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Uncovering the causes and treatment of melasma

This difficult skin condition causes dark spots on the skin that may last for years.

By October, your summer tan might be almost gone, but a peek within the mirror may reveal some dark spots in your skin that appear to stay around. These brown or gray-brown spots, often on the brow, chin, cheeks, upper lip, or nose, can indicate a condition called melasma.

Melasma is usually called the mask of pregnancy, because it is usually triggered by a rise in hormones in pregnant women. But while this condition could also be common amongst pregnant women, it just isn’t limited to them.

A persistent and annoying condition

Although melasma just isn’t painful and poses no health risk, it might cause significant emotional distress for the estimated six million American women who develop these dark spots on their faces. Dr. Kurosh says the condition might be difficult to treat, and there's lots of misinformation about its causes.

According to the American Academy of Dermatology, you're more more likely to have melasma if you’ve gotten a darker skin tone, probably because your skin naturally has more energetic pigment-producing cells. Melasma appears when these cells turn into overactive and produce an excessive amount of pigment in certain areas of the skin. The mechanism is comparable to what causes brown age spots and freckles, but melasma patches are larger.

Melasma is more common in women, but it might affect men as well. It could have a genetic component, because it often runs in families.

Dr. Korosh says there are lots of different causes of melasma. Two particularly stand out:

Hormones (including hormonal drugs). Fluctuations in certain hormones could cause melasma, which is why it often occurs while pregnant. Dr. Gilchrist says melasma may also occur if you either start or stop hormonal contraception, including contraception pills, or if you take hormone substitute therapy.

Sun exposure. The sun is the largest offender in triggering melasma. “Underlying factors such as hormonal changes may not show up until a person goes on vacation to a southern location like Florida, or during the summer when they spend more time in the sun,” says Dr. Korosh. “The sun is a major increasing factor, whatever the underlying cause.” Melasma might be caused or worsened not only by the sun's rays, but in addition by heat and visual light. This signifies that even sunscreens that protect against skin cancer aren't enough to stop melasma, Dr. Korosh says. This makes treating melasma a challenge, especially throughout the summer months.

Treatment of melasma

The first step in treating melasma is to verify with a dermatologist that the dark spots in your skin are indeed melasma, and to find out what's causing it. Melasma treatment is unlikely to be effective if the underlying cause just isn’t addressed, says Dr. Korosh. “Even the oral treatments that are now available for severe cases of melasma are really pointless to do, if there's still a trigger,” she says. If you're still experiencing exacerbating aspects, chances are you’ll just be on a hamster wheel, running and never recovering.

“We take a thorough medical history to find out what's causing the melasma,” says Dr. Korosh. Then adjustments are made. If hormonal contraception is causing the issue, a lady may consider switching to a non-hormonal option, resembling a copper intrauterine device.

Beware of dangerous skin lightening scams

Avoid the sun.

The next step in melasma treatment is to stop the sun from worsening the condition. This may require extreme diligence. “The sun is more powerful than any medicine I can give you,” says Dr. Korosh. The most vital solution to clear up melasma is to make use of a powerful sunscreen. But be mindful that not all sunscreens are created equal. To prevent melasma, you would like a sunscreen that not only blocks the sun's rays, but in addition its light and warmth.

There are two fundamental kinds of sunscreen:

  • Sunscreens that use chemicals, resembling oxybenzone

  • Sunscreens that use physical blockers, resembling zinc and titanium dioxide.

“You want to choose a non-chemical, blocking sunscreen, because it will block all light and different wavelengths,” says Dr. Korosh. Fortunately, these sunscreens have come a great distance from the old formulations that sat in a greasy, white layer in your skin. Today's zinc and titanium dioxide formulas are micronized so that they can sink into the skin, while still providing the identical protection. You can purchase them at your doctor's office, skincare stores, and even the pharmacy. “I'm not loyal to any particular brand,” says Dr. Korosh.

Chemical sunscreens don't offer the identical protection for melasma, and in some cases, they will even trigger allergic reactions that could make melasma worse, she says.

You may give your skin extra protection by following up with makeup that accommodates a second sunscreen to further block the sun's rays. Even in the autumn and winter, it's an excellent idea to wear a hat designed to offer protection from the sun if you happen to're going to be outside for long periods of time.

Medications and treatment of conditions

Your dermatologist may prescribe medications or topical treatments to assist lighten melasma. Some commonly used options are topical retinols and retinoid treatments, that are applied to the skin to assist speed up your body's natural cell turnover process. This can assist the dark spots clear up faster on their very own.

In addition, some doctors may prescribe bleaching agents, resembling hydroquinone, which work by blocking melanin production. But while hydroquinone products might be purchased over-the-counter, they need to only be used under a physician's supervision and only on dark areas of skin.

“High doses of hydroquinone can cause white patches on the skin,” says Dr. Gilchrist. The drug may cause skin darkening in some cases.

Your dermatologist may recommend kojic acid or azelaic acid, that are other topical skin-lightening agents, she says.

Other treatments which can be sometimes advisable for melasma include chemical peels, laser treatments, and microneedling of the skin. But for the time being they're not reliably effective, says Dr. Gilchrist.

For example, peels may fit for some people. “And for some people it makes it worse. It's very difficult to predict,” says Dr. Gilchrist.

Home Remedies

There are many things you’ll be able to do yourself to heal your skin and stop future damage. In addition to reducing sun exposure, try these steps:

Establish an excellent cleansing method. Environmental pollution can contribute to melasma, Dr. Korosh says. Air pollution can bind to the skin and erode the protective layer, making it weaker and more prone to sun damage. Cleanse your skin every night before bed with a cleanser that may thoroughly remove impurities and help protect the skin, she says.

Fight skin stress with antioxidants. Vitamins C and E can assist repair sun damage. So, placed on just a few drops of a serum that accommodates these vitamins to enhance skin health and stop the harmful effects of sunlight.

Moisturize your skin commonly. Use an excellent moisturizer after the serum to revive the skin's lipid (fatty) barrier, which helps protect it from damage.

be patient. Even with treatment, melasma can take months to clear up. No one is cured overnight.

Be diligent. Melasma will come back quickly if you happen to are usually not careful about sun protection. Therefore, long-term care requires an ongoing commitment to protecting your skin.

Photo: © Tanya Loos/Getty Images