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Understanding + Treating Melasma

Understanding Melasma

Melasma – the dreaded M word. Melasma can be one of the most frustrating and emotionally difficult conditions for a client to face, and it can also give the same feeling to the professional who is treating it. It is a common skin disorder that impacts over six million people just here in the United States.

Key Components To Understanding Melasma 

1. Hormones almost always play a part whether due to pregnancy or hormonal birth control. 

2. Additionally, UV exposure can make it worse or even bring it back once it is under control.

3. There is also a genetic aspect to melasma as 33%-50% of people who reported having melasma have a family member who has it. 

Equally surprising is that the majority of identical twins who are affected, both have melasma. 

How Melasma Is Different From Other Hyperpigmentation

Melasma’s hormonal component is what differentiates it from other forms of hyperpigmentation. On the surface It can appear as sun damage, since it shows up in the form of dark brown or greyish patches of discoloration. These are typically located on the cheeks, nose, forehead, upper lip and chin. It can also appear less intensely on the neck and arms. 

While Melasma does not cause any pain, it can cause stress and social anxiety. Melasma can sometimes fade on its own but that usually takes time. That is why those affected with the condition choose to treat it. 

Elizabeth Camocho


Contribution by Elizabeth Camocho

 Elizabeth Camocho is a skin care expert, esthetician, and Co-Founder of DermaJEM. She shares her 15 years of experience on her best melasma treatments.

Creating A Melasma Treatment Plan

The first step to creating a melasma treatment plan is to determine its cause. Is it birth control, genetics, sunlight or pregnancy? When it is triggered by something specific, like birth control, the trigger needs to be addressed first before proceeding with a treatment plan. Otherwise, it can worsen the condition, have the dark spots come back quickly, or have no change at all.

The Melasma treatment plan generally involves a combination of therapies. One thing that is important is to educate clients when preparing a treatment plan. It is going to be a process and no two client treatment plans will be the same. Generally, it will involve consistent use of mineral sun protection, topical creams/serums along with in office treatments that can include chemical peels, dermabrasions, laser treatments, and light based therapies.

Products In Your Melasma Treatment Plan

One ingredient that is commonly used in a melasma treatment plan is Hydroquinone. While it does have its side effects, especially when used for long periods of time, it can be very effective in treating pigmentation. Dermatologists can prescribe a specially formulated compounded cream that can include a combination of Hydroquinone, tretinoin and a moderate corticosteroids to help begin lightening the pigmentation, and stop melanocytes from over producing pigment in that area. Other common ingredients used to treat melasma are alpha hydroxy acids, tranexamic acid, azelaic acid, cysteamine, and methimazole. 

There are less aggressive options available for a melasma treatment plan, that include a non prescription strength hydroquinone (2% or lower combination) and combinations of ingredients that include kojic acid, vitamin C, glutathione, licorice extract, soybean extract, and resveratrol that have been shown to be effective as well.

Prepping The Skin For The  Melasma Treatment Plan

As your clients melasma treatment plan unfolds, remember that before beginning more aggressive treatments like laser, and deep peels it is essential to prep the skin with topicals to prevent the melasma from worsening in response to the treatment. Essentially, helping the skin to stop overproducing pigment first will then allow you to treat the pigmentation without concerns about making the pigmentation darker. 

A big part of your melasma treatment plan must be to have your client commit to consistent daily use of sunscreen. Ideally, a physical sunscreen that includes iron oxide and titanium dioxide as they are physical blocks of the sun and will not disperse heat on the skin. Once your client has made a commitment to great at home care that includes consistent use of sunscreen, then you can begin to treat the pigmentation in the treatment room. 

Services In The Melasma Treatment Plan

Alpha hydroxy acid peels like glycolic, lactic, or TCA are great options for treating melasma. Other options include Microdermabrasion and Microneedling. Whatever melasma treatment protocol you choose, it is important to begin gently and increase intensity as you go, since inflammation can also trigger the condition.

Light based therapies like IPL are generally not recommended to treat melasma as they can make the condition worse. IPL disperses heat along with light, this can cause the melasma to worsen. There are some cases where it can be beneficial but only if it is responding to topical treatment, peels, and dermabrasion first. Beginning gently in these cases is essential to make sure we are not causing more pigmentation to come to the surface. As a general rule stubborn persistent melasma should not be treated with IPL.

Melasma is a complex, difficult and chronic condition to treat. Oftentimes clients want a quick resolution, educating them on the best and safest ways to treat it is critical. You also need to ensure they understand how important their part in the process is.  Ensuring positive results when treating melasma involves patience both from the client and from the treatment provider. Solutions and treatment are only successful when both parties commit fully to the process.

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