Understanding melasma risk and how best to prevent and treat the skin condition has many dermatologists scratching their heads. While management and treatment hurdles remain, there is a growing arsenal of melasma remedies at dermatologists’ disposals.
For now, there is no way to prevent melasma outright, but it can be treated and controlled, according to dermatologist Daniel P. Friedmann, M.D., Westlake Dermatology and Cosmetic Surgery, Austin, Texas.
The Making of Melasma
Patients at most risk for melasma are female — especially those who are pregnant, on oral contraceptives or hormone supplementation, according to Dr. Friedmann.
“This is because a high estrogen environment is essential to trigger melasma. While estrogen may be the spark the ignites this chronic condition, ultraviolet radiation (potentially in combination with visible light and infrared radiation) is the fuel that keeps the fire going,” Dr. Friedmann says.
It’s difficult to predict who will develop melasma, according to Calabasas, Calif., dermatologist Anna Guanche, M.D.
“It usually starts in your late 20s or early 30s and then progresses. Although all skin types may develop it, types III through IV can have the most difficult time camouflaging the robust pigment that develops,” Dr. Guanche says.
Some studies suggest other potential causes or associations, including thyroid disease and genetic influences, according to Lisa Guidry Pruett, M.D., a dermatologist with U.S. Dermatology Partners, Carrollton, Texas.
Prevention and Treatments Tips
The most important thing to do to prevent melasma is to minimize skin stress, according to Dr. Pruett.
“This means cover up and seek shade, wear tinted sunscreen that will protect against UV radiation, but also infrared and [high-energy visible (HEV) radiation,] and apply antioxidants to the skin. There is also good science behind ingesting polypodium leucotomos orally,” Dr. Pruett says.
Dr. Pruett’s first-line treatment includes a tinted sunscreen like EltaMD UV Elements (EltaMD), an antioxidant like [SkinBetter Science’s Alto Defense Serum] and a prescription topical cream that includes hydroquinone and kojic acid. She recommends patients ingest polypodium leucotomos orally twice daily to improve melasma.
“For patients that want to take it a step further, I’ll recommend a series of SkinPen microneedling [Bellus Medical] treatments with topical tranexamic acid or Dermalinfusions [Envy Medical] along with the topical regimen,” Dr. Pruett says.
According to Dr. Friedmann, treating melasma rests on two factors: sun protection and avoidance and arrest of the skin's pigment production pathways.
Dr. Friedmann is a consultant and advisory board member for PCA Skin. He has been a consultant for SkinMedica and has performed clinical research for Neocutis. Drs. Linkner and Dr. Pruett and Ms. Stassiy report no relevant disclosures.