Melasma

Melasma

 

Melasma is a common condition that can also be challenging, long-lasting, and refractory to many treatments.  It is characterized by patches of hyperpigmentation, most commonly in females on the face and neck. 

 

Contributing factors include UV exposure, genetic predisposition, and hormonal factors including pregnancy and use of hormonal contraceptives. Recent studies show that melasma may also have a vascular component.  Melasma may be classified by the depth of increased melanin in the skin as epidermal, dermal and mixed.

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Treatment Options

 

Melasma can be difficult to treat. The condition has a high recurrence rate and worsening of the pigmentation after treatments is not uncommon. For these reasons alone, it is worth visiting with a board-certified dermatologist prior to pursuing treatment.

 

The goals of treatment are to lighten the existing pigmentation and to decrease the production of melanin in the skin. Combination therapies often deliver superior results as compared with monotherapy. These interventions include:

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Sun Protection

 

Strict sun protection is the single most important intervention for melasma.

• Apply and reapply a broad-spectrum sunscreen (SPF 30 or higher)

• Wear wide-brimmed hats

• Avoid prolonged exposure to direct sunlight

 

Topical Treatments

 

First-line treatments consist of topical agents: 

• Topical Hydroquinone, a tyrosinase inhibitor, is a first line treatment that can be used alone or in combination with other therapies. 

• Topical Azelaic Acid, another tyrosinase inhibitor, has anti-inflammatory properties and is safe to use during pregnancy and breastfeeding and is ideal for sensitive skin. 

• Topical Tretinoin (Retinoic Acid) acts to turn over cells and can inhibit melanin production.  It is often combined with other topicals to address the pigmentation.

 

Laser and Light Therapies

 

Laser and light therapies are helpful in some cases of melasma which are refractory to other treatments. The low-fluence Q-Switched Nd:YAG laser safely helps to fade and lighten melasma. This short pulse, nanosecond laser treatment is performed as a series of treatments and in combination with other therapies. The QSY laser breaks down excess melanin in areas of the skin affected by melasma. 

 

Systemic Oral Medications

 

Tranexamic acid (TXA), when taken orally, has been proven to be the most effective route at treating refractory and relapsing dermal melasma. TXA can be administered orally, intradermally, and topically in conjunction with microneedling, resurfacing, or other lasers. TXA has traditionally been prescribed for bleeding conditions, however it has been shown to lighten melasma at a low dose, off-label use. Your practitioner will help assess if you are a candidate for this medication. This treatment is usually combined with other topicals and laser treatments.

 

Chemical Peels

 

Chemical peels can be useful for epidermal pigmentation, especially in combination with other treatments. Peels should always occur as a series of treatments. Depending on your skin type, the following peels may be an appropriate treatment for your pigmentation:

• Glycolic and Lactic Acid (alpha hydroxy peel)

• Salicylic Acid (beta hydroxy peel)

• Trichloroacetic Acid (TCA peel)