What is melasma?
is skin discoloration (tan, brown, blue or black) found most
commonly on sun-exposed areas of the face.
What causes melasma?
Melasma is a common skin disorder. Though it can
affect anyone, women with darker skin tones (especially Hispanic,
Asian, Indian, and Middle Eastern) are at greatest risk. Melasma
can be associated with the female hormones estrogen and progesterone.
It is especially common in pregnant women, women who are taking
oral contraceptives, and women taking hormone replacement therapy
during menopause. The use of cosmetics is associated with melasma
but the relationship between the two is not understood. Sun exposure
is strongly associated with melasma.
What are the symptoms of melasma?
Melasma has no associated symptoms.
What does melasma look like?
Melasma causes irregular tan, brown, or even blue/black
patches on parts of the face including cheeks, forehead, nose, chin,
jaw line, and upper lip. It is most often symmetrical (matching
on both sides of the face).
How is the diagnosis of melasma made?
Your physician can usually diagnose melasma based
upon the appearance of your skin. Your physician may want to examine
your skin with a Wood’s lamp to help guide treatment.
What treatment options are available?
The best treatment for melasma is prevention.
The key to preventing melasma is sun avoidance and daily sunscreen
use. However, for most of us, it is too late for prevention, and
there are a number of treatment options available.
• What they are?
Over-the-counter creams contain 2 percent hydroquinone,
a bleaching agent. Prescription creams may use single agents, such
as Retin-A (tretinoin) or combinations of medications such as hydroquinone
with tretinoin plus a cortisone cream.
• What are the risks?
Over the counter bleaching creams are usually
well tolerated and may gradually lighten melasma over a couple of
months. However, they are not very effective. Prescription formulations
are often more effective but may have more side effects (such as
redness, drying, and peeling) and are expensive. Creams may not
work for everyone and the risks and benefits need to be discussed
with your physician.
• What are they?
Your physician can administer a peel using a variety
of different chemicals to remove age spots, melasma, freckles, wrinkles,
and fine lines. Chemical peels may smooth and firm the skin and
may lighten dark areas gradually. The superficial peels, such as
a glycolic acid peel can be done during your lunch hour, and there
is no recovery time. Deeper peels are more effective but require
longer recovery. See more details under discussion chemical peels.
• What are the risks?
Different kinds of peels carry different risks.
Superficial peels are usually quite safe. However, you may need
a series of superficial peels (done approximately once a month)
before you'll notice improvement. Costs can add up if you choose
a series of peels. The risks and benefits vary depending on the
kind of peel and need to be discussed in detail with your physician.
• What is it?
Laser resurfacing is an in-office treatment where
age spots, melasma, wrinkles, and fine lines are “burned”
off with a laser. Laser resurfacing can remove most age spots, melasma,
and wrinkles, often in just one treatment. Some lasers, such as
the CO2 laser are considered the gold standard in terms of facial
rejuvenation. With good sun protection, the effects can last up
to five years. See more details under discussion of lasers.
• What are the risks?
Lasers actually remove the outer portion of the
skin- called the epidermis. Because of this, you may experience
some pain as well as redness and peeling. You may even form scabs
in the days after the procedure. Expect recovery time of at least
a week. Laser therapy is also expensive. One treatment can cost
anywhere from $1,000 to $5,000, depending on how much of your face
is treated. The risks and benefits of laser resurfacing need to
be discussed in detail with your physician.
Intense Pulsed Light Therapy (IPL)
• What is it?
IPL is one of the newer forms of facial rejuvenation.
Unlike lasers, which use intense, focused light, IPL is intense
broadband light. Although IPL delivers energy to both the superficial
and deep layers of the skin, the epidermis is spared from damage.
Thus, there is virtually no recovery time. In the studies that have
been performed so far, IPL can smooth the skin and fade age spots,
freckles, melasma, and even broken blood vessels. Improvements usually
last for about a year with good sun protection.
• What are the risks?
IPL is safer than laser therapy because IPL does
not damage the epidermis. There may be some pain during the procedure
but no recovery time. Unlike laser therapy, however, you may need
multiple treatments (average is 4-6, at three weeks intervals) to
get the full benefit. The cost is variable, but is usually more
expensive than peels and less expensive than lasers. The risks and
benefits of IPL therapy need to be discussed in detail with your
What are some causes and treatments for melasma?
Melasma is said to be a form of pigmentation on the face usually mistaken for a tan,
appearing around the cheeks, forehead, upper lip, nose, chin, and jaw line. It also may
appear on the forearms, but this is quite rare. Although it is most common in women of
childbearing age, you don’t even have to be women to be afflicted by it. Up to 10% of
cases are shown in dark skinned men. Although there is no real cure, there are steps you
can take to avoid it, to minimize the visible effects and keep them at a minimum. Successful
treatment usually begins with the trio of sunblocks, bleaching creams and time.
Sun exposure is said to be the biggest culprit. In the summer, melasma tends to darken
after exposure to the sun, fading in winter when the sun is not as harsh. Melanin absorbs
the energy of the sun’s rays in order to protect the skin, tanning occurs as a result,
causing dark areas to get even darker.
The melasma pregnancy mask syndrome impacts Latino and Asian women primarily, producing
darkened coloring spots on the face. Skin inflammations from allergic reactions, or waxing
of facial hair especially above the lip, can also be a trigger, in addition to a
predisposition to the affliction. Some medications can also contribute to the cause, such
as the antibiotics like tetracycline, and some anti-seizure and anti-malarial drugs.
The good news is that melasma symptoms tend to fade over time, usually a 3 to 4 month period
after initial manifestation. Laser skin resurfacing offers a relatively successful and controlled
short-term strategy to the facial areas affected by melasma. Chemical peels are also a
consideration. An alternate for use may be steroidal creams and even skin bleaching cream
formulations that include hydroquinone or retinoic acid- these tend to produce encouraging
It is vital that you avoid the sun contraceptive pills that are prone to this type of
reaction. Lifestyle choices have a heavy impact on the rise and spread of melasma. Since
genetics and family heredity are key initial factors, but avoidance of these two main
elements can really impact the continued affliction.
Complex factors may trigger melasma in women, as well as the 15% of men that are
afflicted. Topical creams have been known to have great results, as have skin bleachers,
chemical peels and laser skin resurfacing all provide positive results. Left alone, and
not intensified by sun exposure, melasma tends to stay around for less than a year. Impacted
skin cells with the discoloration are "surface" cells, and melasma becomes "permanent" is
if the discolored area splits, allowing these hyper-pigmented cells to go deeper into the
skin layers. When the discolored cells with melasma are settled within your deeper dermal
tissue levels, they resist conventional treatments.
Be aware of the health of your skin is a major responsibility. Try to avoid drying your skin
out, as well as over moisturizing it. It is a good rule of thumb to avoid sun exposure, but
to use sunscreen daily with atleast a SPF 30 while taking in the appropriate supplements to
counter the sun’s rays, ensuring both your inside health and outside appearance are as well
as they can be.
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