Summer is the most fun time of year. Family gatherings, beach vacations, outdoor weddings and lazy days at the pool make this time of year special. But all the outdoor exposure can wreak havoc on the skin. One very common skin condition often becomes much worse during this time of year: melasma. Melasma is a discoloration or darkening of the skin.
It usually occurs in women age 20-40. It looks like dark or “dirty” irregularly shaped patches on the cheeks, nose, forehead and upper lip. In some cases, it can also occur on the chest and tops of the forearms. There are many factors implicated in melasma. These are genetic predisposition, intrinsic factors (medication or pregnancy) and extrinsic factors (sun or UV radiation). Women of all races can develop melasma, but those with darker complexions (Hispanic, Asian, or African American) tend to be affected most.
Women with melasma often have melanocytes (cells that make pigment or melanin) that are “hyperfunctional”. This means then tend to overproduce pigmentation or be very sensitive to stimuli that cause other people to make melanin gradually. Women also tend to develop melasma during pregnancy or if they take birth control pills due to the hormonal stimulation of the melanocytes. Lastly, summer is the time it becomes more prominent as UV radiation is stronger and people tend to spend more time outdoors.
There is no cure for melasma, and unfortunately, while it can respond to treatment, it often reoccurs. The first step in treatment is to discuss and ensure good sun protection. Zinc based, physical blocking sunscreen every morning is the cornerstone of therapy. In addition, sun avoidance is a must. When outdoor activity occurs, a wide brimmed hat, sunglasses, and protective clothing (for body involvement) should be worn.
The most common prescription for melasma is hydroquinone. This medication blocks the synthesis of melanin in the skin. There are some over the counter preparations containing 2%, but prescription strength 4% usually works best. It may take 2 months to see fading of the patches, and up to 6 months for modest clearing to occur. Hydroquinone can be stressful to the melanocytes, so if you use it, try to use it in cycles of 2-3 months at a time taking 1-2 month breaks to allow the cells to rest. Tretinoin or Retin-A cream can also be using in combination with hydroquinone to help suppress melanin production. This can be used indefinitely. Chemical peels can be used if the excess pigmentation is in the upper layers of the skin. A series of treatments will probably be needed to see improvement.
Lastly, there are some laser treatments that can help. IPL laser uses multiple wavelengths of light to break up the excess melanin. It also helps destroy some of the fine blood vessels in the skin which may play a role in the disorder. There are also multiple fractional lasers that may help. These lasers create thousands of microscopic “columns” of tissue damage using either heat or vaporization which break up the melanin. User experience is necessary with these lasers as sometimes they can make the melasma worse. The practitioner should be very experienced using these technologies for melasma treatment.
If you suffer with melasma, there is help. Seeing an experienced dermatology practitioner and discussing treatment options is the first step. Be patient, persistent and compliant with your treatment regimen and you will see results!
