Melasma may be chronic, but you can make it look a whole lot better.
For many of us, dark spots are the first sign—before laugh lines or crow’s feet or sagging jowls—that we’re not getting any younger. But unlike blemishes, these brown blotches don’t go away on their own. Especially if they’re melasma—a medical term for abnormal darkening of the skin, typically on the forehead, cheeks, and upper lip.
Together with freckles, sunspots, and discolored acne scars, melasma falls under the umbrella of hyperpigmentation, which is triggered by sun exposure: The sun kicks melanocyte cells into overproduction of the skin pigment melanin. Hormones and genetics play a role in whether or not you’ll get melasma and contrary to popular belief, men are not immune (although it’s more common in women). “Melasma is a genetic inflammatory disorder,” explains Neil Sadick, MD, clinical professor of dermatology at Weill Cornell Medical College. Individuals with skin types that fall in the middle of the spectrum—Hispanics, Asians, Native Americans, and people of Mediterranean or Middle Eastern decent—are most susceptible.
Once called the “mask of pregnancy,” melasma has also been linked to birth control pills, hormone replacement therapy, and thyroid imbalances, but the results are inconclusive, according to Yelena Yeretsky, MD, an aesthetic physician in New York: “We say hormones affect it—and there are many studies about oral contraception and hormone replacement therapy, but none of the studies really show consistency,” Yeretsky says. “So, can we be more specific? No.”
Melasma isn’t dangerous but it’s extremely resistant to treatment because the melanocytes responsible for those unsightly brown patches are often found in the dermis, the layer of skin below the epidermis. And blood vessels—not just melanocytes—may also be to blame for the discoloration, says Sadick. “Melasma’s chronic, non-curable—but it is controllable,” he says.
Most treatments try to decrease the level of melanin in the skin, and according to Yeretsky, the number one solution is still hydroquinone: A bleaching cream (available over the counter at 2% and in a 4% prescription strength) that works by blocking tyrosinase, an enzyme needed for producing melanin. But there are dangers to hydroquinone use, which is why scientists keep searching for alternatives.
“Too much hydroquinone can actually bleach your skin and cause hypo-pigmentation,” says New York facialist Elena Rubin. “It’s risky to use and it can make you look splotchy.” The aesthetician, whose black book of celebrity and model clientele is closely guarded, advocates tyrosinase inhibitors like azelaic acid, arbutin, and kojic acid, which work like hydroquinone—only naturally and non-invasively. Other hydroquinone alternatives are licorice extract, rucinol, resveratrol, and melanozyme, a mushroom-derived enzyme found in Elure’s Advanced Brightening Lotion.
Another approach is to inhibit the reproduction of melanosomes, the melanocyte parts specific to melanin synthesis. SkinMedica’s Lytera line works this way, notes Sadick, who adds that a third method is to block the transfer of melanin from the melanocyte to the epidermis. But for now, “that’s just a theory,” he says.
For best results, both Sadick and Yeretsky recommend a multi-faceted approach to treating melasma. Yeretsky likes using a combination of hydroquinone and gentle peels (glycolic or lactic acid stimulate collagen while calming melanocyte activity), before switching over to milder anti-melasma ingredients, like arbutin or kojic acid.
According to Yeretsky and Rubin, lasers aren’t worth the cost—or the risk. “Laser treatments don’t have a very high effectiveness rate for the amount of money you pay,” Rubin says. “And some of my clients have reported that lasers actually scarred their skin.”
Sadick does use a combination of vascular and low-energy fractional lasers on melasma, but warns that “lasers need to be non-aggressive. Less is better because melasma is an inflammation.” He also advocates using alpha hydroxy acids, which strip the outer layers of the epidermis, allowing for deeper penetration of topical treatments.
To prevent melasma from coming back, sun protection is crucial. Sadick suggests the supplement Heliocare, which contains the antioxidant polypodium leucotomos, as an additional precaution against UV rays. Bottom line: “You must wear a physical SPF with titanium or zinc oxide every day—plus hat, glasses, the whole shebang,” says Yeretsky.