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What to do about Melasma


Melasma is a common skin problem that causes brown patches on the face, most commonly on the cheeks, forehead, bridge of the nose, chin and upper lip. Melasma is so much harder to treat than ordinary sun spots because the pigment tends to be deeper, not just at the surface of the skin. Melasma is sometimes called the “Mask of Pregnancy,” but you don’t have to have been pregnant to have it. Birth Control Pills, hormone therapy and hormone disorders can all trigger melasma heat and sun exposure can make it worse. Occasionally melasma will clear on its own, but most of the time it becomes a chronic condition. So, what can we do about it?


Skin Care:

For patients who want to get rid of their melasma, proper skin care is critical. This generally includes exfoliating cleansers combined with pigment correction with at least one if not several ingredients that decrease pigment. Vitamin C and Retinols both help to decrease pigment, in addition to serums that block the enzyme tyrosinase (this enzyme stimulates melanin production in your skin). At Glow, we often use two prescription topicals that combine these ingredients as well, one with hydroquinone and one without. In general, we rotate the tyrosinase inhibitors in and out of the regimen because your skin over time gets used to them, so we recommend taking a break from some of these ingredients for part of the year. And of course, staying out of the sun as much as possible and a daily sun block are both very important. 


Chemical Peels:

There are several medical grade chemical peels that contain ingredients specifically designed to target melasma. We like the VI Peel for this because not only is it effective, but it is safe on any skin type. It usually requires a series of at least 3 peels to make significant impact on melasma. There is no pain with the VI peel, and it is very well tolerated. The only downside of medical peels, is, well… you have to peel. Most people have significant peeling for 2-4 days with the VI peel.


The problem with lasers and Intense Pulsed Light (IPL): Most lasers do not work well for melasma. Many ablative and non-ablative lasers have been studied, and though some can clear the pigment significantly, these often cause a rebound melasma that can be worse than what you started with, often within 3 months of treatment. IPL has been used, but often makes the melasma worse instead of better. 


LaseMD Ultra:

This 1927nm laser was developed in South Korea with treatment of melasma and pigment as a prime goal. Interestingly Asian skin can be very difficult to treat due to the tendency towards post-inflammatory hyperpigmentation (PIH). LaseMD Ultra is a fractional non-ablative laser developed with the ability to use very low energies in order for specific topicals to penetrate the skin in order to maximize their effect. Tranexamic acid (TA) is a topical that has been found to prevent melanogenesis (pigment formation). We use a specially developed protocol using LaseMD and TA serum to treat melasma. This treatment is well-tolerated and does not require any anesthetic. TA can also be prescribed orally (off-label) for melasma as well, and is rapidly becoming more popular for this in the U.S. It is very commonly used for this in Asia.


Oral Tranexamic Acid:

Tranexamic acid comes in pill form, and is FDA approved in the US to treat excessive gynecologic bleeding. It can be used in lower doses to treat melasma, though this is an off-label use of this drug. It has been found to be quite effective in treating melasma. We tend to reserve this oral medication for people with severe cases of melasma, or melasma that does not respond to other treatments.


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