Melasma is skin pigment disorder (hyperpigmentation) which occurs in patches, which is often caused by fluctuations in hormones. It occurs mostly in females, most commonly affects the cheeks, forehead, nose, jawline, and upper lip. When associated with pregnancy it is called Chloasma, “mask of pregnancy”. It is exacerbated by oral contraceptives and exposure to sunlight and heat. Most people have fluctuations in their pigmentation, with the summer months being the worst.
There still is no consensus as to the exact etiology of the disorder. It seems that the melanocytes, the cells which produce pigment (melanin), are abnormally hyperactive. There are 3 forms of the disease: epidermal (superficial), dermal(deep), and mixed. It is often a frustrating disease for both patients and physicians because there is no easy cure. Recurrences are the rule. Often after taking months to improve, one or two sun exposures will reverse the disorder to it’s original state.
The first steps to improve melasma are:
- Limit sun exposure. Use hats, suncreens, and sunglasses daily! Physical sunscreens are better because they also reduce the skin temperature.
- Try to reduce the hormones in your BCP’s or use another form of birth control
- Even if you are fully protected from the sun, heat can exacerbate the pigment, so try to limit outdoor exposure.
- Even visible light has been shown to exacerbate melasma. We now recommend daily use of Heliocare to combat this.
If simple measures don’t improve melasma to your satisfaction, then try these measures from your Dermatologist or Plastic Surgeon:
- Begin Retin A or Retinol. This suppresses the melanocyte and increases cellular turnover thereby decreasing pigmentation.
- Hydroquinone 4%. This is a cream which suppresses the pigmentation production from the melanocyte. Although some physicians go to higher strengths, there are more risks of getting complications and rebound hyperpigmentation. (Please see the link, hydroquinones are on the way out.)
- Lytera from SkinMedica. This is a new product that attacks pigmentation at 4 different levels.
- Chemical Peels. Regular chemical peels seem to help control melasma and are the mainstay of therapy at The Aesthetic Clinique. It seems the consensus among Dermatologists as well.
After exhausting all the above measures and your melasma is still a concern, it’s time to consider using lasers. Only as a last resort are laser used because there are risks of making melasma worse. There are 2 lasers FDA approved for melasma and The Aesthetic Clinique has both of them. The Fraxel Dual is a resurfacing laser and treats the superficial epidermal form of melasma. Usually one to three treatments are needed and there are a few days of downtime. The other laser is the Lutronic Spectra Q switched laser. This is used for all types of melasma and there is no downtime. The Spectra can require 5 to 10 treatments with 1-2 touch ups per year. This laser might give a longer term solution to the problem because it actually causes permanent change to the melanocyte whereas the Fraxel Dual affects the pigmentation secreted from the melanocyte.
Although melasma can be a frustrating stubborn disease, there are many treatment options available. The Aesthetic Clinique has the 2 lasers which are FDA approved for treating melasma.
Please call our office to see what treatment options are available for you melasma. 850.622.1214. The Aesthetic Clinique, Steve Weiner, MD, Facial Plastic Surgeon, between Destin and Panama City Beach, Florida.