From Causes to Treatments: Your One-Stop Guide to Melasma

You’ve heard about sun spots and freckles, but have you heard about melasma before? Also called a “pregnancy mask” or “sun mustache,” melasma is a surprisingly common condition that affects Asian skin. Here’s everything you need to know about melasma, summed up in a one-stop guide

Your Essential Guide to Melasma

What is Melasma?

Melasma is characterized by brown to gray-brown patches of skin on the face, though it may also manifest as flat freckle-sized spots called macules. It usually occurs on the cheeks, forehead, nose bridge, chin, and the area above the upper lip. Less commonly, dark patches may also appear on the forearms, neck, and other parts of the body that are often exposed to the sun.

But if you think that’s all there is to know about melasma, you are yet to discover its types. In the next section, you will learn more about melasma and its different forms.

4 Types of Melasma

Most dermatologists classify melasma into four types, depending on where the excess melanin is deposited in the skin.  

  • Epidermal Melasma

    Excess melanin is deposited in the epidermis, or the superficial layers of the skin. Since the pigment is closer to the surface of the skin, this type of melasma generally responds better to treatment compared to other types.

  • Dermal Melasma

    Excess melanin is deposited in the living tissue below the epidermis. This is identified by the presence of melanophages, or cells that ingest melanin throughout the dermis.

  • Mixed Melasma

    A combination of the two types of melasma mentioned above. Excess melanin is found in both the epidermis and the dermis.

  • Indeterminate/Inapparent Melasma

    This type of melasma is specific to dark-skinned individuals, making it harder to notice at first glance.

Causes of Melasma

  • Sun exposure

    Melanocytes are skin cells which produce melanin after stimulation from ultraviolet rays in sunlight. Too much sun exposure can overstimulate these cells and result in excess melanin. For this reason, melasma often is worse in summer.

  • Irritation from skin products

    Home peeling kits in particular may increase one’s risk of developing melasma.

  • Hormonal changes

    Pregnancy, hormone replacement therapy, and oral contraceptives can all set off hormonal changes and cause melasma. Thyroid disease often causes hormonal fluctuations and can trigger this skin condition as well. The association between melasma and hormonal changes is what sets the condition apart from other types of hyperpigmentation. It is also why melasma is usually harder to treat.

    Apart from the known causes of melasma are the factors that contribute in making a person more susceptible to suffering from this condition. To inform you further, discussed below are the risk factors of melasma that you need to know.

Risk Factors

It is worth noting that melasma does not appear overnight. Rather, it develops over time and worsens with repeated sun overexposure or skin irritation. An individual with the following factors has a greater likelihood of developing melasma:

  • Female

  • Over the age of 40

  • Asian or Latin descent

  • Olive or dark complexion

  • Has a history of melasma in the family


Melasma, Freckles, or Hyperpigmentation?

Melasma is easily interchanged with similar skin conditions such as hyperpigmentation or freckles. After all, these three conditions are all are caused by overactive pigment cells producing too much melanin.

Freckles are small, flat brown spots that appear on sun-exposed skin. These spots have poorly defined borders. They appear early in life and tend to fade over time, although they can also develop into sunspots or solar lentigines. Freckles are more common in individuals with red hair and a pale complexion.

Hyperpigmentation is a general term referring to any condition where a patch of skin is darker than the surrounding area. Because of this broad definition, it also has a long list of causes, including aging, acne, skin products, chemicals, and skin trauma. Aside from melasma and freckles, age spots and moles also fall under hyperpigmentation.

Is Melasma Harmful?

Melasma is harmless and benign. It may be common, but it fortunately does not indicate any underlying illnesses. That being said, many affected individuals suffer distress or embarrassment because of how melasma looks on the face, and they often seek treatment for their condition.

Melasma Treatments

Melasma may be harder to deal with than freckles or hyperpigmentation, but it can still be treated! Here’s a list of common treatments for melasma.

1. Melasma Cream

One easy and common way to keep melasma under control is to apply a topical cream to affected skin. Quality melasma creams often contain hydroquinone to lighten the skin, a retinoid to stimulate cell regeneration, and an anti-inflammatory agent.

2. Chemical Peel

Chemical peels work by essentially breaking up the topmost layer of skin, removing melanin in the process. This type of exfoliation also leaves behind smooth new skin and prompts regeneration, much like natural processes take place whenever the body sheds cells.

One well-known chemical peel for melasma is the depigmentation peel Cosmelan®, which often comes with a matching maintenance cream that is used for a year. Another effective type is the glycolic acid peel, which has the added benefits of dealing with fine lines, wrinkles, and sun damage.

3. Microdermabrasion

As its name implies, microdermabrasion uses a fine abrasive material such as diamond chips or aluminum oxide crystals to exfoliate the epidermis. A single session often won’t last longer than one hour, and it’s common for patients to jump right back into daily routines with almost no recovery time afterwards. Improvements usually become visible after two or more treatments. In addition, microdermabrasion is often followed up with sunscreen and melasma cream for best results.

4. Laser Treatment

For dermal and mixed type melasma, Fraxel lasers and low-intensity lasers may be a viable treatment. These use focused light to break up melanin in the skin. The body’s lymphatic system simply flushes the melanin fragments away afterwards.

Laser treatment by itself generally produces only temporary results, however. Like microdermabrasion, it’s often spread out over two or three sessions and used in combination with hydroquinone creams for a more lasting improvement.

5. Elos Skin Rejuvenation

Elos™ skin rejuvenation is known to stimulate collagen production and deal with fine lines, wrinkles, varicose veins, and redness from rosacea, but you can now add melasma to the list of conditions that it helps treat! This cutting-edge anti-aging treatment makes use of light energy and bipolar radio frequency to even out the skin tone and lessen the appearance of melasma. It also restores a youthful glow to the skin.

Before undergoing Elos™ skin rejuvenation, patients may be requested to undergo a patch test to check the skin’s sensitivity. The dermatologist might also prescribe a serum to help prepare the skin for the treatment.

NOTE: Make sure that you avail of a melasma treatment that is suited for your skin. Otherwise, your skin may be irritated after the treatment, worsening your melasma instead! Consult a board-certified dermatologist such as the professionals at Skin MD to be sure.

Tips on Preventing Melasma

Even after you’ve visited a dermatologist and availed of melasma treatment, dark patches may recur or persist if you’re not careful. Here are a few tips to keep in mind to prevent melasma from occurring or worsening.

1. Avoid Excessive Sun Exposure. Put on sunscreen (at least SPF 30) and wear wide-brimmed hats and sunglasses. Even if you’ll mostly be indoors and seated near a window, you’ll still want to keep the sunscreen on. You can even switch to a moisturizer with SPF content. It may be easy to overlook, but small amounts of sun exposure can cause your melasma to return or worsen. Unfortunately, this is a common reason many people is why many people who’ve gotten melasma treatment wind up with dark patches all over again.

2. Avoid Home Peeling Kits. These are often touted as affordable and convenient, but they can actually worsen melasma if not used correctly. At-home chemical peels have the potential to irritate skin, especially if the acids are at higher concentrations. Spare yourself the trouble and visit a dermatologist if you need a quality peel.

3. Use Skin Products With Gentle Formulations. Pick soothing, fragrance-free products that won’t upset your skin. Avoid essential oils, irritating surfactants such as sodium lauryl sulphate, and synthetic ingredients like bismuth oxychloride and petrochemicals.

4. Skip Waxing. Skin irritation is one of the most common side effects of waxing. This is mainly because of the tugging motion that pulls hair right out of the follicles, but it may also result from wax which is too hot for the skin.

5. Follow your Dermatologist. Most melasma treatments include follow-up procedures or maintenance creams to be applied over several months. Don’t neglect these instructions if you want your skin to stay melasma-free.

With this guide, you’ll have a good overview of melasma and its causes, as well as a quick list of procedures to choose from. If you notice dark patches gradually appearing on your skin, however, your best bet is to consult a dermatologist before anything else.

Do you think you might just have melasma? Schedule an appointment at Skin MD. Our dermatologists in Pasig will provide an accurate diagnosis and prescribe the best and most suitable treatments, whether you have melasma, age spots, or any other skin condition. Contact us today to learn how we can help bring out the most beautiful you!

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Danielle MilitanteComment