Melasma, also known as hormonal pigmentation, is a considerable problem for Texan women, as the sun’s UVA rays are a stimulant for melanin (brown pigmentation) to develop on the skin, and unfortunately the sun can even penetrate through car window glass. It is a chronic skin condition that occurs on the face in the form of brown patches and is a dynamic (active) condition that needs lifelong management. It generally appears on the cheeks, forehead, nose and around the mouth, but it could turn up anywhere. The cause is a combination of hormones and the sun; no matter how much sun protection you use, you could still get it. The pigment cells are also heat sensitive, so if you go out in very warm weather, you’re at risk. It’s more common in pregnant women because they have high estrogen states, but it can happen to anyone.
Any change in hormonal status with higher levels of estrogen is thought to trigger and aggravate the condition (i.e. birth control pills and pregnancy). Discontinuing the use of contraceptives rarely clears the pigmentation and it may last for many years after discontinuation. But, after pregnancy Melasma or pigmentation will usually clear within a few months of delivery but may it may also persist indefinitely.
However many women without these risk factors also develop melasma.
Melasma is seen most frequently in young women but can be seen in men. It is primarily induced and exacerbated by sun exposure, but may also be triggered by;
- Hormonal therapy such as oral contraceptive use or hormone replacement therapy
- Endocrinologic disorders such as Thyroid disease
- Medications such as Dilantin and Minocin
- Cosmetic Skin Care
- Any activities that cause Intense Heat to the face (from steam showers, hot closed environments, sitting on the beach even under cover and with full sun protection)
There are two types of Melasma and each describes how deep the pigment is in the skin and how to treat it. In the office Dr. Wright will evaluate the depth of pigment with a Wood’s lamp, which can roughly estimate if pigment is in the upper layers of skin and will be amenable to topical therapy with hydroquinone and retinoids, or if it will require a deeper treatment with a laser, light source or microneedling. As melasma has a tendency to reoccur (particularly in darker skin tones) consistent use of a retinoid and photoprotection can help prevent flares.
Epidermal Melasma is the most common form and is easily treated with a combination of superficial chemical peels, IPL light base procedures.
Dermal Melasma occurs when the melanin has leached into the deeper skin layer called the dermis. The deeper the pigment is -the more difficult it is to treat. Dermal melasma is not treated with superficial peels and is best treated with lasers and microneedling.