A Dermatologist’s Guide to Melasma: How do we tackle these stubborn brown spots on the face?

6 million women have melasma, so let’s tackle this topic today⚡️

Image credit: DermNetNZ.org

First of all, what the heck is it? Melasma is a skin condition that appears as brown or tan patches around the forehead, chin, cheeks, upper lip, and nose. Sometimes they can be tied to hormonal changes, which explains why pregnant women are particularly prone to developing melasma; it is often called the “mask of pregnancy” (as if pregnant women didn’t have enough changes in their body already!). People with darker skin tones are more likely to get melasma because they have more pigment producing cells to begin with; when these cells called melanocytes become active, they form these stubborn dark spots. .

Melasma can be really tough to treat and requires a multi-faceted approach. When I see patients in clinic, I come up with a comprehensive plan that both prevents further darkening and helps to lighten the preexisting melasma.

1. Sunscreen all day, rain or shine. Choose a sunscreen with physical blockers like zinc or titanium, and make sure that it contains iron oxide to block visible light too. Some of our picks with iron oxide include: Skinceuticals physical fusion defense, Drunk Elephant Umbra Physical Defense, La Roche Posay Anthelios Mineral Ultralight Tinted Sunscreen, MD Solar Sciences mineral creme sunscreen, Supergoop cc cream (more of a foundation than a sunscreen for extra coverage), Skinmedica essential defense mineral shield, Tizo tinted face mineral sunscreen
2. A special blend of retinol or retinoid, hydroquinone for bleaching, and a mild topical steroid. This medication is prescription strength and needs to be specially compounded. Our GlowUp #dermatologists can work with you to find the proper ratio of ingredients to target your melasma without over-irritating it.
3. Topical tranexamic acid or oral tranexamic acid. This is a brand new area of development, folks, and so far, results have been promising. Tranexamic acid is a pro-clotting agent used in the ob/gyn world for bleeding disorders. For melasma, it works by reducing the production of plasmin, which typically stimulates your skin cells into producing more pigment. Orally, tranexamic acid has shown promising results, improving melasma in Asian skin by up to 90%; however, it does carry risks of increasing blood clotting, especially in smokers, patients on birth control, or patients with blood clotting medical conditions. Current experiments are underway to investigate the best way to deliver topical tranexamic acid. Different clinics and labs are experimenting with laser or microneedling followed by tranexamic acid application to increase uptake. Stay tuned for more updates on this coming soon!
4. Serums or creams with brightening agents like Vitamin C, Kojic acid, or Arbutin
5. Procedures such as chemical peels or fractionated laser may be helpful, BUT be careful! Thoroughly research the credentials of the provider offering the treatments because melasma is very finicky, and any procedure or peel done with the wrong settings or with too abrasive a combo of ingredients will result in even worse darkening of melasma. Don’t go for a groupon deal for this one, ladies.

So that is a step by step basic treatment road map for melasma. It contains multiple parts, because prevention and treatment are equally important. We also target the pigment as well as active inflammation at the same time, and use several different ingredients to achieve this goal.

We tell our patients that skincare is a journey, and treating melasma is definitely a journey that we can walk together, our dermatologists and you. Check out GlowUp to get this journey started!