Melasma Malaise
By Deanne Mraz, MD, FAAD
Do you ever feel like hormones are the teething of womanhood? What’s this <insert strange bodily development>? Ah, must be hormones. Well another fun result of those pesky regulating substances chugging around our bodies is something called Melasma - or more commonly, the mask of pregnancy. As if pregnancy wasn’t scary enough without bringing a mask in to it. But I digress…melasma translates from the Greek word for dark, and that’s exactly what it is. Dark brown/grey patches of skin that develop, typically on the face, although they can also appear on the body, most notably on the forearms. Melasma can show up during periods of hormonal disturbance, most commonly pregnancy or while taking birth control, but can also happen without hormonal fluctuations and can even happen in men.
What is actually happening?
Melasma appears when the underlying hormone called Melanocyte Stimulating Hormone (MSG) goes a little crazy and increases production of melanin, which we all know is responsible for the shade of our skin. This is why being out in the sun makes melasma worse, and women who are pregnant during the summer are more prone to getting it (as if summer pregnancies weren’t just a bowl of cherries already). Fun fact: this same hormone is responsible for the linea negra (that dark line running down the beautiful baby bump of many pregnant women).
But I’m not pregnant and I’m not taking birth control…
Then now is probably a good time to see your doctor. If you’re under a lot of stress, your hormones can get out of whack and start disrupting MSG production. Another cause might be underlying thyroid disease, so really, make that appointment. Also, other issues can present with similarly, so best to come in for evaluation.
It’s less likely to be melasma if:
It appears on the lateral forehead
It covers the eyelids
It appears on the tip of the nose or at the nasal openings
It has a straight, symmetrical border
It appears on the ear and ear lobe
How can I make it go away?
Finally, some good news. Melasma can lessen once your hormone levels return to normal. Try and be patient as it can take some time. Make sure you’re using a high SPF every day and wearing a hat when you’re spending any length of time in the direct sun. After a few months you should start to see the patches fade until they disappear altogether. There is also evidence that visible light and other sources of energy, like heat, can worsen melasma. The best way to protect yourself is to wear sunscreen every single day (rain, snow, or shine) and pair with a topical antioxidant to help protect against other sources of damage from the environment.
Um, still not going anywhere…
Now is probably a good time to come see us. Melasma differs from basic hyperpigmentation and we can use special equipment to see exactly what’s going on. Once we’re sure it’s melasma, we can recommend treatment options and a plan to get your glowing skin back.
The first stop on the treatment train is usually Hydroquinone, which is effective about 40% of the time in lightening the skin. While there are some products available over the counter containing hydroquinone, it’s best to come see us and opt for a stronger prescription. Hydroquinone is often used in combination with tretinoin and corticosteroids which enhance the lightening effect and are referred to as triple combinationcreams. Retinols, azelaic acid or kojic acid are other topical remedies. However, a new study shows promising results with the use of tranexamic acid – a drug usually prescribed in the US for abnormally heavy menstrual cycles. Dr. Amit Pandya, professor of dermatology at the University of Texas Southwestern, Dallas presented his findings at The Skin of Color Society Meeting in February 2018 and spoke of “spectacular results” from his study of women using the drug, with up to a 50% improvement in skin coloration over a three-month period, including women who had spent many years trying other medical approaches to no avail. Depending on other medical conditions, we may consider using tranexamic acid either topically or orally in combination with other treatment modalities.
There are many procedures that can be administered by your board-certified dermatologist to treat melasma. These include chemical peels and light-based therapies or laser treatments. Particularly, the Clear and Brilliant laser, PICO toning and low fluence Nd:YAG laser treatments can help clear melasma. Remember, that while we can help reduce melasma, strict sun protection is paramount as the pigmentation can recur quickly with exposure!
The bottom line is, don’t suffer in silence. With a personalized professional approach, it’s possible to get your skin back to its former glory…sadly it won’t help with those newborn sleepless nights, but hey, we’ll take the good skin every time.