Melasma

Melasma also known as chloasma, is a skin condition that presents itself in brown or tan discolorations. They are commonly mistaken for age spots, freckles or sun damage. While age and sun play a factor in its severity, they are not the main cause. Melasma happens when the melanocyte stimulating hormone goes into overdrive. Melanocytes are the cells in the skin that deposit pigment. Melasma is not cancer causing or seen as a danger in skin health it is considered a cosmetic concern.

Typically found in women ages 20-50 it is uncommon to find in males. Melasma has many factors of how and why it develops. Studies have found that sun exposure and hormones play a key role in triggering as well as the role in genetics. Sun exposure is the main culprit for formations as this creates the rush in melanocytes to protect the skin. When one is predisposed (genetics) for melasma those cells are set into overdrive with overstimulation by heat, sun and hormones. Many find that in the summer it will worsen and in the winter fade or go away completely. This is why many assume it is just sun damage. Birth control and any kind of hormonal imbalance are also key factors. Chloasma is classified as melasma that comes out when a woman is pregnant and commonly referred as a pregnancy mask. The discoloration can become quite apparent and it usually forms around the sides of the jawline, middle face such as the upper lip, and the forehead. A tip to determine if you have this skin condition is to assess the opposite side of the face, the pigment will typically mirror eachother. Darker, olive, and asian skin types are most prone to this skin condition but can also be prevalent in fair skin types.

Three types of melasma

1. Epidermal (surface layer) = Excess melanin sits in the superficial layers of the skin.
2. Dermal (middle layer of the skin)= As the new cells regenerate they absorb melanin called melanophages.
3. Mixed (both epidermal and dermal)

Treatments and products can be beneficial in minimizing, clearing, and maintaining an even skin complexion. It is important to become educated and see a professional for treatments and products as many can cause an increase in melanin production or irritate the skin. Treating this skin condition too aggressively may backfire with a vengeance and can make it worse especially in daker or asian skin types. Like many skin concerns the treatment takes time before desired results, and proper patient home care maintenance is key in keeping a desired outcome. Assessing the skin with a professional can indicate how stubborn or severe the melasma is. Like an iceberg what is on the surface is not always what is below. Melasma can be deeper into the layers of the skin than believed to be, or only remain on the surface. Many times aggressively treating what is on the surface will only trigger an inflammatory response into the skin causing more damage such as hyperpigmentation or hypopigmentation. Making sure your patient is on a sunscreen regimen daily with at least a 50 spf with both UVA and UVB protection. Infrared rays cause heat damage which is also important in treating melasma A physical sunscreen with Zinc and titanium is preferred as these protect against UVA rays most effectively.

Melasma fast facts

1. Brown, tan, blue-grey spots and hyperpigmentation
2. Women ages 20-50
3. Found in center of face, jawline, and cheeks
4. Avoid sun exposure and wear minimum physical SPF 50 for prevention and protection against UVA/UVB/IR
5. Eat a diet rich in antioxidants, VIT-D and Zinc
6. Avoid hormone supplements
7. Birth control, heat damage, and sun exposure are main triggers
8. Best results are those customized for epidermal and dermal levels
9. Patient compliance with home care and maintenance followed strictly for best results
10. extreme heat weather conditions and internal heat should be avoided when possible.

For a true professional diagnosis a dermatology or skin professional will assess the skin visually or with a woods lamp. In rare cases, a biopsy may be taken if something appears irregular. Hydroquinone is the most widely used and most effective skin lightening product that will fade stubborn melasma. Although, depending on your residing state you may need a prescription. Using Hydroquinone for too long of a period (months—>years) in too high of a dose can cause temporary skin irritation (redness, peeling, burning), HQ also passes through the liver so it is usually recommended to cycle on and off every 3-6 months depending on physicians orders. In rare cases using extreme high doses 10-20% HQ can cause exogenous ochronosis where the skin is permanently darker (uncommon in the United States). Hydroquinone works by blocking the enzymatic channel that involves the tyrosinase which is the enzyme that converts dopamine to melanin.

Treatment Products

1. 2%-4% HQ (hydroquinone)*
2. Obagi Clear (with HQ)*
3. Retinoic acid/Tretinoin/Vitamin A/tazorac/adapalene*
4. azelaic acid (HQ alternative)
5. TCA (trichloroacetic acid)
6. Lactic 12%
7. Glycolics 10-20%
8. Lytera 2.0, Brightalive, Discoloration Defense (skin brighteners non irritating)

*requires prescription

In Office Professional Treatments

1. Peels light to medium depth tailored to patients skin type and condition.
2. Pure Retinol peels 4%-6%
3. Combination of Microdermabrasion and peels (less aggressive)
4. Microneedling
5. Laser (not an ideal method due to the heat damage which can trigger an inflammatory response.)

In my professional treatment experience, micro-needling and PCA 4%-6% pure retinol peels have proven the best results as well as the ZO skin health 3 step peel. All of which take time and may require multiple treatments for maximum benefits. I cannot stress enough how important home care is in protecting the time and financial investment on your skin and maintaining results.

Resources: https://www.medicinenet.com/melasma/article.htm