Melasma is a common skin disorder that affects an estimated six million people in the United States. In fact, 90% of those afflicted are women, according to the American Academy of Dermatology. Melasma is often associated with sun exposure but it's also common in pregnant women, hence the nickname the "mask of pregnancy." Other common triggers include estrogen supplements and birth control pills. Joshua Fox, MD, a board certified dermatologist and medical director of Advanced Dermatology PC in Roslyn Heights, New York, cautions that patients should consult a dermatologist before trying any at-home remedies for melasma. "Some household remedies and over-the-counter treatments involve scrubbing and/or chemicals that can aggravate the skin and make the condition worse," he says.
The good news for patients is that technologies are evolving to better treat melasma. The Fraxel laser (a type of fractional laser) is a tool that is increasingly used to treat melasma, especially in severe cases and in cases where it doesn't respond to other treatments. The Dual 1550/1927 Fraxel laser received new FDA approval specifically to treat skin pigmentation problems such as melasma in June 2013. The benefit of the Fraxel laser is that it can safely treat the cells producing pigment yet it protects the outer layer of skin at the same time," says Fox. He cautions that patients who go this route must be vigilant about avoiding the sun and must wear a high grade UVA/UVB sunscreen at all times.
Signs of melasma
Melasma most often affects young women with so called olive or brownish skin tone. The condition is characterized by skin discoloration typically located on areas of the body more exposed to the sun, such as the cheeks, nose, forehead and chin and to a lesser extent, the neck and arms.
While melasma does not cause any physical discomfort, managing the psychological stress associated with the appearance can be a challenge, says Fox. "Melasma can rarely fade on its own but most women prefer to treat it because it's not only unsightly but it also causes some degree of embarrassment," he says. "Appropriate treatment can significantly improve quality of life and restore self-confidence."
Tips for treating melasma
Fortunately, there are many treatment options to help manage melasma. "Dermatologists are excited about the FDA's approval of Fraxel for treating Melasma. And while there is no magic bullet for the problem, we have additional therapies at our disposal that are safe and effective," says Fox. These include:
- The first line of defense is a broad spectrum sunscreen, which will help prevent further skin discoloration. "If a patient is vigilant about sunscreen use and stays out of the sun, the condition can spontaneously improve," says Fox. "More importantly, it will help prevent further discoloration."
- One of the first-line treatments is often a hydroquinone (HQ) cream, lotion or gel to lighten skin, which is available over-the-counter and in prescription doses. A dermatologist may also prescribe other topical medicines to lighten skin such as tretinoin, corticosteroids, azelaic acid and kojic acid. Several new products have been developed without HQ to treat the condition.
- Procedures for melasma include chemical peels, microdermabrasion , Fraxel Dual 1550/1927, Q-switched Nd-YAG and Ruby Lasers.
- A final option is a combination of several aforementioned therapies. In one recent study researchers in New York found that microdermabrasion and laser treatments used together can be a safe, a non-invasive approach with minimal or no recovery time, and it had long-lasting effects.
Fox reinforces the importance of sun avoidance and sunscreen to help prevent melasma and recommends everyone applies sunscreen 20 minutes prior to going out in the sun. This is particularly important for people aiming to prevent or minimize melasma. In addition, reasonable efforts to reduce sun exposure such as wearing a wide-brimmed hat and large sunglasses can also be helpful in avoiding the sun and aiding in the prevention of melasma.
Joshua L. Fox, MD, is the founder and medical director at Advanced Dermatology P.C. He is a leading authority in the field of dermatology with expertise in skin cancer, cosmetic surgery and laser procedures and is program director of a fellowship in laser and cosmetic surgery.