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Melasma

By February 7, 2012 No Comments

I recently ran into a few women that recently had children and complained about the discoloration or melasma on their face since their pregnancies.  It was interesting to me that each person had seen very reputable dermatologists in town, however still had the condition lingering.  They asked me if I knew about the condition and its treatment and if I could help.

So in a nutshell I have somewhat summarized the cause and treatment of melasma. At Beverly Hills Plastic Surgery Group, we always start with minimally invasive and low cost solutions with minimal downtime and move from there.  Therefore I reserve laser treatment for melasma as my final weapon and start with topical remedies.

What is melasma?

Melasma is a skin condition most commonly characterized by the presence of brown irregular patches on the face of a woman. Quite often, both sides of the face are involved symmetrically, with the most common sites of involvement being the cheeks, bridge of nose, forehead, and upper lip.

Melasma is extremely common, and it affects millions of women annually. Over 90% of melasma cases occur in women, and it is especially common in darker skinned individuals, particularly Hispanics, Asians, and women of Middle Eastern ancestry.

What causes melasma?
Although the causes of melasma are not completely understood, several factors are known to play a role. Clearly genetics is a factor, as women with a family history of melasma are more likely to develop the condition. Also, hormonal factors play a role, as pregnancy and birth control pills may also cause melasma. In addition, sun exposure is an important contributing factor and is the only factor that we can control.

It is believed that melasma results from exposure to estrogen and progesterone combined with exposure to ultraviolet light from the sun. This results in an over-stimulation of the pigment producing cells in the skin called melanin which in turn lead to the characteristic brown patches of melasma.

How is melasma treated?
Several modalities are available to treat melasma.

Melasma resulting from pregnancy frequently, but not always, disappears spontaneously over a period of several months after giving birth.

Melasma due to oral contraceptive use may improve after discontinuing their use. However, melasma that results from the use of birth control pills usually persists even after the pills are stopped.

Melasma treatment always starts conservatively. If at all possible, it is preferable for women undergoing treatment of melasma to discontinue their use of birth control pills. Although melasma can be treated while continuing the use of birth control pills, this is not optimal.

Sunscreens, sun avoidance, and depigmenting creams are three of the mainstays of melasma treatment. The sunscreen must provide both UV-A and UV-B protection. We at BHPSG prefer to use TIZO. Regardless of how melasma is treated, the treatment will fail if sunlight is not strictly avoided. Prudent measures to avoid sun exposure include hats and other forms of shade combined with the application of a broad-spectrum sunscreen. Sunscreens containing physical blockers, such as titanium dioxide and zinc oxide, are preferred over chemical blockers because of their broader protection.

Topical depigmenting creams should also be used. Hydroquinone is the most commonly used depigmenting agent; it works by decreasing the production of melanin pigment. At BHPSG we formulate our own topical formulas to cater to each patient individually due to differences in skin type and condition.  In some cases we add tretinoin (retinoic acid), kojic acid,  and a steroid to the hydroquinone. The tretinoin acts by increasing cellular turnover, resulting in a quicker response to therapy.  Other treatments for melasma include azelaic acid, kojic acid, and peels containing alpha hydroxy acids such as glycolic acid and most recently we have started using Cosmelan.  The treatments are administered by our certified skin care expert Rebecca Casper.

Patients who have not responded to conservative treatment can consider laser treatment. Fraxel laser to the area approximately 4-5 times can help relieve the melasma but is the last option of treatment.

Melasma treatment is complex and several months of therapy are required to significantly improve melasma. Any of our patients who believe they may have melasma or who have abnormal pigmentation in their face are invited to make an appointment with Drs Danielpour and Layke and have a complete skin assessment by Rebecca Casper.

CAll (310) 853-5147 for your free consultation