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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This is an excellent exfoliating foaming cleanser that preps the skin for glycolic acid creams and lotions. It's an excellent cleanser for acne treatment or to exfoliate as part of an anti aging skin care regimen.$31.00
AHA therapy with a light water base for oily skin. Perfect for acne and anti-aging skin care for people with oily or normal skin.I have patients use it to improve acne and rejuvenate skin.$43.00
An extremely hydrating glycolic acid cream. It's a perfect starting point for beginning AHA therapy for dry skin types.$50.00
Professional glycolic acid skin care products are among the best, non-prescription anti-wrinkle face creams that also fight sun spots. Glycolic acid rejuvenates and reverses so many of the signs of skin aging including: dull skin, fine lines and wrinkles, crepey skin, sun spots, and crusty age spots.$72.00
Tolerant skin benefits from 10% glycolic acid, which I think is the ideal concentration to loosen black heads. These medicated pads perform this feat while lifting oil and debris from the skin.$26.00
2% Glycolic Acid and 2% Salicylic Acid acne treatment medicines are strong enough to treat stubborn acne but gentle on sensitive skin.$20.50
This extremely strong 10% Glycolic Acid/2% Salicylic Acid foaming cleanser is the strongest acne cleanser I recommend. Regular use dissolves oil and black heads. It's ideal for tolerant skin.$26.00
Our Dr. Bailey Foaming Acne Treatment Cleanser, formulated for sensitive skin types. This 2% Glycolic Acid/2% Salicylic Acid foaming cleanser is strong enough to remove oil and debris from clogged pores while remaining gentle enough for most sensitive skin.$22.00
The perfect AHA face cream for normal and combination skin. Available in 10%, 15% and 20% strength for all skin types$31.00
Eco-friendly beads combine with AHA and BHA to instantly brighten your complexion. Loosen dull dead cells and uneven pigmentation. Renew skin luster to a more youthful glow and instantly reduce the appearance of fine lines and wrinkles.$46.00
This rich soap-free cleanser brightens your complexion and leaves your skin silky smooth and ready for your treating and correcting products. Ideal for all skin types including oily skin because it gently but thoroughly removes product, oil, dirt and debris from the skin surface.$34.00
Most regular acne products are irritating to sensitive skin, but this acne treatment kit delivers the best acne medications at levels that are appropriate for sensitive skin.$56.00
Tolerant skin benefits from the high concentration of acne medicine in the Ultimate Acne Solutions Skin Care Kit, Extra Strength.$65.00
Fade an uneven complexion almost instantly with the best pigment lightening products. Reverse fine lines and wrinkles and return your appearance to younger days. This kit has everything proven to do the job!$327.00