Melasma: What to Do

What can you do about those brown splotches on your face? It could be melasma, usually caused by hormones in women and light. Dr. Irwin gives info and tips on treating melasma.


Hi, this is Dr. Brandith Irwin, and I am doing this video blog for my website I’m a board-certified dermatologist practicing in Seattle, and I created SkinTour to give users really reliable, medical information on skin care and anti-aging.

And I have no financial ties to any cosmetic company or laser company, so I can give you unbiased information on what works and what doesn’t.

Today, I want to talk about:

Melasma. So Melasma, it’s a complicated, frustrating problem for a lot of women and men too. But mostly women, because Melasma is by and large hormone driven.

It starts usually either with oral contraceptives or pregnancy and in some people, once the pregnancy is done, those blotchy brown patches on the face, sometimes on other sites too, chest or arms. But usually the face or the neck will usually go away but not always. And oral contraceptives, because they contain estrogen can cause Melasma.

So once Melasma has gotten firmly established on your face it’s really tough to get rid of it. In fact I tell my patients there’s really no cure for this, there’s just good control.

I have Melasma too from my pregnancies and I control it really well but if anybody knows of a cure, call me! Because, all the things that we have, you know the topical creams we’re using for Melasma, the lasers, and believe me we have the state of the art lasers here, um, help, but they’re not a cure.

So, why is this so tough to cure and what should we be doing? One of the reasons it’s so tough to cure is because when those pigment-making cells (in Melasma you not only have an increase in pigment, but the actual pigment-making cells), the Melanocytes increase in number and size. And Melanocytes are like little factories churning out brown pigment granules, which is the pigment in our skin and they happen in a patchy way, rather than all over. If it happens evenly all over, you just get a tan right (but you’re, hopefully, not tanning). But if it happens in a patchy way then you get blotchiness, and we all hate that.

And it involves women of every skin type and color, from a type one skin to a type six skin. Dermatologists look at skin color a little bit differently but Type one would be the person who’s as pale as a ghost and never tans, always burns. A type six skin would be someone who has very dark, beautiful ebony skin and, you know can get blotchy with hormones and sun as well and that’s a problem across all races, all ethnicities. We all have that in common.

So Melasma, what can you do if you have it? Okay, so I’m just going to go through a couple of things. If you’re on hormones you got to stop them, um, if you can. If you need them for medical reasons, okay, that’s different, but if you can, you know, if it’s just a birth control issue find a different method because as long as you’re on those hormones your Melasma’s going to get worse and will be really tough to control. And that includes post menopausal hormonal replacement if it contains estrogens.

Then you got to use a great sunscreen. I mean, and it has to block UVA. It can be an SPF 55, but if it doesn’t block UVA, well, you’re you know what. It’s not going to work. So you got to find sunscreens that either have 5 to 10% or greater Zinc or Titanium or 3% Mexoryl.

And then I layer that. Like in the winter here in Seattle, I might use just a light sunscreen with a little Zinc in it. But if I’m out in the sun and I’m really active outdoors, I have three children, you know. I’m out a lot and I like to run, I like to cycle, all that stuff, so, here’s the thing, you know, you got to double layer. So what I do is I put my base sunscreen on and then I put, take that Colorscience powder which I love, that’s in a brush and you shake it down into the brush and you double layer it if you’re outdoors a lot. If you live in Arizona of Florida you need that stuff. So, double layer your sunscreens. That will help.

And then the other thing is, another thing proven to work is Retin A, Renova, generic name is called Trentinon. But any of those vitamin a products, you know, think Retin A, Renova, even some of the retinols if they are of better quality or stronger ones, um, will help with Melasma. And it helps the skin cells to turn over a little faster and slough that brown pigment, but you’ve got to be using sunscreen and out of the sun to make that retinoid work. So um, I usually will stop my Renova about a week before I go someplace sunny and then resume it when I get back again. Um, that helps I think too.

Link to over-the-counter retinoid, Skin Medica’s Retinol Complex

And then you know as far as prescription bleaching creams go, I tested all of them with my patients. I’ve tried all of them. I still think of the prescription creams, Triluma is the best. It does contain Hydroquinone, they all do. And they all contain, the prescription ones all contain 4% Hydroquinone. I think that, if you can’t tolerate those, and I don’t like my patients to use them more than three to six months a year max, then the plant-based one.

The only plant-based one that I’ve ever found that I think actually works even slightly is the Meloderm, M-E-L-O-D-E-R-M. You can get it online. It contains about 4, well 5 or 6 plant based, bleaching agents. And try it, I mean I’m not guaranteeing it and I think the jury’s still out on it but it seems to be better than any other of the non hydroquinone based ones that I’ve seen. So, there’s that.

Also, you know peels work well for Melasma, you want to see your dermatologists for those. Don’t just go somewhere to a salon and have a Glycolic Peel. If you have Melasma the peels if they’re not done well can make your Melasma worse so take the time, go to a dermatologist, try to get it done right for sure.

And then the other thing I was going to say are the plant-based ones like Arbutin, Kojic Acid, there’s a dozen of them now. They don’t really bleach anything. What they do is they inhibit, they inhibit the Melanagenesis, in other words they keep the pigment-making cells from making the pigment by interrupting a particular enzyme. So bleaching is really kind of a misnomer but you know what, it’s how we talk about it.

I’m hoping that plant-based bleaching creams will become better as time goes on. I’d love to see some actual testing done so we would know. But right now they’re being marketed mostly as cosmetics or cosmeceuticals. I know the FDA hates that term but you know that’s kind of what we think of them as, but they’re not prescription items so.

So Melasma, hope that helps. Again, no true cure, but you can make it so much better.

Link to Dr. I’s article, Melasma In Depth

Dr. Brandith Irwin, MD

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Hi, I’m Dr. Irwin, and I believe that consumers need and deserve a medically trained and unbiased skincare advocate.

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