Do You Suffer From This Embarrassing Skin Woe?

Melasma_slide01Illustrated by Sydney Hass.
Without a shadow of a doubt, uneven skin tone (read: hyperpigmentation) is one of the biggest skin anxieties, with acne and aging taking the cake. But, did you know that all these concerns can often be interrelated?
Do you have wrinkles and sun damage? You probably have irregular brown patches bundled into your complexion, too. Suffer from serious breakouts and blackheads? Post-pimple, scar-like discolorations are probably coming your way. Melasma — patches of dark skin that often appear after sun exposure — can cause major psychological distress, especially if you have darker skin and were born into a culture where flawless, alabaster skin is still seen as the pinnacle of beauty. (Don’t even get me started on all that!)
Melasma_slide02Illustrated by Sydney Hass.

So, who gets it?
Melasma (or chloasma) is a very common skin-related complaint and is estimated to affect around six million people in the U.S., 90% of whom are women, according to the American Academy of Dermatology. And, the the American Pregnancy Association says that as many as 50% are pregnant women may suffer from it as well. While lighter skins can experience melasma, it mainly impacts olive or darker skin tones due to higher activity of the pigment-producing melanocyte cell. Latino, African-American, Asian, Indian, Middle Eastern, and those of Mediterranean descent often get the brunt of this skin issue. Add in a blood relative who had melasma and you have a target on your back.

What does it look like?

If you have just a couple of random brown spots on your chin, you don’t have melasma; you have post-
inflammatory pigmentation that’s probably the result of a crop of pimples. Melasma is an irregularly-shaped blotch of hyperpigmentation that’s symmetrical. We called it the “butterfly masque” in skin school, but it’s not quite so pretty, fragile, or fleeting. It can range in color from light brown to greyish, dark brown and has a specific pattern, mainly affecting the central facial zone: the chin, upper lip, cheeks, nose, and forehead. Sometimes, it can be just on the cheeks and nose but rarely just the jawline.

Melasma_slide03Illustrated by Sydney Hass.

What causes it?
Melasma formation has always been understood as being linked to hormones, UV exposure, and genetics. Interestingly enough, melasma runs in families regardless of whether a man or woman inherits the disease. Today, we know a bit more about what is flicking the pigment switch in our skin, but it is complicated and not as simple as simply switching over, to a different birth control pill. Let’s explore these two causes a tad more as there’s not much we can do about the genetic aspect.

Hormones: We know that around 50% of melasma cases are related to elevated female hormones like estrogen, progesterone, and melanin — especially during pregnancy or when on the pill. Stimulating Hormone MSH (yep, there’s a hormone whose job is to arouse pigment), especially in the third trimester of pregnancy, is likely to be involved. The good news is that pregnancy-related melasma usually fades within a year after delivery; however some areas of hyperpigmentation might not shift, especially if there’s been considerable UV exposure. Unfortunately, contraceptive-induced melasma will persist as long as the medication is used. In addition to the sex hormones, stress and thyroid hormones may also play a role, as do some ovarian disorders.
Melasma_slide04Illustrated by Sydney Hass.

Here's what to do for your skin.
Help to stabilize pigment overproduction by using safe but effective peptide and botanically-based skin brightening products with ingredients like oligopeptide 34 & 51, zinc glycinate, niacinamide, vitamin C, algae extracts like laminaria, ascophyllum, palmeria, and phytic acid from rice bran. Kojic acid and azelaic acid are also prescribed by some docs, but can cause skin irritation for some people. Any form of inflammation in the skin will stimulate more pigment, so it’s a delicate balance. Though it’s the only FDA recognized skin-lightening agent, I don’t personally recommend hydroquinone at any percentage — prescribed or over-the-counter — due to its scary side effects like loss of pigment, contact dermatitis and tissue cell death. It’s also a no-no for some MDs if you are pregnant, as are topically-applied retinoids that are sometimes recommended to speed cell turnover and help with penetration of HQ. Read more about it here.

Melasma_slide05Illustrated by Sydney Hass.
No matter what you're using, you must be diligent in applying your treatment products morning and night for a minimum of six-to-eight weeks. Some dermatologists even recommend six months of topical product use. It will take about a month to see results, and skin might even look darker before it looks lighter.
One thing we do know is that exposure to UV radiation is a major factor for melasma. It stimulates the growth of more pigment cells, spreads the pigment through the skin, and makes existing pigment look darker. Scientists suspect that even visible light can produce pigment, especially in darker skin tones. You might want to avoid artificially fragranced products and makeup yourself for good measure.
Think like a vampire, and avoid sun exposure at all costs. Wear a broad spectrum sunscreen daily of SPF 30 or higher. Wear a wide brimmed hat and never leave the house without a generous layer of sunscreen on your skin, which you must reapply every two hours if you are in direct daylight. Look for the latest SPF technology like olesomes that not only help stabilize products but boost SPF levels without the need for adding extra chemicals. Sophisticated products will also have antioxidants like vitamins E and C, white tea, and licorice to squash free radicals and calm any UV-induced inflammation. Zinc and titanium dioxide-based, chemical-free sunscreens might be more suitable for sensitive skins and also provide a little coverage and luminosity due to their reflective nature.
Melasma_slide06Illustrated by Sydney Hass.
At Dermalogica, we utilize a Woods Lamp for our treatments, which uses a black light and helps determine if you have epidermal or dermal pigment, dermal being much more stubborn to treat successfully. Exfoliation, microdermabrasion, chemical peels, laser, and light-based therapies are all part of our arsenal for effectively treating melasma — sometimes, combinations of all these treatments will be necessary depending on your Fitzpatrick skin type. If you have darker skin, think again before you book laser procedures, especially if it’s not being performed under the supervision of a board-certified dermatologist.
One thing you can count on is our insistence that you utilize brightening products at home and avoid prolonged exposure to UV rays. Someone once said that treating hyperpigmentation and failing to use SPF each day is like going to the gym, then having a milkshake. I can’t think of a better way to sum it up!

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