Everything You Need to Know About Melasma
While skin conditions aren't discriminatory, melasma is a frustrating, stubborn one that's reserved mostly for women. According to the American Academy of Dermatology, 90% of people that develop melasma identify as women. The condition manifests itself in the form of dark brown patches on the face, usually on the forehead, cheeks, and jawline. What's more is that many people don't realize that they even have melasma, which can lead to mistreatment or the condition intensifying if it goes untreated.
To bring you up to speed on the skin condition, we turned to Miami-based dermatologist Dr. S. Manjula Jegasothy, MD, CEO and Founder of Miami Skin Institute to find out what causes melasma and how to treat it.
SO, WHAT EXACTLY IS MELASMA?
Melasma is characterized by tan or brown, flat pigmentation that sometimes has a net-like pattern on the forehead, cheeks, and occasionally the chin. Although the condition mostly impacts women, it is possible for men to develop melasma too, but it's much more rare. "While we do know melasma does tend to occur more in ethnic skin types, such as Latin and Asian women, we do not know much more about the demographics of melasma than this," says Dr. Jegasothy.
WHAT CAUSES MELASMA?
It's believed that the pigmentation happens when there's an increased sensitivity to circulating estrogen levels in the blood. "Why some people develop this enhanced sensitivity to estrogen is not known. What we do know, however, is that this condition most commonly occurs after a hormonal change in the individual’s system (i.e. starting a birth control pill, hormone replacement therapy for menopause, or pregnancy)," explains Dr. Jegasothy. "Because of this connection with hormonal upheaval, melasma used to be called 'the mask of pregnancy' in the past. However, since we now recognize that melasma occurs frequently in conjunction with medicinal hormonal treatments (fertility treatments can contribute as well), we do not associate it strictly with pregnancy."
WHAT MAKES MELASMA SO DIFFICULT TO TREAT?
There's no cure for melasma, and although it can eventually resolve itself, there's no way to tell when that will happen. Since the fluctuations in hormone levels that cause melasma can be extremely minor, the underlying health issue often goes undetected under routine testing. For people dealing with melasma, discontinuing with any hormonal treatments they may be on such as fertility medication, birth control pills and menopausal hormonal replacement therapy, can be helpful.
Dr. Jegasothy says to think of melasma like a glass of water. "I tell patients that the level of water in the glass is the amount of pigment they have at any given time on their skin. If they use a good quality bleaching cream and get light fruit-acid peels with me at my office, I can reduce the water level, perhaps almost to zero, so that their face is clear. However, their hormone issues will replace the water in the glass if they do not continue therapy," she says.
SO, WHAT ARE THE TREATMENT OPTIONS?
At home, use over-the-counter products with brightening ingredients like kojic acid and arbutin. Although, Dr. Jeasothy says that this will only help for people in the early stages of melasma, and that they will eventually need to see a dermatologist for stronger treatment.
In office, Dr. Jegasothy says that brightening creams and light fruit acid peels are commonly used, as well as mild laser treatments like fraxel or Nd:YAG are used if the patient has already tried topical methods with no success. "I tend to proceed cautiously with treatments, since many of my patients have darker skin and can have pigmentary problems from the treatments themselves," she explains. "As such, we use clinically studied brightening creams that are safe to use in darker skin patients, as well as light fruit-acid peels that have also been proven to be safe to use in darker skin patients. Lasers can only be used on melasma patients with lighter skin tones because they are less likely to develop hyperpigmention."
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WHAT CAN YOU DO TO PREVENT MELASMA?
Since most research being conduction on melasma focuses on its causes and treatment of underlying hormonal imbalances, Dr. Jegasothy says there's no known way of preventing it. However, if you have melasma, there's one thing you can do not to exacerbate it: stay out of the sun. "If patients are deciding to undergo melasma treatment, it is much more effective if they do not get direct sun exposure, she says. "If they are unable to comply with this, I tell them that it is still OK. We can treat their melasma, but their sun exposure may reduce the rapidity of the effectiveness of our treatment."