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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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
State of the art antioxidant skin care powerhouse and my absolute favorite facial product. If you were going to pick just one antioxidant for your skin care, the best would be green tea - it helps calm skin redness and fights sun damage.$160.00
State of the art antioxidant skin care powerhouse and my absolute favorite facial product. If you were going to pick just one antioxidant for your skin care, the best would be green tea - it helps calm skin redness and fights sun damage.$82.00
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Mother Nature is an amazing chemist and sometimes just what the doctor ordered! My Omega Enriched Booster Oil combines ingredients that help calm inflamed and irritated skin while restoring a weakened skin barrier with essential fatty acids.$44.00
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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
This has been a popular facial product in my dermatology practice for years! This unique oil free cream contains a high concentration of green tea antioxidant polyphenol, combined with caffeine and hyaluronic acid (a very expensive protein moisturizing ingredient).$82.00
An extremely hydrating glycolic acid cream. It's a perfect starting point for beginning AHA therapy for dry skin types.$50.00
Dermatologist recommended skin cream for sensitive skin. One of the best skin care products to heal dry skin for people with eczema or skin allergies.$8.00
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
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