Melasma and Blotchy Pigmentation

People who have dark skin or tend to tan easily also are the most prone to develope blotchy dark pigmentation where some areas of skin are darker than the surrounding areas. Multiple factors stimulate the production of excess pigment, including the sun of course, but other triggers include any type of skin irritation or trauma, hormones, and heat.

Melasma is a chronic disorder in pigmentation that produces symmetric dark patches of skin on sun-exposed areas of the skin, & the patches darken or appear when triggered by sun exposure, inflammation & hormonal changes. This blotchy pigmentation can be very distressing and can impact confidence and emotional well-being, but it can be managed.

Melasma is most common in women with darker skin types but can be seen in lighter skin types as well as men. Although hormones can be the trigger for melasma, there's no evidence that stopping birth control pills or hormone therapy will reduce it once it starts.

Although there's no "cure" for melasma, it can be managed. Topically applied products are the first line of treatment in controlling (not curing) melasma, and lasers & other devices that target pigment can be helpful with resistant cases. Patience & persistence are required when dealing with melasma since even with treatment, improvement may not be seen for months. 

Current Topical Treatment Recommendations for Melasma:

  • Products that decrease the production of pigment, like hydroquinone, are the mainstay of melasma therapy. Azelaic acid, available as a 20% cream-based formulation, appears to be an effective alternative to 4% hydroquinone but unlike hydroquinone, azelaic acid seems to target only hyperactive pigment producing cells and won't lighten skin with normal amounts of pigment. 
  • Daily use of a broad spectrum sunscreen that contains iron oxide (most tinted sunscreens) with reapplication every 2 hours when outside
  • Topical retinoids such as tretinoin or SkinMedica's Retinol increases skin cell turnover and helps inhibit pigment over-production. The use of retinoids also helps topical products to penetrate to a level where they're most effective.

Chemical peels, when used in conjunction with a consistent topical program, can be helpful with melasma, but can worsen it if not done by experienced estheticians. In our experience, the Vi Peel, which is a medium depth peel that can be used with darker skin types, produces safe and effective results in melasma.

Melasma- a vascular problem with a tan?
Recent studies show that the dark patchy areas of melasma not only have more pigment, they have more blood vessels than the surrounding skin. One study found that even after the pigment is reduced, the areas where the patchy pigment had been were more red (caused by more tiny blood vessels) than the surrounding skin.

It's not clear whether increased pigmentation causes the increase in blood vessels or if it's the other way around, but it makes sense that treatments that decrease both the excess pigment & the excess blood vessels simultaneously will produce more improvement than either alone.

There are no topical products currently that reduce facial blood vessels but studies are currently being done to determine if the drug Timolol, a beta blocker that's produced improvement in hyper-vascular infantile hemangiomas, may be effective.

Oral Melasma Treatments That May Help

Heliocare is a supplement made from a fern that acts like an internal sunscreen to protect the skin's reaction to UV rays & is available at Skinspirations.

Tranexamic acid, available by prescription in pharmacies, decreases the activation of pigment cells by sunlight, hormonal influence, and injured skin cells. It can not only reduce the development of melasma, but may also reduce the possibility of recurrence after other treatment modalities like lasers. Since tranexamic acid is used to prevent excessive bleeding, it has a risk of potentially serious side effects like excessive clotting.

Treatment Options for Resistant Melasma
It can be difficult to clear melasma completely even with consistent daily use of the above products, & in those cases, specific laser or IPL devices may provide additional improvement.

Q switched lasers like our Revlite Si can break up unwanted pigment in darker skin without producing the heat associated with longer wavelength lasers, & therefore have less risk of hyperpigmentation. Vascular lasers and devices like our Cutera nd:YAG 1064 laser and our IPL, can reduce the tiny facial blood vessels seen under melasma on all but the darkest of skin. Skinspirations offers a melasma treatment package that combines both treatments to help reduce both the pigment & tiny blood vessels associated with melasma.

Skinspirations' Melasma Management Laser Treatment Package*:  

Three monthly sessions of both a vascular treatment with either IPL or the Cutera 1064, followed by a pigmentation treatment with the Q switched Revlite Si laser.

*(done in conjunction with a home product routine that includes scrupulous use of sunscreen, hydroquinone 4% or another pigment inhibitor, & a retinoid)

Fractional lasers have not been shown to produce long-lasting results when used for melasma.

Because people who develop melasma tend to have more pigment than those who don't, any irritation to their skin can cause rebound hyperpigmentation, so it's very important to choose a practitioner with a lot of experience & the right device for the goal. Even with experience in using these devices, it's important to understand that there is a risk with device treatments for melasma to experience increased, rather than decreased, pigment changes.

Because melasma is a chronic condition that requires long-term commitment to a professional skincare program in order to reach and maintain results, trust your face to the experienced estheticians at Skinspirations to guide you on this journey.  

Our 3 estheticians together in the hall

Our experienced estheticians, from L. to R.:
Donna Monette, Gale Pingleton, & Melissa Kennow

 

Call us today at 727.571.1923 to schedule your complimentary consultation and learn about what we can do to help you achieve your best look possible.