8 ways to treat melasma?

Melasma, sometimes referred to as the ‘mask of pregnancy,’ is a tan or dark skin discolouration usually seen on the cheeks, nose, upper lip, forehead and chin.

What causes melasma?

Melasma is caused mainly by sun exposure, genetics, hormone changes and skin irritation.  It can affect anyone, however it’s particularly common in women, especially pregnant women and those who are taking oral or patch contraceptives or hormone replacement therapy (HRT) medications. 

The science bit

Melasma occurs when the pigment producing cells in the skin, the melanocytes, produce too much pigment (or melanin).  The underlying hormone responsible for triggering the melanocytes is the melanocytes stimulating hormone (MSH).  This hormone increases the production of melanin, which is responsible for darkening the skin.  

People with darker skin are more prone to melasma because they have more active melanocytes than people with light skin.

Hormone fluctuations – when it comes to melasma, it has been found that elevated levels of oestrogen and sometimes elevated progesterone levels contribute to increased skin pigmentation.   Hence, why melasma is often seen during pregnancy, in women taking birth control pills and hormone replacement therapy (HRT) – because hormonal levels are elevated and stimulate melanocytes to increase pigment production. 

Hormones + stress – when you become stressed, your body produces the hormone cortisol to help you cope.  More cortisol creates an imbalance in oestrogen levels and elevated oestrogen stimulates MSH resulting in increased melanin production.   Therefore stress and hormonal levels are one of the keys to presentation and management.  

Hormones + thyroid – People with thyroid disorders, specifically autoimmune thyroid conditions, have a higher incidence of melasma.

The sun + heat – UV rays from the sun stimulate your melanocytes, which means your melasma can return with more sun exposure.  This is why melasma is worse in the summer months.   In addition, the sun’s heat, and heat of any kind, is a common trigger for melasma as it increases vascular dilation which is a component of this condition.   Heat can lead to more inflammation which can also stimulate melanocyte pigment production.   What does this mean?   Sunscreen and other surface protection may not be enough to keep the skin from darkening.

Genetics – recent studies have found that melasma tends to run in families regardless of whether a man or women inherits the condition. 

Irritation from skin care products – always be careful of how you treat your skin.  If a product or treatment irritates your skin whether due to heat or friction resulting in trauma, melasma can worsen. So be extra careful of IPL, microdermabrasion and some chemical peels.

Mask of pregnancy

The phrase ‘mask of pregnancy’ is simply due to the fact that many pregnant women get melasma but the discolouration usually disappears over a period of several months after giving birth.

How do you know it’s melasma and not something else?

Most advanced aestheticians or dermatologists can diagnose melasma by looking at the patients skin.  What makes it challenging to treat is how deep the pigment lies in the skin.  The deeper it penetrates, the more difficult it is to treat.   This is when your skin may be checked under a device called a Wood’s lamp.  To rule out another skin condition, the dermatologist may remove a small bit of skin to perform a skin biopsy. 

What are the treatments for melasma?

  • Avoid sun exposure and apply a broad spectrum sunscreen every single day and reapply every couple of hours if outdoors.  When heading outdoors wearing a broad-brimmed hat, big sunglasses, and a broad spectrum sunscreen with at least SPF 30 is important. I prefer moisturizers and sunscreens with physical sunscreens like zinc oxide and titanium dioxide because they are tolerated by most skin types and less prone to cause irritation.  Please remember that damaging rays penetrate through a car window.
  • Stop hormone medication such as birth control pills or HRT
  • Good nutrition.  Additional sun protection includes eating an anti-inflammatory diet rich in antioxidants and phytonutrients which means load your dinner plate with colourful fruits, veggies, healthy fats like olive and avocado oil as well as omega-3 fatty acids like salmon. 
  • Use a cleanser containing alpha-hydroxy acids including glycolic and lactic acid to throw off your dead skin cells to lighten and brighten your skin.
  • Use a retinol based serum at nighttime to quicken up the skin renewal system, throwing off dead skin cells and encouraging new fresh skin.
  • See your dermatologist to chat about prescription Tretinoin which is a stronger retinol treatment.
  • Consider having a course of alpha-hydroxy acid peels to remove surface skin to lighten the pigmented areas.
  • Use a vitamin C (L-Ascorbic acid) serum under your daytime moisturiser.  Vitamin C is anti-inflammatory and anti-ageing.  Vitamin C helps to inhibit the enzyme tyrosinase, which helps prevent melanin production.   Plus, vitamin C will significantly lighten the pigmentation. 

JL loves :  Exfoliating Cleanser

               Perfect Skin Vitamin C Serum

               Smart Retinol

               Tinted Moisturiser Mineral Defense SPF30