Melasma: Causes and Treatments

Melasma is a common skin condition that occurs primarily in women. It tends to be most prevalent in women with a light brown skin tone such as Hispanics, Asians, Indians, Middle Easterners, and those from North Africa. And, it affects millions of individuals worldwide with more prevalence in the summer than the winter.

When Melasma is associated with pregnancy, it is called chloasma or “mask of pregnancy”.

What Does Melasma Look Like?

Melasma appears as a skin discoloration of dark, irregular patches on the face of adults. Both sides of the face are usually affected, with the cheeks, bridge of nose, forehead, and upper lip commonly involved. It tends not to cause any other symptoms beyond the discoloration.

What Causes Melasma?

Although the exact cause of Melasma is unknown, it’s thought that it may be triggered by hormonal changes involving estrogen and/or progesterone. Melanocytes (pigment producing cells) are stimulated resulting in the production of melanin pigmentation. Birth control pills may also lead to the condition. And a genetic predisposition may also be implicated.

Exposure to the sun’s ultraviolet rays can contribute to Melasma by stimulating melanocytes, or pigment producing cells in the skin. It’s thought that this is one reason why Melasma tends to affect darker skinned individuals more as they tend to have more melanocytes than lighter skinned individuals.

Treatment of Melasma

If Melasma is caused by the hormonal changes associated with pregnancy or the use of birth control pills, then the discoloration may spontaneously disappear after giving birth or stopping use of the oral contraceptive. However, it may also remain for many years.

There’s no known cure for Melasma, but a multi pronged approach, using a number of active ingredients that attack the problem in different, but synergistic ways, is most effective. Here’s an overview of ingredients and products to consider:

1. Sunscreens – The most important aspect to managing and treating Melasma is sun avoidance at all costs. UV rays darken pale pigmentation and will make it more noticeable even after just a few hours.
Choose a broad spectrum UVA and UVB blocking sunscreen that delivers maximal protection from the sun’s rays. And, wear it everyday, year round, regardless of the weather or whether you are indoors or out. UVA rays can penetrate through clouds and windows.
Look for a minimum of SPF 30, but go higher if you can. Good choices are Anthelios sunscreens, which come in a range of SPFs, as high as 60. If you have sensitive skin, then consider a product like Cotz SPF 58 Total Block, which incorporates physical blockers zinc oxide and titanium dioxide.

2. Bleaching creams – Technically not “bleaching creams”, these creams lighten skin by decreasing the activity of melanocytes at various stages. Bleaching creams can include a range of ingredients either on their own or combined with other ingredients:

Hydroquinone– Considered the gold standard for the treatment of Melasma and other hyperpigmentation disorders, hydroquinone is one of the most commonly used bleaching ingredients. It may be purchased as a 4% concentration while higher concentrations can be made to order by a compounding pharmacy by prescription. Hydroquinone is often combined with a Vitamin A derivative such as a prescription retinoid or over the counter retinol such as Green Cream with good efficacy. Choose from a range of brands including Lustra and Glyquin XM.

Arbutin – Extracted from the Bearberry plant, arbutin is also found in wheat and pear skins and works by inhibiting tyrosinase, the enzyme responsible for the synthesis of melanin. Bearberry extract is found in Neostrata Spot Lightener, which also includes Gigawhite, another effective inhibitor of tyrosinase.

Tyrostat – Also known as Rumex occidentalis, Tyrostat is derived from Field Dock, a plant native to the Canadian prairies. Extracts of Field dock have been shown to inhibit tyrosinase. You can find Rumex extract in Reversa UV Anti Spot UV Treatment or Reversa Anti Spot Night Care

Gigawhite – This skin brightening complex is derived from plants and has been shown to inhibit tyrosinase at concentrations between 3 and 5%. Consider Neostrata Spot Lightener.

Kojic acid – Used widely throughout Asia as a bleaching agent, kojic acid is derived from fungal material and helps to reduce the synthesis of melanin. Consider Mela D (with added SPF 15 protection) or Mela D Bright (with the added benefits of Vitamin C).

3.  Alpha Hydroxy Acids (AHAs) – work by exfoliating the top layer of skin and removing pigmentation. Research has shown that they may also inhibit the production of melanin. AHAs include ingredients such as glycolic acid, lactic acid, malic acid and mandelic acid. They are often added to bleaching agents to increase their penetration as well as remove pigmentation. Consider products such as Lustra and Glyquin XM, which include hydroquinone plus alpha hydroxy acid. MaMa Lotion is a unique combination of mandelic and malic acids and is particularly suitable for dark or sensitive skin types.

4. Vitamin C – Has been shown to have skin brightening properties at higher concentrations (5% or higher). Look for magnesium ascorbyl phosphate, L-ascorbic acid, ascorbyl glucosamine. Consider products such as UltimaSkin Potent C, La Roche Posay Active C, Active C XL, Credentials Vitamin C Serum.

5. Retinoids – Increase cell turnover and are often combined with hydroquinone to effectively lighten skin. While retinoids may not be the best option as a sole treatment option for skin lightening, good results can be obtained in conjunction with hydroquinone. Retinoids may be continued once skin has been lightened satisfactorily due to its many skin benefits including cell communication, stimulation of collagen production, and increase in skin thickness. Consider Green Cream, which contains retinol, a non-prescription retinoid.

6. Chemical Peels – Always work with a qualified professional if you choose to undergo a chemical peel. Though a peel may benefit some individuals there is always the risk of inflammation and injury, such as post inflammatory hyperpigmentation – just the opposite of the effect you are trying to achieve.

7. Laser treatments – Results vary amongst individuals and not everyone will see a benefit. However, it does work well for some individuals. Laser treatments can be combined with any of the topical treatments discussed above and if this is the route you select, work with a skilled dermatologist to ensure that they are using the right type of laser for your skin type.

The treatment of Melasma is a gradual process and you may have to try a number of products before finding a regimen that works for you. Once you’ve achieved your desired results, stick with your sunscreen. You may also want to continue with any alpha hydroxy acid, retinoid or botanical brighteners such as Vitamin C. These ingredients deliver additional skin benefits beyond skin lightening and are an important component of any anti aging skin care plan.