Melasma: What is it and how do I treat it?
Melasma (aka cholasma or mask of pregnancy) is an acquired hyperpigmentation of the skin, usually in sun-exposed areas such as the face. The darkening of the skin is caused by an increase of melanocytes (the cells that color our skin). Although we don’t know what causes melasma we do know there are some common contributing factors. It is most common in pregnant women (thank you, hormones), people with hormone imbalances, people on oral birth control, and people with darker skin tones. Many people find the darkening of their skin disturbing and upsetting. It can cause depression, social inhibition and embarrassment. Melasma can be difficult to treat and often requires a multifaceted approach to help the skin return to its original state.
Camouflage it! Cover the area with makeup. This is an easy, at home ‘treatment’ but can be time consuming. It is by far the least invasive. It is worth getting help with finding a foundation that blends well with your skin.
Skin lightening agents: these are topical treatments that are applied to the skin daily. They work by blocking an enzyme important to synthesize melanocytes (the cells that darken our skin). They can cause irritation, burning, scaling, redness, and itching. These typically take more than 6 months to notice a change in the skin, they need to be used for many years and cannot be used continuously (you must take a break from them periodically).
Topical retinoids: Like the skin lightening agents retinoids are applied topically. Our bodies make them naturally when we eat foods high in vitamin A. Retinoids are important for cell-to-cell communication, help regulate cell proliferation and growth of the skin cells. These topical agents are created in a lab. These topicals are NEVER used to be used in pregnancy or someone seeking pregnancy. As will all topical agents they can cause irritation.
Combination therapies: combination skin lighteners plus retinoids seem to have the most promising results. Side effects are the same as above.
Chemical peels: the research is very mixed for the efficacy of chemical peels. It is inconsistent but does work for some people. Again, irritation and burning are the biggest complaints.
Laser/Light therapy: This treatment works well for patients who have tried #allthethings first. Light therapy can cause redness, scaling, drying, burning, swelling, hyperpigmentation (darkening) or hypopigmentation (lightening) of the skin. So, it could help but could also make it worse.
PRP (Platelet-Rich Plasma) injections and microneedling: Although the research is limited PRP is a very promising treatment option. First, it works by using your own body’s mechanism of skin/tissue repair. Second, there are no added irritating chemicals/agents. It works best with 3 treatments one month apart each. Side effects are mild redness and/or swelling that resolve within 24 hrs.
Remember to avoid the sun during treatment. Many of the treatments increase sun sensitivity therefore exposure could potentially increase symptoms. Use an organic, zinc based sunscreen and wear a hat whenever out in the sun to prevent premature aging and hyperpigmentation of the skin
**Also, there are lots of other causes for darkening of the skin (hyperpigmentation) so be sure to chat with your doctor before trying treatments.