What is Melasma?
While best known as the “mask of pregnancy”, Melasma literally means dark skin. It commonly affects the apples of the cheeks, the mid forehead, jaw line and areas around the mouth. Hyperactive pigment cells in skin are to blame. These pigment producing cells become stimulated to produce extra unwanted pigment resulting in patchy discoloration. Triggers include estrogen supplements, birth control pills, pregnancy and sun exposure. You don’t have to be pregnant (or even a woman) to develop melasma. And if you think you’re silently suffering alone, think again, an estimated six million women throughout the U.S. are currently affected by this distressing condition.
Do I need to stop the pill?
Certainly it seems that some women simply cannot avoid developing melasma when on oral estrogens. However, experiencing melasma does not automatically dictate having to discontinue the pill. Highly effective melasma therapy and a well thought out maintenance plan to prevent recurrences are your best approach.
How much does sun exposure matter?
All the estrogen in the world won’t give you melasma if you don’t have some sun exposure. Sunlight dramatically darkens pale pools of pigment with as little as a drive in the car. The single most important first step in preventing melasma is avoid sun exposure at all costs! This means visible light, UVA and UVB. You must apply a true broad spectrum greater than SPF 30 multiple times a day.
The best type of sunscreens for melasma patients include a physical block like titanium dioxide or zinc oxide sunscreen. Newer formulations that have micronizing technology make these types much easier to use than they used to be. Suncoast Skin Solutions is a firm believer in these physical blockers for melasma.
In addition a wide brimmed hat of greater than 3 inches will help protect your face from the sun. Wear your favorite extra-large sunglasses. Then minimize your sun exposure, especially during the hours of 10-4.
What is the Melasma treatment?
In addition to sun protection, melasma treatment can include bleaching creams, which are commonly prescribed by your provider. Many bleaching creams are available alone or in combinations. The most popular bleaching medication is hydroquinone; it comes in over the counter strengths, 1-2% or prescription strength of 4-12%. Hydroquinone cannot be used in pregnancy or while nursing.
Other prescription medications that help the bleaching process are tretinoin, azeleic acid, and topical steroids. Talk to your provider to see if any of these medications alone or in combination are right for you.
There are some over the counter preparations with mild amounts of hydroquinone, kojic acid, glycolic acid, salicylic acid, and retinol that can be tried prior to an appointment with your provider.