Treating the Persistent Hyperpigmentation of Melasma

Melasma is a common, stubborn, and recalcitrant dermatological condition we see in Bonita Springs, Marco Island, and Naples. The skin discoloration typically effects pre-menopausal women and is characterized by brown patches on sun-exposed areas—specifically the face. These asymptomatic brown patches are usually symmetric and with irregular borders. Melasma is not harmful, but many people do find it to be a cosmetic nuisance. 

The most common triggers for melasma include hormones (estrogen and progesterone), birth control pills, ultraviolet light, visible light, and heat. Melasma is often called the “mask of pregnancy” because it is commonly triggered by the hormonal changes associated with having a baby.

Melasma is something that we treat, but do not cure. The treatments improve melasma, however, further exposure to triggers is likely to cause a recurrence. Florida is unfortunately a difficult place to treat melasma because even exceedingly small doses of light (for example, walking to the car/mailbox) are enough to further worsen the hyperpigmentation. That being said, persistence with a good skin care regimen, proper treatment, and sun avoidance will keep melasma under control. 

Thankfully, there are numerous treatment options, and I will cover some of them today. The most important treatment is sunscreen and sun avoidance! Staying out of the sun and heat is paramount. In addition to sunscreen, wide-brim hats, sunglasses, and neck gaiters are extremely helpful. There are also full-face visors for those looking to go the extra mile.

A thoughtfully crafted topical regimen is critical to treatment success. Again, the first step is daily sunscreen application. The best sunscreen for melasma is one containing iron oxides (typically a tinted zinc-based sunscreen). There are different topicals that reduce hyperpigmentation, including (but not limited to) antioxidants (SkinCeuticals CE Ferulic and Phloretin CF), tranexamic acid (SkinCeuticals Discoloration Defense), hydroquinone, kojic acid, azelaic acid, alpha/beta hydroxy acids, and retinols. Heliocare is an oral herbal supplement, derived from the Polypodium leucotomos fern plant. When taken daily, it works in conjunction with your sunscreen to block the effects of UV light.

Light to medical depth chemical peels are also effective for treating melasma, and there are many options, including alpha hydroxy acids, beta hydroxy acids, and trichloroacetic acid (TCA). 

Finally, laser and light-based devices can be used to treat melasma, but must be used with caution. If the laser settings are too aggressive, they can cause worsening of the pigmentation. 

Although melasma is a chronic condition, it can be managed with the help of your dermatologist. Contact us atSkin Wellness Physicians to arrange a consultation. Send a message online or call (239) 732-0044.

Dr. Anne Marie Tremaine

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