What is Melasma?
Melasma is a common (and often life-long) skin condition in which the skin is discolored with brown patches commonly located on the forehead, cheeks, upper lip, and/or bridge of the nose. The patches are often symmetrical - occurring in the same area on both sides of the face - and are primarily seen in women.
What Causes Melasma?
There are several internal and external factors that contribute to melasma including hormones (think birth control pills, pregnancy, breastfeeding), sun exposure (think tanning beds, time spent outside), heat (think warm climates, hot yoga), genetic tendency (think family history), and physical trauma.
Personally, I have fought melasma since Spring Break my senior year of high school. I remember the exact moment like it was yesterday - I went out to the beach that morning, came back to the house a few hours later for lunch, looked in the mirror and BAM– melasma. For a moment, I truly thought I had dirt smeared on my face – oh how I wish it was just dirt…
Fast forward 15 years and I’ve been fighting it every day since. While I can certainly control my exposure to the sun and moderately control my exposure to heat, I have a genetic predisposition due to the fact that I am part Cuban that will obviously never go away. And while I could come off of birth control pills to help reduce the hormonal aspect contributing to my melasma, quite frankly I am not willing to (my new business is baby enough!).
Approaches To Treating Melasma
Because I’ve struggled with this problem for so long, I think I have literally tried everything on the market that claims to remove it. Below I have listed my personal experiences with different treatment methods that claim to improve melasma:
LASERS:
I have tried both IPL and BBL (short for Intense Pulsed Light and Broadband Light) which are common laser treatments that treat hyperpigmentation. The problem with lasers is that they produce heat, which as I previously mentioned, can worsen melasma. Not surprisingly, both of these lasers made my melasma worse. Not only did my current spots darken, but new spots popped up that were not there prior to the laser treatment. (Sidenote: I even tried using an ice-roller immediate pre- and post-treatment as well as ice packs afterwards in order to control the heat as much as possible, however I did not find that this helped).
MICRONEEDLING (WITH OR WITHOUT PRP):
While I absolutely love these treatments for collagen stimulation, acne scarring, retexturing the skin, and fine lines/wrinkles, I did not experience much improvement of my melasma. (Luckily it did not worsen my melasma, so this is a treatment I will continue to do for collagen stimulation.)
CHEMICAL PEELS:
I have tried both mild and moderate chemical peels, and while the mild peels brightened my skin and gave me a nice glow, they didn’t touch my melasma. And while the moderate chemical peels ideally seem like they’d help more, the stronger acids typically induce more heat and thus can worsen melasma - as I experienced with mine.
So... What Has Worked?
In my opinion, one of the best ways to treat melasma is skincare. There are so many great products on the market that target melasma (down to a molecular and enzymatic level) that are virtually guaranteed to help. Could you try other modalities such as lasers? Yes. But I always warn my patients that there is always a risk of this treatment worsening the melasma which makes it even harder to treat. I learned the hard way…
The great thing about treating melasma with skincare is that it is very low risk and still highly effective. The chances of it worsening your melasma are practically zero (I’ve never seen it). Can it be a slower process? Yes. But slow and steady wins the race.
Example Melasma Skincare Routine:
MORNING:
1. Wash with Brightening Wash (contains both glycolic and salicylic acid to help brighten and exfoliate skin)
2. Tone with Tonic (improves skin tone + texture)
2. Apply 1-2 pumps C+ Correcting Complex to full face (Vitamin C made specifically for melasma)
3. Apply Melan 130+ to full face (tinted high factor sunscreen that has 130 SPF) - Don’t forget to reapply sunscreen every 2-3 hours, even if you aren’t in the sun.
EVENING:
1. Wash with Papaya Enzyme Cleanser (gently exfoliates dead skin with papaya fruit extract)
2. Apply 1-2 pumps RET+ to full face (retinoid that helps increase cellular turnover to remove hyperpigmenation and reveal fresh clear skin)
3. Apply Crème de la Blair to full face (replenishing moisturizer packed with nutrients to keep skin youthful and moisturized)
COSMELAN MD TREATMENT
If you want faster results than skincare can provide and are up for a couple of weeks downtime, then the Cosmelan MD Treatment is a great option! While it is still a chemical peel, it is not your typical peel. Most peels sit on your skin for approximately 8-10 minutes, during which time produces an intense burning sensation (often inducing heat). Cosmelan, on the other hand, sits on your skin for 8-10 hours (yes – HOURS!) using different ingredients over a longer period of time to induce the same results without inducing the heat response. A mixture of potent hydroquinone and many powerful pigment fighting acids including azelaic acid, kojic acid, phytic acid, ascorbic acid, and retinoic acid make this peel ideal for combatting melasma on a deeper level. For more information about this treatment, and to see my Cosmelan journey, I have a full blog post on it here.