Melasma / Hyperpigmentation

More than six million people in the United States live with melasma – patches of tan, blue-gray, or brown skin. About 90 percent of those cases are women, 20 to 50 years of age. It is not physically uncomfortable, nor a medical hazard. However, melasma typically appears on the upper cheeks, forehead, upper lip, and chin; sometimes on the neck and forearms as well. Since those areas are quite visible, this discoloration impacts your appearance and emotional well-being.

Approximately 200,000 new cases of melasma are diagnosed each year in our country. For individuals in the San Antonio area, diagnosis and treatment for this common condition is just a phone call away.

What is Melasma?

Melasma is a dermatologic condition that causes patches of skin to become discolored. This type of hyperpigmentation primarily affects women, and often during times when hormones are unbalanced.

Women (and men to a much lesser degree) of Middle Eastern, Indian, Asian, Latin, Mediterranean, and North African heritage are most prone to hyperpigmentation. Their naturally darker skin tone contains more active melanocytes, color producing skin cells, than lighter skin. These active cells already produce extra pigment, and that action increases when cells are stimulated by sun exposure or fluctuating hormones.

What Causes Melasma?

The direct cause of melasma is an overproduction of melanin in the cells that give skin its pigment. Melanocytes may become overactive in response to a few factors. These include hormone fluctuations during pregnancy, use of oral contraceptives or other hormone-based birth control, and hormone replacement therapy. Sun exposure may also be an instigating factor due to the damage UV light does to melanocytes. Some studies suggest that systemic inflammation, or localized inflammation in the skin may lead to melasma. Finally, there is a genetic factor that may make some people more susceptible to this benign condition.

In some cases, melasma may clear spontaneously, usually when it is caused by oral contraceptives or pregnancy and those conditions change. When the dark spots do not fade naturally, you need specialized treatment.

What are the signs of Melasma?

Indications of melasma are consistent from one person to another. Gray or brown patches typically develop on areas of the face, including the cheeks, chin and jaw line, upper lip, and the bridge of the nose. Sometimes, patches may occur on the neck, forearms, or other area that has suffered extensive sun exposure.

Hyperpigmentation is the only symptom of melasma. Patients do not experience discomfort, flaking, or any other indication of excess melanin.

What Is Hyperpigmentation?

The coloring in your skin is called pigmentation. When something such as injury, disease, or sun exposure damages your skin, it can disrupt the natural distribution of pigmentation. Dark areas of skin are called hyperpigmentation. Several conditions fall under this classification. Melasma is a form of hyperpigmentation. Other forms of hyperpigmentation include age spots and postinflammatory hyperpigmentation/scarring.

Melasma Diagnosis

Because the physical symptoms of melasma are obvious, diagnosis usually consists of a general dermatologic exam.

Treating Melasma

The primary objective in treating melasma is to reduce or eliminate hyperpigmentation. The timing of treatment is patient-driven. Some patients choose to postpone formal care in order to allow time for the production of melanin to naturally return to a normal rate. This may occur over several months after childbirth, or after the completion of hormone therapy, or with a change in birth control method.

Over-the-counter creams are available to minimize the production of melanin in the skin. Without a prescription, however, the concentration of active ingredients is much lower. Therefore, the results that are obtained with self-care may be less than optimal.

If melasma does not resolve on its own, we may consider a number of treatment options. Melasma is commonly treated with prescription creams that contain retinoids or hydroquinone. These ingredients gently lighten dark spots on the skin. Derived from vitamin A, retinoids are beneficial for melasma patients due to their suppression of melanocyte activity. Topical remedies may be used as an adjunct to laser or light treatments that are performed in our Sonterra or La Casita office.

Treatments that accelerate cell turnover may be advantageous because they can hasten the transition from patchy, discolored skin to a more even tone. Options to consider include gentle chemical peels and microdermabrasion.

Recovery after treatment

Topical melasma treatments work gradually to halt the production of excess melanin, allowing surface pigment to return to normal. Laser and light treatments, such as IPL, are gentle enough to support healthy skin tone without requiring downtime. Some laser treatments may cause temporary redness, but typically do not interrupt normal activities.

Can Melasma be prevented?

Because melasma may occur as a result of changing hormones, predisposed by genetics, there is no way to completely eliminate risk. However, if there is a known risk factor, such as a family history of melasma, or melasma during a previous pregnancy, steps can be taken to manage melanin production in the future.

UV protection is a crucial aspect of treating and preventing future melasma. As much as possible, sun exposure should be strictly avoided – zero exposure during peak hours. Exposure to UV rays may be diminished with appropriate clothing such as wide-brimmed hats and long sleeves. Sunscreen is also a vital necessity for melasma patients. High quality sunscreen that blocks both UVA and UVB light is needed. Depending on the degree of concern, patients may double-up on protection by applying a cream sunscreen and topping it with mineral powder makeup with protective capabilities.

Melasma doesn’t just affect the skin, it can diminish the confidence you feel. Learn more about the diagnosis and treatment of melasma in our San Antonio offices.

Why You Should Choose Dr. Bucay for your Melasma Treatment

Dr. Vivian Bucay puts extensive experience and state of the art technology to work refining discoloration, but only after thoughtful evaluation of your skin condition and type. She takes into consideration your level of concern, the degree to which melasma has affected the appearance of your skin, and the total area requiring treatment. Then she will recommend a plan tailored to your needs. It will begin with daily sunscreen – a must. She may prescribe topical treatment with professional strength creams containing hydroquinone, azelaic acid, retinoids, kolic acid, corticosteroids, or glycolic acid to bleach the dark spots. Dr. Bucay may even recommend Heliocare, an oral supplement with antioxidant activity that can reduce the effects of ultraviolet rays on the skin and aid in skin repair. Chemical peels, microdermabrasion, intense pulsed light therapy, and fractional skin resurfacing may also be effective in restoring natural skin tone.

In addition to administering precise treatment to eliminate discoloration, our experienced staff provides guidance on protecting your skin from further occurrences. For example, those prone to melasma should use high quality mineral-based makeup, and wear sunscreen every day. UV rays reach the skin even through clouds, so daily protection is necessary for a beautiful, glowing complexion.

Our goal is to provide relief from melasma and hyperigmentation through an ideal treatment plan, so you may regain confidence in your appearance, knowing that you have radiant skin. Schedule a compassionate, personalized consultation with Dr. Bucay today.

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