What is melasma?
Melasma is a chronic skin condition that affects many women, and is more commonly found in women of Asian or Latin ethnicity. It is a type of hypermelanosis, or overproduction of melanin. It appears as large brown macules covering the side the cheeks, the entire face, the forehead, nose, chin, or upper lip. There are many causes for melasma: genetics, pregnancy, hormones, sun exposure, heat, and environment – there is no one specific reason. Unfortunately, melasma is a chronic condition. This means that once you have it, you will probably continue to have it for several years. Also, if you leave it untreated, it will generally worsen and/or spread over time.

Do you take care of melasma?
Yes. We specialize in treating Asian and ethnic skin, and we have a very successful melasma treatment program.

Types of Melasma
Melasma localized in to the epidermis is called epidermal melasma. This type of melasma typically responds well to topical bleaching agents. Mixed melasma has an epidermal and dermal component. There is also a dermal melasma classification, although some experts would argue dermal melasma is in fact another dermal skin condition such as hori’s nevus. Some of the older literature suggest that wood’s lamp examination is useful for classification purposes, but in practice, the usefulness of the wood’s lamp is better at detecting very subtle epidermal melasma that is not completely detectable in visible light.

Traditional treatments
Dermatologists around the world agree that hydroquinone is the gold standard in bleaching agents. Over the counter, it is available in 2% formulations in such products and can be purchased readily in any drugstore. Prescription strength formulations usually use a 4% concentration, while some doctors may opt to compound in 5, 6, 8, and 10% formulas. While this is a wonderful drug that can significantly reduce the appearance of epidermal melasma, overuse at high concentrations can cause exogenous ochronosis, and for this reason, hydroquinone has been banned in countries such as Africa, the European Union, and Japan.

How does the Medispa Institute treat melasma?
Before recommending a course of treatment, we need to know several things about your condition.

1. How long have you had melasma?
2. Does anyone else in your family have melasma?
3. When you first noticed it, was it the result of pregnancy or sun exposure?
4. Do you work inside or outside? Do you have regular sun exposure? Do you apply sunblock daily?
5. Have you taken any birthcontrol/hormones in the past? Are you menopausal? Do you have regular periods? Are you taking any other medications? Have you had a hysterectomy?
6. Are you regularly exposed to heat or elements that would cause your face to get red?
7. Have you tried any other treatments or used any other bleaching products before?

If you haven’t treated your melasma before.
If you haven’t used anything before, we suggest that you start out with a light bleaching cream, a good full spectrum sunblock, and follow strict sun and heat avoidance. Over a period of 4-8 weeks, you should see improvement in your melasma. That is the first course of treatment. We can always increase to a stronger bleaching agent and use strong methods such as laser or chemical peels, but this is the first place we should start. Typically, if you have epidermal melasma, a bleaching agent will be able to adquately address it. If you have deeper dermal melasma, we may need to take a stronger approach.

If you’ve used everything and nothing works.
We several effective treatment programs for melasma, depending on your particular circumstance. For patients with sensitive skin, we combine laser treatment with an all natural bleaching product that contains multiple types of natural bleaching agents. For patients with thicker skin and dark deep melasma, we may recommend laser or IPL. For patients who are not candidates for laser treatment, we may recommend a chemical peel. Our treatment programs aim to treat epidermal (surface) melasma as well as dermal (melasma in the deep lower layer of the skin). Most bleaching products contain the same key ingredient, so if you’ve tried other bleaching products with no effect, our melasma treatment programs can significantly help. From our experience, our treatment programs work on about 90% of our patients. There are 10% of patients who do not repond to any type of laser or topical (cream) treatment. If you are a non-responder, we can also prescribe a medication that has been shown to work very well with melasma in Asia, but we only do this for a select few cases.

I don’t want to use any creams.
The cornerstone of melasma treatment is maintenance with creams. If you’ve had an adverse reaction to one type of cream, we can recommend other creams that may be more compatible with your skin. We can treat the condition with laser or chemical peels, but in the long term, you will see better results with a combined laser and bleaching cream treatment program.

Will it go away forever?
Melasma is a chronic condition that requires continued maintenance. The goal of treatment is to treat melasma until your skin is lightened or the melasma has disappeared. After that you must continue to maintain your skin at home using bleaching creams, strict sun avoidance, and good full spectrum sunblock. We have all the maintenance products in our office to help keep your melasma under control. We also recommend that you come back periodically (every 6 months to 1 year) to get a maintenance laser and/or deep white mask treatment.