This chronic skin condition is a common cause of dark patches—Here's how to treat it
If you're someone who's always keeping tabs on the changes in your skin, odds are you can tell when even the smallest of shifts are happening.
Maybe you notice an uptick in hormonal acne, or perhaps you're seeing more dry patches than normal on your face. When it comes to hyperpigmentation, though, those tiny changes can be harder to catch until they make a bigger difference in the overall appearance of your skin. While there are many reasons your skin tone can appear uneven, one of the most common culprits is melasma.
So common, in fact, that between 1.5 percent and 33 percent of the population may get melasma between the ages of 20 and 40, according to the the Cleveland Clinic. Still, it can be hard to know for sure whether what you're experiencing is melasma or something else. To make things a little less confusing, we spoke to two dermatologists to explain what causes the condition, how to manage it, and how to know if you have it in the first place.
Meet the experts: Gina Charles, MO, is a family physician specializing in skincare. Jessica Dowling, MD, is a New York-based board-certified dermatologist.
If you're curious to know more, read on for all the details.
What causes melasma?
In short, melasma is a chronic skin condition that appears as darkened areas on the face due to an overproduction of melanin, says Gina Charles, MO, a family physician specialising in skincare. It usually appears on the face around the upper lip, cheeks, and forehead in patches. While the cause is unknown, experts have come to realise that there's a strong link between the condition and sun exposure and hormonal changes.
Who does melasma affect the most?
Anyone can get melasma, but a 2018 study from the Journal of Clinical and Aesthetic Dermatology found that it affects women and those with melanated skin who live in areas with higher levels of UV radiation in greater numbers. Because of the hormonal component, it's commonly seen in 'women of childbearing ages, specifically women who are pregnant, or women who are taking exogenous hormones, like women who are on the birth control pill' says Jessica Dowling, MD, a New York-based board-certified dermatologist. This may be why the condition is often referred to as the 'mask of pregnancy.'
How is melasma diagnosed?
Most doctors usually diagnose melasma during a clinical exam. 'It's confirmed using a Woods Lamp examination which determines the depth of pigmentation,' says Dr. Charles. During this process, a lamp that uses long-wave ultraviolet (UV) light will make certain cells show colour or appear fluorescent, according to the Cleveland Clinic. Doctors also take time during the appointment to go over health history and can also provide a diagnosis via dermoscopy or biopsy.
The best ways to treat melasma
If you've been diagnosed with melasma or you suspect you might have it, you may be thinking about what can be done to treat it. Unfortunately, there's no cure for melasma considering the exact cause has yet to be identified, but there are still ways to manage it. Here are some tips straight from the pros:
Wear sunscreen daily
Whether you're spending the day outdoors or working in the office, sunscreen is the best thing you can use to treat and prevent melasma. For the best protection, Dr. Dowling recommends a tinted mineral sunscreen over a chemical one. 'A mineral sunscreen has active ingredients like zinc oxide or titanium dioxide, and tinted mineral sunscreen has iron oxide added to the sunscreen,' says Dr. Dowling. These ingredients create a physical barrier between your skin and the sun and protects against longer wavelengths of light, like the long-wave UVA light and visible light that tend to make melasma worse.
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Use a retinol cream
Retinol increases cell turnover, which can lighten pigmentation. 'For melasma, retinol can be used as a stand-alone topical and is also commonly prescribed as a combination cream,' says Dr. Charles. Still, some doctors may recommend you skip using it on its own if it's an ingredient you're sensitive to—so it's best to consult a dermatologist first.
And since any retinol product can make your skin more sensitive to the sun, you should always be following up with SPF. But you knew that already (see above).
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Try an in-office treatment
Laser facials and chemical peels containing alpha hydroxy acids are the two main options for in-office treatments. 'Nd:YAG lasers and Pico lasers have demonstrated effective at improving melasma,' says Dr. Charles. She explains that the former uses short pulses of light energy to target the epidermal and dermal melanin deposits associated with melasma. The latter also uses short pulses of light energy, only it breaks down melanin pigment clusters that are causing the discolouration. Pairing these treatments with other methods can lead to an easier process managing the condition.
Consider taking medication
Your doctor may suggest taking a low dose of melatonin because it inhibits tyrosinase (an enzyme in our skin that helps produce melanin), reducing pigment production, says Dr. Charles. Dr. Dowling adds that other doctors may suggest prescription hydroquinone compounded creams to help decrease the pigmentation. "We usually prescribe hydroquinone cream to be mixed with other creams such as topical steroids and prescription retinoids to increase their efficacy," says Dr. Dowling. "These creams are usually used once a day at night for 3 months at a time."
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What is the difference between melasma and hyperpigmentation?
While the terminology can be a bit confusing, melasma and hyperpigmentation are actually the same thing. 'Hyperpigmentation just means darkening of the skin,' says Dr. Dowling. 'So basically, 'hyperpigmentation' is an umbrella term for lots of different conditions that cause hyperpigmentation (including melasma).'
At the end of the day, melasma is extremely common and multifactorial, meaning there's no one-size-fits-all solution. To make sure that you're opting for the more effective form of treatment, talk with you doctor to get a proper diagnosis. From there, they can assess the severity of your melasma and provide the best guidance.
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