Melasma

Melasma typically appears as symmetrical, blotchy patches of discoloration, primarily on the face. These patches are not raised or painful, but they may be aesthetically concerning to patients. Common areas affected include:

• Forehead
• Cheeks
• Bridge of the nose
• Upper lip
• Chin

The color of the patches can range from light tan to deep brown or gray, and the severity can vary depending on the degree of sun exposure, skin tone, and hormonal factors.

Melasma is caused by the overproduction of melanin, the pigment that gives skin its color. This overproduction can be triggered by a variety of risk factors, including:

• Hormone fluctuations: Estrogen and progesterone influence melanin production, which is why melasma is common in pregnant women, those taking oral contraceptives, or individuals using hormone replacement therapy.
• Sun exposure: Ultraviolet (UV) radiation from the sun is a major trigger for melasma and can worsen existing pigmentation. Even small amounts of UV radiation can worsen existing melasma or trigger its recurrence. This includes exposure to natural sunlight as well as artificial sources such as tanning beds. In addition, infrared heat (from cooking, saunas, or even hot weather) and visible light (especially in people with darker skin tones) can exacerbate melasma.
• Female gender: It is estimated that up to 90% of those affected are women, likely due to the hormonal factors described above.
• Genetics: A family history of melasma increases the likelihood of developing it.
• Skin type: Melasma is more frequently seen in individuals with medium to darker skin tones.
• Medications and skin care products: Certain medications, cosmetics, and skin care products may make the skin more sensitive to sunlight and contribute to pigment changes.
• Thyroid dysfunction: Some studies suggest a link between melasma and thyroid dysfunction, especially hypothyroidism.
• Stress and inflammation
  Chronic stress may affect hormonal levels, and local inflammation in the skin can stimulate pigment-producing cells. Both may indirectly contribute to the development or worsening of melasma.

Dr. Brian Hibler conducts a thorough clinical evaluation to diagnose melasma. Diagnosis is usually made based on the appearance of the skin and a detailed patient history, including sun exposure, hormonal influences, and use of medications or cosmetics. Recognizing risk factors is important for both prevention and management.

The most common cosmetic treatments for melasma include chemical peels, fractional lasers, and microneedling. Chemical peels work by exfoliating the outer layers of skin, removing cells with extra pigmentation revealing brighter skin underneath. Fractional lasers create microscopic areas of thermal injury promoting cellular turnover and promotes the growth of new, healthy, evenly toned skin. Microneedling works in a similar fashion, by creating micro-injuries in the skin and triggering the skin’s natural healing process. Topical ingredients, such as tranexamic acid (TXA) and Vitamin C may be applied post-procedure to further reduce hyperpigmentation.