Melasma

Key points

Symptom appearance

Melasma presents as brown, gray-brown, or tan patches on the face, most commonly on the cheeks, forehead, nose, and upper lip. The patches usually have a symmetrical distribution and may vary in size and shape.

Triggers

Sun exposure is a significant trigger for melasma. UV radiation can stimulate the production of melanin (the pigment responsible for skin color), leading to the darkening of melasma patches. Hormonal changes, such as those occurring during pregnancy or with hormonal medications, can also contribute to its onset or worsening.

Diagnosis

A dermatologist can typically diagnose melasma based on a visual examination of the skin. In some cases, a Wood’s lamp examination may be used to assess the depth and extent of pigmentation.

Recommendations

Here are some general recommendations that are often suggested for managing melasma. However, it’s important to consult with our healthcare professional for personalized advice and treatment options. Here are some common recommendations for managing melasma:

Sun
protection

The first step in managing melasma is strict sun protection. This includes wearing broad-spectrum sunscreen with a high SPF daily (several times during the day abd even when indoors), seeking shade, and wearing a wide-brimmed hat and protective clothing. Sun exposure can worsen melasma and make it more challenging to treat.

Maintenance
therapy

Melasma is a chronic condition that requires ongoing maintenance to manage its appearance. This includes continued sun protection, regular use of prescribed topical medications, and periodic treatments as recommended by our dermatologist.

Topical
medications

Prescription-strength topical creams or gels containing ingredients such as hydroquinone, retinoids, corticosteroids, kojic acid or azelaic acid can be used to lighten melasma patches. These medications are typically applied directly to the affected areas and work by reducing pigmentation and evening out skin tone.

Procedures

Certain in-office procedures can be effective for treating melasma, including chemical peels, microneedling, PRP and hydrafacial treatments. These procedures aim to reduce pigmentation and promote skin rejuvenation. We personally discourage strong peelings, microdermabrasion and strong lasers as this may worsen the condition at the end. In some cases, a combination of topical medications and procedures may be recommended for optimal results.

Combination
therapy

In some cases, a combination of topical medications may be prescribed to enhance their effectiveness. For example, a combination of hydroquinone, tretinoin (a retinoid), and a corticosteroid may be used for a short period to target melasma more aggressively.

Treatment

While melasma is a chronic condition, so far we have not been able to cure it but there are several treatment options available to manage and improve its appearance. These can include:

Sun
protection

Protecting your skin from the sun is crucial in managing melasma. Use broad-spectrum sunscreen with a high SPF (30 or higher) every day, even on cloudy days and indoors. Reapply sunscreen every two hours, especially if you’re spending time outdoors. Wear wide-brimmed hats, sunglasses, and seek shade when the sun is strongest.

Patience and
consistency

Treating melasma takes time and consistency. Results may not be immediate, and it’s important to follow your dermatologist’s recommendations and treatment plan consistently. Be patient and continue your skincare routine as advised.

Gentle skincare
routine

Use mild, non-irritating skincare products and avoid harsh exfoliants or scrubs that can aggravate the skin. Opt for gentle cleansers, moisturizers, and makeup that are suitable for your skin type and do not trigger irritation or sensitivity.

Regular
follow-ups

Schedule regular follow-up appointments with your dermatologist to monitor your progress and make any necessary adjustments to your treatment plan.

Manage
hormonal factors

If hormonal factors are contributing to your melasma, such as during pregnancy or while taking hormonal medications, it’s important to discuss with our healthcare provider. They may advise on hormonal management strategies or alternative medications to minimize the impact on melasma.