Melasma

Melasma is a common acquired increase of brown pigmentation (melanin) that occurs in sun-exposed areas of the face. It affects 6 million American women annually most of which are of child-bearing age. However, up to 10% of cases have been reported in males. While all races are affected, there is a prominence among Latinos and Asians. Melasma is more apparent during and after periods of sun exposure and less obvious in winter months, when sun exposure is lacking.
Melasma is often present on the cheeks, upper lips and forehead and sometimes occurs on the forearms. It looks like brown patches of skin which can sometimes cover the entire face, giving a mask like appearance. Not only can this mask affect how others see a patient with Melasma, it can affect how patients with Melasma see the world. Anxiety and depression are more common in patients with Melasma.

Causes of Melasma

Melasma has been considered to arise from pregnancy (giving rise to the term, "mask of pregnancy"), oral contraceptives, endocrine dysfunction, genetic factors, medications or cosmetics and other factors. The majority of cases appear related to pregnancy or oral contraceptives. Sun exposure does appear to be a stimulating factor in predisposed individuals. Up to a third of the occurrences in women are not preceded by any specific condition.

Treatments for Melasma

Melasma is very difficult to treat, and even harder to cure. It usually requires a combination of lasers, topical medicines, strict sun avoidance and daily sun block. When medicines such as birth control pill are the cause they generally have to be discontinued to see long term improvement. One may see their melasma clear with therapy, but flare during the summer months after sun exposure and this may required additional maintenance treatments.

Treatment Technologies for Melasma

Fraxel Laser
Q-switched laser
Topical Medicines
Chemical peels

Fraxel Laser for Melasma

Using the Fraxel laser's unique approach of using millions of microscopic thermal spots to gently resurface only portions of skin at a time; we now have the ability to penetrate deep enough into the skin to eliminate the skin cells that cause melasma while protecting the skin’s outer layer.
FDA clearances for the Fraxel laser include skin resurfacing, treatment of sun damaged skin, acne scars and melasma. For melasma, Fraxel laser treatments are performed monthly for a three or four month period. We generally prescribe a topical lightening agent such as TriLuma for a few weeks prior to the Fraxel treatment and continue it after the treatment. A few days of downtime are generally required after Fraxel. Sun avoidance and the use of a high grade uva and uvb sun block is essential at all times.

Q-switch YAG

The Q-switched Nd:YAG laser at a wavelength of either 532 nm or 1064 nm and is used for facial lines, wrinkles and laxity, tattoos, sun spots, nevus of ota, caf-au-lait, and melasma. The laser can penetrate and target melanin in the deep dermis, making it another option for the treatment of melasma. This procedure is provided in a series of monthly treatments. Sun avoidance and the use of a high grade uva and uvb sun block is urged.
There is minimal prep time with no need for anesthesia. Initially, a white area on the skin appears and then there is some mild redness. The use TriLuma topical bleaching agent is strongly recommended to help enhance and maintain the results.

Topical Medicines

Treatment regimens include the use of a sunscreen with a minimum of SPF 40, bleaching agents such as Hydroquinone (2-4%), retinoids such as Retin A and a prescription product named TriLuma. (Which combines a retinoid, bleaching agent and Cortisone).
Bleaching agents such as Hydroquinone do not "bleach" the skin but instead decrease the activity of the melanin, or pigment-producing cells in the skin. Retinoids works by promoting the rapid loss of pigment by increasing skin turnover and easing penetration of bleaching ingredients into the skin. Azelaic Acid, Mandelic Acid and Kojic acids are types of alpha hydroxy acids which are commonly used with patients who have darker skin types. Glycolic acids have to be used with great caution in patients with darker skin types due to potential side effects. No matter what treatment regimen a patient follows, the use of a broad spectrum sun screen is mandatory.
Unfortunately the only type of Melasma that may respond to topical therapies is mild, epidermal melasma, and this may take a minimum of 3- 6 months to work. The more common form of Melasma affects both the epidermis and dermis and for this variety, topical treatments are generally ineffective. Various light and laser treatment may be used to treat melasma including the Fraxel laser and Q-switch YAG laser.