Melasma

Characterized by brown discolored patches, melasma is a common cause of facial dyspigmentation. These patches are usually asymptomatic, involving the cheeks, forehead, nose, and/or perioral areas. Melasma tends to favor individuals with darker skin types and occurs almost exclusively in the adult female population.

Causes

While the exact cause remains unclear, melasma appears to be driven by physical and hormonal factors. Sunlight is considered the number one trigger or modifiable risk factor, and as such, strict avoidance and photoprotection is critical to ongoing management. Additionally, estrogen and progesterone appear to play significant roles of their own, explaining why adult females are primarily affected.

Diagnosis / Treatment

Typically, your dermatologist will diagnose melasma on routine physical exam. Occasionally, he or she may use a special light known as Wood’s Lamp to assess the depth of your disease. Finally if other conditions are being considered, it may be necessary to undergo skin biopsy for confirmation or further assessment. 

Melasma often fades in winter months and with hormonal changes such as post-pregnancy. However, most patients will suffer with the condition for several months, years, or even the rest of their lives. For those seeking treatment, there are numerous options available including topical, oral, and procedural interventions. 

• Sun Protection: Crucial for ALL patients, regardless of other treatments or procedures. For sunscreen, it is physical blockers are recommended, such as zinc and titanium, as well as iron oxide for blue light protection. 
• Over-The-Counter (OTC) Topicals: Countless agents from nearly every major cosmetic brand. Typically contain weak skin-bleaching agents such as hydroquinone, kojic acid, L-arbutin, azelaic acid, L-ascorbic acid.
• Prescription Topicals: Similar compounds as OTC but with higher strength and concentration. To be utilized under direct physician supervision as misuse can lead to paradoxical skin-darkening. 
• Tranexamic Acid (Oral>Topical): Novel therapeutic agent that is highly effective for many patients. Should be managed by your dermatologist due to risks for side effects such as blood clotting, etc.
• Chemical Peels: Performed in-office with various agents such as glycolic acid, TCA, and proprietary blends. Typically requires multiple sessions over a period of weeks to months.
• Laser: Should be used with extreme caution, only under direct supervision of your dermatologist’s office. Inappropriate devices or laser settings can lead to significant worsening or irreversible scarring.