Melasma is a discoloration of the skin most commonly found on the face. It has several names including Chloasma and the mask of pregnancy. Although it can affect anyone, melasma is particularly common in women, especially pregnant women and those who are taking oral contraceptives or other hormonal therapies. Its occurrence is greatest in darker skinned individuals such as Hispanics or those of Middle Eastern descent.
The presence of Melasma is marked by dark, irregularly shaped patches found on the upper cheek, nose, lips, and forehead. It is a disease of hormonally induced sun sensitivity, mostly estrogen and progesterone. Patients with thyroid abnormalities may get Melasma as well. Although it is correlated with sun exposure it is dissimilar to the type of pigmentation seen in sun damage and sun spots.
Melasma can occur in the superficial and deeper layers of the skin. Its presence is each area can be determined with the use of a Wood’s lamp in Dr Frank’s office. Determining where the increased pigment is helps in deciding which of the several treatment options will be best for the patient. Regardless of the treatment, the effects are gradual and a strict avoidance of sun is essential. The use of broad-spectrum sunscreens with physical blockers, such as titanium dioxide and zinc dioxide is preferred over other sunscreens. Topical treatments include bleaching agents such as hydroquinone, retin-A, Azelaic acid, and Kojic acid and antioxidants. See PFRANKMD skincare.
Older, less aggressive cosmetic treatments include light chemical peels and microdermabrasion. To date, the most effective treatments involve the combined use of topical therapy and lasers. There are several lasers that are used depending on the patients skin type, the severity of the condition, and the depth of the pigment. The Photofacial laser, the Fraxel Restore, or Fraxel Dual/Thulium all provide excellent options. Read about our treatments online and ask Dr Frank which treatment plan will best suit you.
Treatments to hasten the fading of the discolored patches include:
Topical depigmenting agents, such as hydroquinone (HQ) either in over-the-counter (2%) or prescription (4%) strength. HQ is a chemical that inhibits tyrosinase, an enzyme involved in the production of melanin.
Tretinoin, an acid that increases skin cell (keratinocyte) turnover. This treatment cannot be used during pregnancy.
Azelaic acid (20%), thought to decrease the activity of melanocytes.
Facial peel with alpha hydroxyacids or chemical peels with glycolic acid.
Laser treatment. A Wood’s lamp test should be used to determine whether the melasma is epidermal or dermal. If the melasma is dermal, Fraxel laser has been shown in studies to provide improvement in many patients. However, intense pulsed light will actually darken the spots. Dermal melasma is generally unresponsive to most treatments, and has only been found to lighten with products containing mandelic acid (such as Triluma cream) or Fraxel laser.