Top 4 Causes of Melasma, Best Treatments

Melasma is a benign skin condition characterized by excessive pigment deposition in the skin. Hyperpigmentation is most common in the area of the upper cheeks, forehead, and jawline.

The top 4 causes of melasma:

• Hormones (estrogen, progesterone)
• Genetics
• Sun exposure
• Inflammation of the skin

Treatment is based on reducing the production of pigment in the melanocytes. Although there are several alternative natural treatments, the most effective are the following:

• Hydroquinone. Creams containing a combination of tretinoin, kojic acid, and azelaic acid have also been shown to improve the appearance of melasma.
• Chemical peels
• IPL
• Fractionated Laser (Fraxel)

However, be careful as the last three treatments, although effective, can actually worsen the melasma if not done by an experienced physician.

Hydroquinone + tretinoin 
The best approach for treating melasma is a combination of a prescription topical regimen and chemical peels. The topical regimen should include a hydroquinone product with a minimum of 4% strength, and a tretinoin product at a strength appropriate for your skin type and condition. Hydroquinone helps to suppress the overactive pigment-producing cells, and tretinoin exfoliates the skin and repairs cellular damage while helping to drive the hydroquinone deeper into the skin.

Laser treatment for melasma : a Wood's lamp test should be used to determine whether the melasma is epidermal (upper skin), dermal (lower skin) or mixed (dermal and epidermal).

Wood's lamp

If the melasma is dermal, Fraxel laser has been shown in studies to provide improvement in many patients.

However, Intense pulsed light(or "IPL") will actually darken the spots. Dermal melasma is generally unresponsive to most treatments, and has only been found to lighten with products containing mandelic acid (such as Triluma cream) or Fraxel laser.

Prevention

Daily sunscreen use not only helps prevent melasma but is crucial in the prevention of skin cancer and wrinkles. Zinc oxide or titanium oxide physically block the sun’s rays.

Warning

By Harold J. Kaplan, MD - Los Angeles Facial Plastic Surgeon
We believe that IPL (and Fraxel for that matter) treatments are the worst choice for melasma for the vast majority of those that have it. Melasma can be an epidermal (upper skin), dermal (lower skin) or mixed (dermal and epidermal) condition. We have found that the only results we have achieved for treating melasma were achieved with Q-switched laser technology and only in cases for epidermal melasma.

But so few patients have just epidermal melasma that many actually get worse after light based treatments such as q-switched lasers, Fraxel and IPL treatments. Every patient that has come to our office after receiving Fraxel or IPL treatments elsewhere has had their melasma worsen after treatment.

Fraxel Dual a real breakthrough to improve melasma

Melasma -- treatment options

Topical

• Lotions/creams/ointments
• phenols (i.e. hydroquinone, mequinol)
• retinoids (i.e. tretinoin)
• azelaic acid
• corticosteroids (i.e. dexamethasone, fluocinolone)
• Chemical peels
• trichloracetic acid (TCA)
• glycolic acid
• salicylic acid
• tretinoin
• phenol retinoid
• phenol retinoid corticosteroid
• phenol retinoid chemical peel
• phenol retinoid corticosteroid chemical peel

Surgical

• cryosurgery
• lasers (i.e. er: YAG, Q-switched ruby, dye 510 nm,
• CO2, argon, Nd: YAG, and frequency-doubled
• Q-switched Nd: YAG)
• dermabrasion