Melasma

“Mommy you have dirt on your face!” My son said that to me when he was about two years old. I proceeded to find the nearest mirror only to discover that virtually overnight I had developed a particularly ugly patch, in a not-so-lovely shade of brown, making its way across my cheek. I remember when I was a kid telling my mom that she had so many freckles that they connected and made one big patch of brown. It seemed like an innocent comment at the time, but now I realize karma got me good for that one because oh my, how I battle the brown!

What is Melasma?

Melasma, say it with me, melaaaaaaasma sounds like it should be the name of some super decadent gooey dessert, but actually it is the name of a hormonally driven skin condition that causes patches of unsightly pigment that apparently looks like dirt to small children. This type of pigment is one of the most stubborn and complex skin phenomena that I treat.

As a medical aesthetician, here’s some of what you should know. Sun exposure and hormonal stimuli, like pregnancy, the use of oral contraceptives, and hormone replacement therapy in a genetically predisposed individuals can lead to the development of melasma (aka: chloasma or “mask of pregnancy” when developed while pregnant). Typically, hormonal pigment is seen on the forehead, across the cheek bones, bridge of the nose and on the upper lip and chin (basically 90% of your face). In particularly uncontrolled cases, it can present in other areas of the face and some parts of the body. The condition is mostly found in women, but it is possible for men to develop melasma too. It is more prevalent in darker skin and is thought to be linked to Estrogen and Progesterone sensitivities. Melasma is not physically harmful but the emotional toll of having patches of pigment can be considerable. While there is no cure for melasma, there are several ways to treat it. Be prepared for a fight though, hormones are tricky and so are the pigment patches they stimulate.

What to Lookout for and How to Treat Melasma

When treating sun damage, or hyperpigmented spots resulting from photo stimulation alone, we can use pulsed light therapies like IPL and BBL to efficiently and effectively break down pigmented lesions. Unfortunately though, heat exacerbates melasma, and these treatments produce a lot of heat! Pulsed light, radio frequency and laser therapies could actually worsen melasma instead of improving it because of all the heat they yield. There are some devices on the market that claim to effectively treat melasma despite the heat that they produce. In my experience, these devices clear the skin significantly at first, but then there is a rebound effect and pigment comes back with a vengeance. My go-to treatment is the heat-free option of microneedling with topical lightening agents and peels. When this treatment is administered correctly, it produces beautiful and predictable results. I typically do a series of three spaced 4 weeks apart then 2 maintenance treatments per year in Spring and Fall. There is significant peeling with this treatment that can last for 5-7 days, but the amount of correction we see makes it worth a few side-eye glances from coworkers.

Following treatment, patients should do their best to stay out of the sun or protect with SPF of 30 or better when that’s not possible. Wearing a wide brimmed hat for additional protection, if they plan to be out for longer than 20 minutes, is a good idea. Remember that heat will increase and darken pigment so instruct them to avoid prolonged exposure to heat as well. Patients with melasma will notice that working out or raising the body’s core temperature will also make pigment more visible. With proper in-office care and at-home maintenance, patients can, however, enjoy long term clearing of their melasma.

Home Care Regimen Tips

A good home care regimen should include products that contain active prescription-grade lightening ingredients. There are two that I recommend. One is 4% hydroquinone which can be found in products like ZO Pigment Control Crème 4% HQ – RX. Hydroquinone is a slightly controversial ingredient because it’s found to be carcinogenic when ingested in laboratory mice, but not when applied topically. When applied to the skin, it acts as a tyrosinase (chemical messenger for pigment production) inhibitor but can’t be used long term because the body eventually acclimates to it and there is a rebound effect making pigment more pronounced. We combat this rebound by cycling patients on and off the product. Three months of twice daily 4% HQ application then two months of non-hydroquinone lighteners like Kojic Acid, arbutase or azelaic acid is standard. Another option is Cyspera Intensive Pigment Corrector which contains 5% Cysteamine Hydrochloride, a chemical that already exists in the body and is richly present in human breast milk. This ingredient’s mechanism is, again, to inhibit tyrosinase, but it is also blocking melanin synthesis by inhibiting peroxidase, scavenging dopaquinone, chelating iron and copper ions, and increasing intracellular glutathione. I know, I know, I’m geeking out again! Cyspera has no known side effects and has only three contraindications: vitiligo, pregnancy, and breastfeeding. Most importantly, in a randomized, double blind, placebo controlled clinical study it significantly outperformed 4% HQ. For the most stubborn of melasma, you or your medical director can prescribe a Groot’s cream which is a compounded topical medication formulated with 4%, 6%, or 8%HQ, .05% or .1% tretinoin, an antioxidant and kojic acid. A Groot’s cream prescription should never be used for longer than a three month stretch.

Learn How to Treat Melasma at Med-Surg Academy in Phoenix

Clearing pigment will not only give your patients a boost in self-esteem, it will also give their skin a dewy more reflective appearance! Pigment absorbs light rather than reflecting it, making the skin look dull and sallow, and enhancing fine lines and wrinkles. Nobody wants that. As a provider, be wary of any treatment that leaves the skin hot or sunburned feeling. Remember that heat exacerbates melasma.

To learn how to treat Melasma efficiently and correctly, consider registering for one of our upcoming Laser and Aesthetic Training courses. Click here to contact us and learn more about our Medical Aesthetics certification programs.