Melasma Treatment

Melasma is a common acquired increase in pigmentation that occurs exclusively in sun-exposed areas. Brownish in color, it is worsened by sun exposure, pregnancy, birth control pills and other medications.

Melasma is relatively common, especially in women of child-bearing age. However, up to 10% of cases have been reported in males. While all races are affected, it is more common in people of Latin or Asian descent. Melasma is more noticeable during and after periods of sun exposure and less obvious in winter months, when sun exposure is less intense.
 
Melasma presents itself in one of the three usually symmetrical facial patterns. The most common is a centrofacial pattern, involving the cheeks, forehead, upper lip, nose, and chin. Less common patterns include, the malar pattern, involving the cheeks and nose, and the mandibular pattern, the side of the cheeks and jaw line. Melasma can also occur on the forearms, but this is rare.

What are the Causes of Melasma?
It is thought that melasma comes from hormone changes caused by pregnancy, oral contraceptives, endocrine problems, genetic factors, medications, nutritional deficiency, liver problems, and other factors. The majority of cases appear related to pregnancy or oral contraceptives. The infrequency of melasma in postmenopausal women on estrogen replacement suggests that estrogen alone is not the cause. In more recent experience, combination treatment using estrogen plus progestational agents is being used in postmenopausal women, and melasma is being observed in some of these older women who did not have melasma during their pregnancies. Sun exposure would appear to be a stimulating factor in predisposed individuals. Although a few cases within families have been described, melasma should not be considered a genetic disorder.

Treatments for Melasma
Melasma treatment is difficult.  Most importantly, one must avoid the triggers and use a sunblock regularly, especially between April and October.  In addition to avoidance, certain treatments can improve melasma.  The most common approach is a combination of a Vitamin A cream with a bleaching cream (hydroquinone).  Sometimes a steroid cream is added.  This approach can easily take up to six months to get a significant benefit, although some will notice improvement in as little as one month.  Unfortunately, some may get an excessive lightening of the skin or irritation in the area of hydroquinone application. 

An even more effective treatment in our experience is the Cosmelan peel, which utilizes Azelaic and Kojic acids.  This peel works very well in all skin types.  Results are often seen by the end of the first month and continue to improve with home therapy.  Prevention of recurrence is crucial and therefore requires ongoing home treatment.