Melasma is a common condition characterized by the appearance of dark patches on the skin. Any area on the skin can be affected; the most common areas are the forehead, upper cheeks, and above the lips. Melasma is caused by an imbalance of hormones on the inside which makes the skin very sensitive to the sun. When exposed to the sun, the patches appear and become dark. The pigment that is produced in the skin can be deposited either in the surface layers, deep layers, or most commonly both. The dark patches are seen more frequently in the summer months when the suns rays are stronger and when people are outdoors more. Melasma affects women more frequently than men and is common when hormone levels change such as during pregnancy, after delivery, and when going on or off birth control pills.
Since the cause of melasma is internal, unfortunately there is no cure. So melasma is a condition that is controlled, not cured. Treatment is multi-factorial and can often be frustrating. The most important aspect of treatment is applying sunscreen every day and minimizing sun exposure. Look for a physical sunscreen with active ingredients such as zinc oxide or titanium dioxide that has an SPF of at least 30. These provide broad spectrum coverage, meaning they protect against UVA rays which causes aging and UVB rays which cause burns. The next step in treatment includes the use of a good skin care regimen that prevents the skin from producing excessive pigment. Dr. Alex recommends the A E Skin Brightening Cream, Exfoliating Serum, Triple Antioxidant Serum, and Hydrating Serum. Look for products that reduce pigmentation. Active ingredients in such products include hydroquinone, kojic acid, vitamin C, alpha-arbutin, licorice extract, and a variety of others. Ingredients such as retinol, retin-A, salicylic acid, glycolic acid, and lactic acid will help to exfoliate the skin to get the pigment out faster. Often times these products will dry or irritate the skin so it is important to moisturize the skin twice daily. Lighter moisturizers work well for youthful skin, while heavier moisturizers work better for mature skin. Adding products with hyaluronic acid to the regimen will increase the hydration and benefit the skin. It is important to use a good skin care regimen for three months prior to having any treatments. This will correct the skin before the treatment and prevent the risk of worsening of the melasma with treatments.
There are a variety of treatments available for melasma. After having a good skin care regimen in place, the most important aspect of melasma treatment is to be conservative. Treatments must be mild and six to eight sessions are often required. Treatments are usually performed every four to eight weeks. The mildest treatments include basic facials and microdermabrasion. Microneedling and Ultra Microneedling are also effective treatments. Chemical peels and laser peels serve to exfoliate the skin and get the pigment out to the surface faster. Contrary to what most people hear, IPL photofacials can be used to treat melasma. Such treatments are useful especially when the pigment is closer to the surface. Not all IPL photofacial devices are versatile. But the Forever Young BBL IPL photofacial by Sciton that Dr. Alex uses has many settings that can be adjusted for safe treatment of melasma. Dr. Alex uses higher wavelengths of light, lower energy settings, longer pulse widths (the time that the light is on), and colder temperatures to ensure safe treatments. When the pigment is in deeper layers of the skin, fractional lasers such as Pro Fractional or fractional CO2 can be used. These create tiny hole sin the skin which allow the pigment in the deeper layers to come out. Again, many people say not to use such devices for melasma. But they can be effective when appropriate settings are used, the dwell time should be minimized and treatment densities should be low. Combining multiple of such modalities will provide even better results.