Melasma

Many patients may begin to notice the presence of tan to brown to gray patches symmetrically distributed on the cheeks, upper lip, and forehead, which are worsened with sun exposure. This condition is called melasma, and it occurs most commonly in women, but men can be affected in 5-10 % of cases. Many patients also have family members with a history of melasma.

Why treat melasma?

Physical, emotional and social reasons for treating melasma include:

  • Improved appearance.
  • Enhanced self-esteem.
  • Promotion of better skin health.

What you need to know

Melasma occurs when the pigment producing cells of the skin, called melanocytes, begin to produce too much pigment. This leads to the development of large tan to brown patches on the skin. It may appear on the cheeks, cheek bones, chin, nose, forehead, above the eyebrows, and/or the upper lip. Occasionally in patients with significant UV exposure, melasma will appear on the forearms and neck. Melasma occurs in all skin tones, but is more common in patients with darker skin tones. Melasma can be more common in some families.

Sun exposure and increased amounts of female hormones can worsen melasma. Heat, severe skin dryness, some cosmetics, and inflammation are other precipitating factors.

Melasma lasts decades, so patients will need a treatment plan that is life long. Treatment often begins with a skin care regimen composed of a daily sunscreen, moisturizers and skin care brightners. Some of the more common skin brightners include hydroquinone, vitamin C, azelaic acid, tretinoin and kojic acid.

For patients who don’t see improvement of their melasma with a skin care regimen alone, procedures may be added. These include superficial chemical peelsmicrodermabrasion and/or lasers. Lasers should be used with care in patients with darker skin tones by an experienced laser surgeon.

Melasma is a delicate condition and patients often have flares throughout their lifetime. Your ASDS physician will be there to care for you and your skin throughout your life.

Do's and Don'ts

Do
  • Avoid excessive sun exposure.
  • Wear a hat, sunglasses, and seek shade when outside.
  • Wear sunscreen daily with an SPF greater than 45 and remember to reapply. 
Don't
  • Forget your sunscreen. One day of missed sunscreen can cause melasma to darken.
  • Aggressively scrub at your skin.

Melasma treatment questions to ask a dermatologic surgeon

  1. Which melasma procedure is the correct one for me? (What are the options?)
  2. What is the estimated cost of the procedure?
  3. How long is one appointment?
  4. How often will I need to receive treatment to improve and/or clear my melasma?
  5. How far apart are the treatments?
  6. What are the common side effects or complications associated with the procedure?
  7. How can I prepare for the treatment/procedure?
  8. Does the treatment hurt?
  9. How long is the recovery time associated with my procedure?
  10. Do you have before-and-after patient images to help to prepare me for what to expect?
  11. Will someone walk me through the process before going in for treatment?
  12. What are the risks?
  13. What should I expect after the procedure is performed? (i.e., short-term and long-term effects; activity restrictions; expected recovery period)

General questions to ask before melasma procedures

  1. Is a doctor on site?
  2. Is the doctor board-certified in dermatology or in another specialty with equivalent training and experience in treating melasma?
  3. Was my medical history taken?
  4. Was I given an initial evaluation to determine if the technique or procedure is appropriate for my skin type?
  5. Did the doctor show me before-and-after photos?