn, we are always game for a challenge!
- Combination melasma is—you guessed it—a little bit of both (and not uncommon)!
What Causes Melasma?
Melasma is more common in women than men and often appears between the ages of 20 and 40. Melanocytes (the receptors in the skin that produce pigment) can be activated by a few different things:
- UV light / sun exposure
- Heating of the skin, which can be a result of sun exposure, or even sitting in a hot sauna!
- Hormones (progesterone and estrogen) which is why some women develop melasma during pregnancy! Melasma can also present or worsen with the use of hormonal contraceptive pills.
- Skin trauma or injury that causes hyperpigmentation can lead to melasma (waxing, popping pimples, etc.)
- Genetic predisposition – Many people simply have this in their genes. When one of the above factors occurs, they’re more likely to develop melasma. Melasma is more common in skin types with olive and darker tones, however any individual can develop melasma.
Melasma is most common on the face, neck, chest, and forearms, but can appear on other parts of the body as well.
Prevention & Treatment for Melasma…Can we prevent it?
While we can’t totally prevent melasma—especially if there is a genetic predisposition—there are a few things we can do to keep it at bay. First and foremost: SUN PROTECTION.
- Sun Protection!
We favor broad spectrum SPF like EltaMD, ISDIN and Colorescience and prefer mineral over chemical formulations. We are OBSESSED with ISDIN sun protection. Their formulations enzymatically break down existing sun damage via a plant derived protein, while simultaneously protecting the skin from ultraviolet damage. We are always on the hunt for the best and most effective technologies, and this is one product you do not want to miss.
- Avoid Excessive Heating of the Skin
Since excessive heating of the skin can cause melanocytes to have a party, it can be beneficial to keep skin cool. If you’re beach bound, wear a wide brimmed hat and seek shade.
Remember that exercising in warm environments can even be a trigger: hot yoga, or a run in summer months. Dr. Kademian has seen forehead melasma worsen in runners who run outside in warm temperatures with a ball cap! Be weary of these things if you’re prone to melasma. Consider opting for an indoor temperature-controlled gym on a hot day.
Topical Treatment Options
Topical treatment depends on where your melasma is located (epidermal or dermal) AND your particular skin type (dry, combination, acne-prone, etc.). It is imperative that we do a thorough consultation to assess your skin as treatment is not the same for all individuals. The best treatment for your melasma may not be the best treatment for your BFF!
Luckily, we have an arsenal of highly effective ingredients to treat melasma. These include alpha hydroxy acids, topical cysteamine, hydroquinone, tretinoin, vitamin C, kojic acid, and both topical and oral tranexamic acid.
We carry a few different lines that are specifically formulated to treat melasma, including Cyspera, our own VÉRITÉ line, and several others.
In-Office Treatment Options
Your treatment regimen will be highly specialized and fine-tuned. The presentation of pigment in YOUR skin and other variables in YOUR skin will determine the best treatment plan for YOU! We cannot stress enough the importance of a consultation to receive a game plan and, consequently, your best results.
We have an arsenal of amazing treatments for hyperpigmentation and melasma, but the KEY is to properly prep the skin PRIOR to the treatment so that the repair process (lasers, peels, etc.) does not cause the skin to produce more pigment! Our pre-treatment skin protocols maximize results and minimize risks post-procedure.
Unfortunately, we have many patients who come to us because their melasma worsened after a treatment at another medispa or office. Usually this is because they did not have proper pre and post skin care or were treated with devices or settings inappropriate for their particular skin type.
Our TOP TWO in-office treatments for melasma are:
- Controlled Peels – We absolutely love the results we’ve seen from the VI Peel in particular. This product was developed with the goal of treating darker skin types or skin at risk for melasma safely and effectively.
- Fractionated Clear & Brilliant Laser – This popular fractionated laser treats stubborn pigment, improves texture and fine lines, and decreases pore size with very little to no downtime.
A few more tricks that can be beneficial for melasma on a case-by-case basis:
- Microneedling
- Diamond Glow Treatment (which combines microdermabrasion, extraction and infusion of customized serums to improve texture + tone of the skin)
- A well-rounded skincare regimen with frequent check-ins so that we can tweak as needed, combined with in-office Laser + peels
- Biologique Recherche’s p50 is a phenomenal adjunct to treat hyperpigmentation. We often utilize Biologique Recherche Cream Pigment 400 as well as several BR serums in our toolbox.
A note on IPL/ BBL
PLEASE do not rely on ILP / BBL treatments for your melasma!! As we discussed earlier, melasma can be triggered by heating the skin. IPL / BBL uses broadband light which drives a tremendous amount of heat into the skin! During the treatment, the pigment will pull to the surface and then peel off within a week after treatment to reveal an even skin tone…BUT a few weeks later, those activated melanocytes often begin to activate making melasma and hyperpigmentation worse than before!
Often patients come to us after failed treatments. Please do yourself a favor and make sure that you are consulting with a true skin expert before getting your face blasted with a laser. These tools can be incredibly effective, but in the wrong hands, they can also do tremendous damage. Pre and post care is equally important, as is the education on application, especially when it comes to the prevention and treatment for melasma.
Dr. Kademian’s Recommendations for Prevention & Treatment of Melasma:
Our favorite physical sunscreen at a reasonable price that isn’t white and pasty! EltaMD’s zinc-based sunscreen goes on clear for a lightweight, flawless finish — and it’s even available in a tinted version.
Enter our latest obsession: a fast-absorbing, ultralight all-mineral SPF 50. Its innovative formula contains DNA Repairsomes®, naturally occurring enzymes which are clinically proven to repair existing sun damage. Eryfotona Actinica is the perfect lightweight sunscreen everyday wear.
Colorescience Sunforgettable Brush-On Sunscreen
This full-mineral formulation is great for reapplication throughout the day—so much so that Dr. Kademian likes to always have one on the go!
