Melasma is the frustrating patches of facial hyperpigmentation often associated with hormones; this includes your natural, everyday hormones, those your body produces with pregnancy, and hormones taken for contraception. The excessive melanin pigment in these patches can reside in the top living layer of cells, called the epidermis. This is also where pigment is when you get a tan. The body sheds this pigment regularly. The bad news is that melasma pigment can also reside in the deeper layer, called the dermis. This layer does not normally hold melanin pigment, and so is one of the reasons melasma is so hard to treat.
The cause for this excess pigment production is difficult to control, compounding the challenge of treating melasma. Some aspect of it is driven by the immune system. Short treatments of strong prescription cortisone creams have been used to treat it with moderate success. However, melasma tends to recur, and topical cortisone treatment has skin thinning (and other) undesirable side effects, and thus is not a good long term solution.
For all of these reasons, the treatment of melasma is tricky, yet significant improvement is possible. Treatment needs to be both consistent and very intensive, because the pigment production and deposition of melasma is tenacious. Your treatment needs to be equally tenacious. When I create a skin care routine to treat melasma, I cover all of the bases, including:
- First and foremost, sun protection, which needs to be absolute and used without exception, because one “indiscretion” in the sun will set you back after you have worked so hard to lighten the patches and even the color in your complexion. Sun protection needs to be broad spectrum and used 365 days a year. I trust only the mineral zinc oxide products for this job.
- Skin lighteners that reduce pigment production such as retinoids (retinol and prescription tretinoin), hydroquinone (2% available without prescription and 4% or higher with prescription), botanical lighteners like kojic acid, and vitamin C are all good options. Dead cells carry pigment upwards, accentuating the uneven skin color.
- Exfoliators to reduce pigment carried in the dead cell layer and enhance penetration of the lightening products. I use glycolic acid for this job. Rough scrubs and sponges can be used too.
This is a very intensive treatment and sensitive skin may become irritated – which can lead to inflammation and uneven pigment production! It may be good to enlist the help of a dermatologist to treat melasma in order to get prescription-strength products. Many over-the-counter professional products, such as the ones I have here, are highly effective and yet need to be used with care. At any sign of skin irritation or inflammation, a rest needs to be taken and then treatment resumed slowly. Options are based on what you know about your skin and your skin type.
I created the Ultimate Pigment and Sun Damage Repair Kit to incllude the best non-prescription products to fight hyperpigmentation, at the right concentrations to improve the pigment problem without irritating skin. The kit builds a complete skin care routine with compatible products that enhance ingredient penetration and sooth potential irritation so your skin can heal and improve simultaneously.
If you want to build your own skin care routine, here is how I often treat my patients:
- Cleanse with a Clarisonic Brush (to help products penetrate better) and a gentle cleanser or a glycolic acid cleanser. A toner will help remove any residual dirt and skin oil to enhance penetration of products as well.
- Correct with Pigment Fading Pads followed by either Vitamin C or Glycolic Acid. At night, use a retinoid such as a professional retinol product. Because inflammation may drive melasma, I add green tea as an ingredient to calm inflammation naturally and safely.
- Hydrate to balance skin moisture with your favorite skin cream or lotion.
- Protect in the day from sun up to dusk with a good application of broad spectrum zinc oxide sunscreen. If makeup is worn, use mineral makeup to enhance sun protection.
Shankar Krupa, et. al., Evidence-Based Treatment for Melasma: Expert Opinion and a Review, Dermatol Ther, 2014 Ded; 4(2): 165-186 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4257945/
Melasma, American Academy of Dermatology, 2018 https://www.aad.org/public/diseases/color-problems/melasma
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Lightweight, cool, and breathable cloth UPF 50 sun protection hats. Get in the habit of wearing this broad−brimmed hat along with your broad spectrum sunscreen − proven effective in the prevention of skin cancer and premature aging. Fits your head perfectly with its clever, adjustable inner brim cord. Highly packable too and makes a great gift!$25.00
These stylish and high-performance men's microfiber hats have a breathable mesh lining and a 3 1/4" brim. They fit perfectly and won't blow off because they have both an adjustable chin strap and an adjustable brim strap to hold them securely to your head.$19.00
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Good looking and high-performance sun protection for kids.$15.00
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At last, the best mineral zinc oxide sunscreen product proven not to run into and sting your eyes - even when you're wet! Reef safe too.$16.00
Raw Elements is the highest performance sunscreen I’ve ever found. A product that’s perfect for your most rigorous athletic activities in intense sun exposure circumstances. Reef safe too.$19.00
The highest performance sunscreen I’ve ever found. A product that’s perfect for the most active kids, high powered athletes and sensitive skin all in one! Reef safe too.$20.00
Broad spectrum UVA and UVB protection in a lovely moisturizing lotion that's sheer and elegant of the skin. Perfect for normal to dry skin with it's hyaluronic acid and just a little light oil to moisturize your skin without leaving a heavy feel.$26.50
Non-greasy natural non-nano zinc oxide mineral sunscreen for every day sun protection. This is a lovely natural mineral sunscreen made with organic ingredients - and it's not just for babies!$24.00
This luscious and all natural face cream is my absolute new favorite face sunscreen! Natural, broad-spectrum mineral zinc oxide protection that feels and looks so good on your skin that you'll want to wear it 24/7.$45.00
My favorite sunscreen for sports, swimming and sweaty activities. Solbar Zinc provides protection for up to 80 minutes in the water with its hefty 7.5% mineral zinc oxide combined with other chemical sunscreen agents. Oil free and shouldn't aggravate acne.$13.00
My favorite every day sunscreen! I wear it every day on my face, neck and chest! It gives a great matte finish that's SPF 40 and water resistant for up to 80 minutes.$35.00
At last, an ultra-light sunscreen spray that’s pure mineral protection with micro (not nano) zinc oxide for the best anti-aging broad spectrum protection.$44.00
Enjoy an oil free, non-whitening and “light as air” feel on your skin. Pure mineral zinc-oxide protection that’s perfect for even the most sensitive skin.$47.00
Oil-free and oil control ultra-light and tinted matte technology in a hypoallergenic sunscreen – it’s the holy grail for oily and sensitive skin AND it’s elegant for all skin types too! Contains iron oxide too making it the best sunscreen for melasma.$47.00