If You’ve Ever Dealt With Melasma, You Should Read This

Expert Advice

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Hyperpigmentation comes in all kinds of forms. Tiny dark spots that form at the edge of your eyes, splotchy redness on your neck, and post-inflammatory spots that linger after a breakout. Melasma is another common form of hyperpigmentation, and it’s more common than you may realize. It’s also one of the more difficult types to treat since it can rear its head over and over again. If you’ve ever had melasma, are dealing with melasma now, or know someone who is, we’ve got answers for you.

What is Melasma?

Unlike other forms of hyperpigmentation, melasma shows up almost exclusively on the face – including the cheeks, forehead, and nose – and it’s characterized by recurring, chronic discoloration.

What also sets it apart from other types of discoloration is that it disproportionately impacts women of reproductive age and seems to be closely linked with hormones. In fact, melasma even has a second name – pregnancy mask” – because it often appears or gets worse while pregnant. (Interestingly, men with melasma have been found to have low testosterone levels, which also suggests a hormonal link.)

Certain ethnicities are also more prone to experiencing melasma, including those from East Asia (Japan, Korea and China), India, Pakistan, and people from the Middle East and Mediterranean-Africa.

What Causes Melasma?

There is yet to be a defining or known cause for melasma, but it’s clear that hormonal fluctuations have an impact, notes Dr. Simran Sethi, MD and founder of RenewMDBeauty & Wellness. Big changes that occur with pregnancy and menopause seem to especially trigger melasma.

Physiologically-speaking, Dr. Sethi says melasma is caused by hyperfunctionalmelanocytes”– AKA pigment-producing cells. They deposit excessive amounts of melanin pigment in the superficial skin layer (the epidermis) and the deepest skin layer (the dermis).

Melasma is made notably worse by sun exposure. It can cause existing melasma hyperpigmentation to darken or get bigger – even if previously treated and faded – and can trigger new episodes.

How Do You Treat Melasma?

Generally speaking, hyperpigmentation is a bear to treat. Melasma is known for being even trickier to treat, largely because it’s so sensitive to triggers like hormones and sunshine. What makes it especially frustrating is that melasma can fade pretty substantially and then come back with a vengeance.

Typically, melasma gets lighter during colder months and seems to be exacerbated in heat or sunlight,” explains Dr. Sethi. She adds, “Melasma can be treated with some in-office medical- aesthetic treatments. However, these treatments are generally not permanent, and maintenance is highly recommended.

The three best things you can do to treat melasma are to wear sunscreen every day, follow a nourishing, hydrating skincare routine, and use exfoliating treatments.

1. Wear Full Spectrum SPF 30+ Every Day Without Fail.

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Dr. Sethi says, “Wear sunscreen even when it is not sunny, and also when sitting in front of your computer indoors. We get incident light from windows, which is why wearing sun protection indoors is as important as outdoors.

Sunscreen doesn’t have to be boring, btw! There are so many gorgeous, glowy, lightweight options that’ll have your skin looking lit. Some of our favorite facial sunscreens include:

Neogen Dermalogy Day-Light Protection Airy Sunscreen, $32
• Buttah Skin Tinted Mineral Sunscreen SPF 30, $24

If you have sensitive, oily or acne-prone skin, we particularly love the all-mineral Biossance Squalane + Zinc Sheer Mineral Sunscreen SPF 30 PA +++, $30, which works beautifully under makeup, doesn’t feel sticky and doesn’t leave an obvious white cast.

2. Follow a Nourishing Skincare Routine

A consistent, nourishing skincare routine is a must for everyone, but it can make a notable difference with melasma.

Melasma can deplete the integrity of the skin barrier between the superficial epidermis layer that houses pigment cells and the deeper dermis layer,” says Dr. Sethi. “If skin dryness or inflammation is present, it will further deplete the skin barriers and promote pigment deposits, making it difficult for potential treatments for melasma – like laser therapies or microneedling – to reach the pigment.

A solid skincare regimen consists of a gentle cleanser, hydrating serum, moisturizing lotion, and daily SPF – in that order! You can double down on the above by adding nourishing masks once or twice a week.

3. Try Exfoliating Treatments and Products

Along with preventative care and maintenance, you can target melasma with exfoliating products and treatments. There are some over-the-counter options available that can help slightly, but more aggressive in-office treatments will likely provide better results.

Over-the-counter ingredients to look for include trichloroacetic acid (TCA), tranexamic acid, arbutin, and tetrahexyldecyl ascorbate (THD). Some of our favorite products to try are:

StackedSkincare TCA Lactic & Glycolic Face Peel (mini), $42 
Ourself Daily Dark Spot Intercept, $260
SkinCeuticals Discoloration Defense, $98

There are a handful of in-office treatments that can make a notable dent in melasma discoloration. Some of the more popular options include specific types of laser treatments (note that some lasers can actually make melasma worse!), microneedling, and strong chemical peels.

Typical laser treatments contradict with melasma because heat and light exposure inflame and worsen, especially, if they are not designed to treat or suitable for deeper and darker pigment and melanated skin,” says Dr. Sethi. “I always recommend the Picosure Laser, which delivers pressure waves in very short pulses to break pigment without generating heat, making it safe and effective for melasma pigmentation reduction. 

When treating melasma with Picosure, Dr. Sethi starts with four to six treatments spread four weeks apart. In some cases, she may also prescribe 8% hydroquinone to reduce additional melanocyte activity during treatment.

In-office microneedling and/or aggressive chemical peels using AHAs, TCA, and hydroquinone can also help. As is often the case, a customized approach that’s tailored to your specific needs is best.

Have you dealt with melasma before? What’s your experience been like? Let’s chat in the comments. 

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