Different
skin conditions can be difficult to diagnose, and sometimes even more so to
treat. Melasma (chloasma) is one of the more complex conditions that affects
many patients leaving them frustrated and struggling for answers. Melasma is
different than sun damage and hyperpigmentation because of its unique mechanism
of action-it is stimulated by hormonal fluctuations. Unlike UV-induced pigment,
melasma has some key characteristics that can make it easier to identify.
Having a better understanding on this tricky condition can help you to better
control your symptoms.
What does melasma look like? Unlike a diffuse distribution
of hyperpigmentation (like you commonly see in sun-damaged patients), melasma
has a patchy distribution with a distinct line of demarcation. These brown, or
sometimes grayish/brown patches will most likely be present in the face,
cheeks, chest, forehead, nose, and chin areas.
(photo: American Academy of Dermatology)
“My melasma seems to get worse in the summer, and better in
the winter” This observation is commonly seen with this condition. Sun
exposure can make the hormonal spots appear darker, and heat exposure can have
the same effect. Unfortunately, any time a patient experiences any type of
internal heat (even working out, and hot yoga), the pigment can become worse.
What can I do to treat my melasma? Treatment for melasma
includes reducing stimulating factors (sun + heat exposure) when possible, and
following a strong home-care regimen. Unlike other sun damage, deep chemical
peels and lasers can actually cause more harm to melasma patients because of
the stimulation of heat. Gaining control of your hormones can also be difficult
because typically eliminating pregnancy, birth control, and breastfeeding are
not desired options, or preferences.
What products should I use at home? Patients will see a huge
benefit from a few powerhouse pigment products: Vitamin C + E (to help lighten,
tighten brighten), retinol (to speed up cell turnover), SPF (to protect from
sun damage), and Hydroquinone/Other lightening agents such as kojic acid,
azelaic acid (to lighten and brighten existing pigment). Some patients are
even diagnosed short-term steroids to gain control of inflammation; this will
need to be initiated and controlled by a physician.
What products do you recommend? I would suggest picking at
least one product from EACH category to treat melasma effectively.
Vitamin C: I will warn you that NOT all Vitamin Cs are
created equal. L-Ascorbic acid is a very difficult ingredient to stabilize and
although many products claim to contain vitamin C, there are very few
formulations that are still active after packaging. A few of my favorites
include:
Skinmedica Vitamin C
+ E ($102)
PCA Skin C + E Strength Max ($96)
PCA Skin C-Quench Antioxidant
Serum ($74)
Retinol: Again, not all retinols are created equal. Some
formulations are not “cosmetically elegant” and can cause skin irritation,
redness, and excess flaking and peeling. I would recommend any of the following:
Skinmedica Retinol 0.5 and Retinol 1.0 (0.5: $78, 1.0: $93)
PCA Skin Intensive Clarity Treatment ($106)
SPF: PLEASE Do not minimize the importance of SPF! It is
protecting you from future damage as well as skin cancer, and future aging.
Skinmedica Total Defense + Repair (Tinted + Non-tined
formulations available) ($68)
and PCA Skin Perfecting Protection broad
spectrum spf 30 ($34)
Hydroquinone/Brightening Products:
Hydroquinone- Products that include this ingredient are
typically available for purchase through a physician or medical practice.
Hydroquinone has specific instructions for use, and they should be followed
closely for safety.
Skinmedica Lytera Brightening Complex ($130) this 4%
Hydroquinone equivalent is highly effective in patients that cannot tolerate
hydroquinone, or need to be on their “hydroquinone break” as directed by
physician.
Intensive Brightening Treatment 0.5% pure retinol treatment
($106) Similar to
Lytera Brightening Complex, this hydroquinone-free complex is
highly-effective in treatment pigment.
PCA Skin Pigment Gel 2% Hydroquinone spot treatment can be
applied to specific patches of pigment on the face. A 2% may be ideal for
someone new to using hydroquinone, or that cannot tolerate a full 4% formulation.
For questions or comments, please post below or feel free to
contact me at the office. You may schedule a complimentary consultation at any
time and we can review the specific needs for your ideal skin health.
For appointments, please call: 480.214.9955 and ask to
schedule with Annie Bruno, RN.
Be well,
Annabelle
xo