90% Of People With This Skin Condition Are Women

Photographed by Mark Iantosca.
While most pesky skin conditions are equal opportunity offenders, melasma is a special kind of joy that’s reserved mostly for women. It's estimated that of the 5 to 6 million Americas who suffer from melasma, 90% are women, according to the American Academy of Dermatology. What's more, many don't even realize they have it — which can make things worse with mistreatment.
"Melasma affects the skin of the face with irregular brown and gray-brown areas of discoloration,” dermatologist Michael Swann, MD, explains. "The cheeks, nose, forehead, chin, and upper lip are most commonly affected.” Like all skin issues, it can range from light to severe — a few patches or spots above the upper lip to a full face of discoloration.
Having dodged the wrath of this issue up until this year, melasma was always an issue makeup artists would talk about covering or dermatologists would discuss lasering away — never something I had to deal with. Then brown patches, a bit bigger and more concentrated than freckles, started popping up above my upper lip and on the bridge of my nose. The end of the world? Of course not, but annoying nonetheless.
So what the heck can you do about it? And how do you prevent it from getting worse this summer without avoiding pool and park days? We checked in with the experts.
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Step 1: Understand What Melasma Is — & Isn't

First things first, let's knock out the broad-strokes. Los Angeles dermatologist Annie Chiu, MD, describes melasma as "chronic hyperpigmentation of the skin occurring in patches on the face, most often forehead, cheeks, and upper lip." She credits sun exposure and hereditary predisposition as major culprits, as well as hormonal changes, but adds that the causes range. "Most commonly an increase in estrogen either through pregnancy or birth control pills," she says, noting that darker skin tones are affected more frequently. Tip: Google melasma and you'll see exactly what we're talking about.

One more rumor to bust: Melasma is not the same as freckles. "The pigmentation in melasma is much deeper in the skin than more common sun spots, aka 'lentigenes' or freckles," Dr. Swann says. "This deposition of pigment deeper in the skin means the resulting color that we see with our eye doesn't match normal skin tones. It also makes the pigment harder to treat, so prevention is actually much more effective than treatment."

Sun exposure — like after a long holiday weekend, ahem — exacerbates the issue, but long days in front of a computer aren't great, either. Remember the debate over whether selfies are aging us? It has merit, Chiu says. "Studies have shown melasma is triggered not only by UV exposure, but can also be worsened by infrared energy, which is felt as warmth," she says.

Suffice it to say, it's impossible to cut out everything that could be causing melasma, so let's talk about slowing it down instead.
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Step 2: Learn How To Deal

You guessed it: SPF, SPF, & more SPF! "The single most important thing you can do for your skin is to protect it from the sun," celebrity aesthetician Shani Darden told us. "Sun exposure ages your skin and is extremely hard to reverse later in life, so apply SPF 30 daily!"

Chiu agrees and suggests an especially-strong sunscreen, or "superscreen," like Skinmedica Total Defense and Repair, which also protects against light from your devices. "Every day use with regular reapplication is crucial to the control of melasma," she says.

Dr. Swann agrees with Dr. Chiu, stating that it's not just sunlight you have to worry about. "Melasma may be more linked to UVA or infrared light and heat than it is to UVB," he says. Moral of the story: Liberally apply a tinted, mineral-based, broad spectrum SPF every day for extra protection. Dr. Swann recommends any formula from Elta MD.

Next, stay cool and learn to love big hats and shade. That means baking in the sun and even hot yoga can trigger melasma, our experts say.
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Step 3: Pick The Right Skin-Care Products

"Effective treatment of melasma requires adhering to a skin-care regimen with 'superscreens,' pigment-decreasing ingredients, and behavior modification," Chiu says. That is: seeking shade when outdoors, and avoiding too sunny or too hot environments.

SPF? Check. Big hats and sunnies? Check check! An affinity for shade? Working on it. The last step? Finding the right ingredients to help lessen the discoloration at home.

A stable vitamin C serum is the first step, applied in the morning, after cleansing and before SPF, she says, noting that SkinCeuticals C E Ferulic is the "gold standard." Darden and Chiu both recommend at-home peel pads, too. They recommend Dr. Dennis Gross's formula and Murad's options, respectively.

Finally, you can add a skin lightener to temper the issue, just look for ingredients like kojic acid and alpha arbutin, Dr. Swann says. He recommends SkinMedica's Lytera 2.0 Pigment Correcting Serum to his patients.

Want to take it a step further? All our experts note that a professional chemical peel and/or laser treatment can jumpstart results, but be weary, because "many lasers can actually worsen melasma given the heat exposure," Dr. Chiu says. (She recommends the "cautious use of limited lasers like the Clear and Brilliant Permea fractional laser.")

Talking to your doctor about a lower dose of estrogen in your birth control or adding a topical, prescription strength hydroquinone for a few weeks (too much can make things worse) are also helpful, but the meat of this problem truly lies in daily, religious use of broad spectrum SPF.

Have you had success treating and preventing melasma? Tell us in the comments below what worked for you!
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