Unmasking Melasma

Uneven skin tone is a common complaint at any aesthetics office. But imagine having to wear a “mask” of stubborn pigment every day that can draw stares and questions from bystanders while pummeling one’s self-esteem into the ground. This is a day in the life of someone struggling with melasma.

Melasma is a very common skin condition that can be mistaken for UV damage but is trickier to treat. It causes asymptomatic bilateral brown to brownish grey patches on the face, most frequently seen on the forehead, cheekbones, nose, upper lip and chin. It predominantly affects women, especially women with darker skin tones and of child bearing years, but that’s not to say that men can’t have it. The American Academy of Dermatology estimates that melasma affects 5–6 million women in the United States alone while only 10% of people who get melasma are men.

The exact cause of this condition is unknown but definite triggers have been identified by researchers that include a genetic predisposition, sun exposure, oral contraceptives, hormone replacement therapy, and pregnancy. It is also known that exposure to heat, both internal and external, and repeated irritation can make melasma worse. All of these triggers make pigment producing cells, called melanocytes, to become over stimulated and begin to pump pigment into the skin.

Treating this disorder is a test of patience and commitment over the long haul. Many patients have a tendency to ease up on in-office procedures and at home care skin care once they start seeing results but it’s important to stay consistent. Protecting the skin from the sun and UV rays, suppressing melanocyte activity, interrupting the production of melanin and removal of it are the main goals at hand. (Ortonne JP1, 2009) Typical treatments for melasma aim to do all of these things by combining different treatments and products to offer a potentially better end result. Before starting any regime it’s important to have a consultation with your aesthetician or skin care provider to talk about expectations. It is also wise to have a polarized picture taken in order to “see” what’s really going on beneath the skin’s surface. At Aesthetics by Design we utilize the Visia Complexion Analysis for this purpose.

Hydroquinone based products to reduce the dark color are a cornerstone in the fight against melasma. Incorporating a prescription strength tretinoin into the regimen will also increase cellular turnover and help reduce visible pigmentation along with the added benefits of softening fine lines and promoting clearer skin. Daily application of a broadband physical sunscreen, containing zinc and titanium dioxide, with an SPF of at least 30 is imperative. It’s important that the sunscreen protect against both UVA and UVB rays as the UVA encourage pigment production. (Gagnon, 2011) The Obagi NuDerm system is a great option for treating melasma as it has products that contain all of the above mentioned active ingredients in an easy- to- use daily kit.

To compliment all of the necessary at home products, in-office procedures are equally important. Some practitioners prefer to incorporate microdermabrasion or dermaplaning to thin the top layers of skin which help active corrective products penetrate more effectively. (Bryant, 2003) Appropriately formulated chemical peels can also be used to treat melasma but beware of laser treatments. The jury is still out on their efficacy and long term results.

There’s no magic recipe for eliminating melasma but with patience, consistency, and some professional help clients no longer need to endure it alone. Call today to set up your consult with a Visia analysis to start unmasking your melasma.


American Academy of Dermatology. (n.d.). https://www.aad.org/public/diseases/color-problems/melasma. Retrieved March 02, 2016, from https://www.aad.org.
Bryant, R. (2003, February). Melasma: Combination Therapy Holds Promise. Dermatology Times , p. 41.
Gagnon, L. (2011, September). No Quick Fix. Dermatology Times , pp. 74-75.
http://www.aad.org/media/background/news/skinconditions_2004_02_06_derm.html. (n.d.). Retrieved march 18, 2016, from American Academy of Dermatology.
Nataloni, R. (2006, May). https://www.highbeam.com/publications/dermatology-times-p137923/may-2006. Retrieved March 19, 2016, from http://dermatologytimes.modernmedicine.com/: http://search.proquest.com.csuglobal.idm.oclc.org/docview/231178693/4817240A8D944D01PQ/8?accountid=38569
Ortonne JP1, A. I. (2009). A Global Survey of the ROle Ultraviolet Radiation and Hormonal Influences in the Developmentof Melasma. Journal of the European Academy of Dermatology and Venereology , 1254-1262.