Melasma is a facial skin disorder characterized by brown patches of irregular size and shape that appear on the forehead, cheeks, upper lip, and nose. Melasma occurs when certain pigment-producing cells known as melanocytes are stimulated. Female hormones, particularly during pregnancy, can make melanocytes more susceptible to stimulation. Therefore, it is not uncommon for women to present with this type of hyperpigmentation during pregnancy.  Additionally, a history of prolonged sun exposure has been documented as a catalyst of melasma. Women are not the only sufferers: Any individual with a genetic predisposition for melasma can be at risk for developing the condition. Other conditions that may cause melasma include thyroid disease, allergic reactions to medication, cosmetics, and procedures such as waxing that physically manipulate the skin. 

The best approach to treating melasma is a combination of several different techniques. Bleaching agents such as hydroquinone 4% work very well in decreasing the discoloration. It can be advantageous to use a combination of various bleaching agents at a lower percentage, 2%, each. They are equally effective in treating the darker pigmented areas and also help to minimize any unwanted side effects. Tretinon (Retin A), a popular topical agent, is useful in promoting cell turnover, which aids in eliminating the older, more pigmented melanocytes. In women of color, the best results are sometimes achieved using a cream that combines Retin A, hydroquinone, and a mild steroid. These products are available by prescription only and should be used under the care of a physician.

Bleaching agents are most effective in treating melasma when combined with laser and medical microdermabrasion treatments. Microdermabrasion aids the topical agents in breaking down the pigmentations and removing them from the surface of the skin. Fractionated lasers, such as the popular Fraxel, are very effective in treating melasma.

The most effective way to combat melisma, however, is by preventing its occurrence. A good sunscreen is paramount: An SPF of a least 30 should be applied routinely every day, year round. When choosing a sunscreen, it is important to read and understand the ingredients. Sunscreens containing physical blockers such as titanium and zinc oxide are preferred over those containing chemical blockers. This is because UV-A, UV-B, and visible light are all capable of stimulating melanocytes. You don’t have to hide from the sun to remain healthy. With the right treatment and by following a good prescribed home-care protocol, you will be able to lessen the chances of melasma occurring and manage and control this unsightly condition when it does.