Melasma is characterized by brown patches on sun-exposed areas, especially on the cheeks, upper lip, nose, forehead, and chin. It often occurs in women in their late 20’s, but can also occur in men.
Melasma is caused by a combination of sun exposure, genetics, and hormonal changes. Ultraviolet radiation and visible light are thought to increase reactive oxidative species production and stimulate hormones that regulate the production of melanin in the epidermis and dermis, which is responsible for the brown patches. Furthermore, there is an increased production of blood vessels and inflammation, which also can trigger increased pigmentation.
Melasma is characterized by light or dark brown patches on sun-exposed areas, such as the cheeks, upper lip, nose, forehead, and chin. The brown patches may or may not have some background redness as a result of increased blood vessel formation and inflammation.
Risk factors for melasma include sun exposure, hormonal changes, and genetic predisposition. Failure to reapply sunscreen or use of a sunscreen that does not block ultraviolet A and visible light can increase the risk of melasma. Patients who are on oral contraceptives or have had pregnancies are at increased risk of melasma.
Melasma is a clinical diagnosis, based on the appearance of light and dark brown patches on sun-exposed areas of the face.
Treatment of melasma starts with using a lightening agent containing hydroquinone 4%, tretinoin 0.05%, and fluocinolone acetonide creams. The hydroquinone helps decrease the production of melanin while the tretinoin promotes the loss of pigment with increased turnover of the skin. The fluocinolone acetonide helps decrease other factors associated with melanin production and reduce potential irritation. Hydroquinone can also be prescribed at higher strengths and also compounded with other lightening agents such as topical kojic acid and tranexamic acid.
Oral tranexamic acid has also been shown to decrease melanin production, redness, and inflammation associated with melasma. While studies have shown the medication does not increase the risk of blood clots in patients without risk factors, patients must be carefully screened based on evaluation of past medication history, family history, and laboratory tests. Oral tranexamic acid is not FDA approved for the treatment of melasma.
Cosmetic procedures, which are not covered by insurance, can help decrease pigmentation associated with melasma. Medium depth chemical peels such as Vi Peel Precision Plus increases epidermal cell turnover and decreases pigment. Light resurfacing lasers such as Clear and BrilliantⓇ Touch Laser and LaseMDTM features a 1927 nm wavelength that absorbs pigment. Sylfirm X is a specific radiofrequency microneedling device that can be used as a superficial pulse wave setting to decrease senescent fibroblasts and redness in the dermis found in melasma. PicoLO laser is a pico laser that can safely break down pigment in the dermis with very short laser pulses. These laser treatments can be combined to optimize results. Intense Pulsed Light (IPL) is not a recommended treatment due to the risk of worsening of melasma.
Sun protection against ultraviolet and visible light is considered the most critical strategy to prevent further worsening of melasma. Patients are encouraged to use a tinted sunscreen containing zinc and iron oxide, as both filters are effective to block ultraviolet and visible light. Examples of these sunscreens include ISDINⓇ Eryfotona Ageless and Skinbetter ScienceⓇ Sunbetter Tone Smart Sunscreen. Wide brimmed hats with UPF of at least 30 or higher will also help protect the face from ultraviolet and visible light exposure.
HeliocareⓇ is a fern extract made of Polypodium leucotomos. Studies have shown the oral supplement has antioxidant properties that protects the skin from the effects of free radicals from ultraviolet exposure that can cause increased pigmentation. Patients are encouraged to take HeliocareⓇ 15 minutes before sun exposure, every two to three hours.
Over time, untreated melasma can be more difficult to treat, especially with the development of dark brown pigment in the dermis (or deeper layer of the skin) and senescent fibroblasts.
Melasma can overlap with other conditions associated with photodamage such as the development of lentigos or sun spots.
Individuals are recommended to immediately incorporate sun protection against ultraviolet and visible light to prevent further worsening of melasma. They are recommended to see a board-certified dermatologist to assess the depth of melasma and discuss treatment options.
Please Note: The information provided on this website is for general informational purposes only and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment. Reliance on any information provided on this website is solely at your own risk. Newbloomderm.com does not endorse or recommend any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on this site. This website does not provide medical advice, and nothing on this website should be interpreted as a diagnosis or treatment.