Beyond the Surface: Understanding Melasma and Its Causes

Posted by Azadeh Shirazi MD on

Melasma, also know as the “Mask Of Pregnancy”, can be the unexpected (and unwanted) guest on your skin's journey. It’s a chronic condition that does not discriminate, characterized by brown-grey patches that typically develop on the forehead, nose, cheeks, and upper lip. Typically genetic components with hormones such as estrogen and progesterone play a role in the development of Melasma, but sun exposure can also be a culprit.

There are a number of options to treat hyperpigmentation depending on your skin type and the cause of hyperpigmentation. Let’s dive into some of my top tips including prevention and treatment options! 

For more tips on treating discoloration, check out my YouTube video below, where we break down different types of discoloration and how to identify them.

Tip #1: Sun Protection 

This is the most important step, regardless of skin type and cause. Sun protection and avoidance is the most important method for preventing hyperpigmentation from developing or getting worse. Wearing broad-brimmed hats with a UPF 50+, sunscreen, and staying in the shade are lifestyle habits that reduce your exposure. I recommend using a daily broad-spectrum mineral based tinted SPF product with Iron oxide to minimize UV rays and HEVL (Blue rays) such as HydratintBB SPF 44. Avoiding irritation or inflammation and treating the underlying cause in the first place is really important. Anything that results in “traumatizing” the skin such as heat, rubbing, friction stimulates melanin formation as a response to trauma. 

Tip #2: Skincare Can Make A Difference

When shopping for over-the-counter products that reduce hyperpigmentation, look for ingredients like Azelaic acid, Arbutin, bearberry, and licorice root. These are natural skin lighteners. Ingredients like Vitamin C, Niacinamide, tranexamic acid, and retinol also help to even out skin tone and lighten hyperpigmentation.

Certain skincare agents like hydroquinone, retinols, azelaic acid, kojic acid, glycolic acid, and Arbutin help reduce melanin and melanocyte activity therefore lightening dark areas. They work by blocking an enzyme called tyrosinase, responsible for making melanin in our skin (pigment). Hydroquinone reduces the number of pigment forming cells in addition to stopping the production of melanin. 

Retinols encourage cellular turnover bringing new evenly pigmented cells to the surface delivering a more even skin tone rather than bleaching the skin out.

Another skincare ingredient is Tranexamic Acid. More recently, it’s the new “it” ingredient for Melasma. Some studies suggest that it interferes with UV light’s activation of plasmin which increases the production of melanin pigment. In turn, the interference with UV light helps prevent the production of melanin.

Tip #3: Chemical Peels

Chemical peels help remove the top outer skin layer allowing more even toned skin cells to come to the surface of the skin. Various formulations using alpha or beta hydroxy acids and retinoids are available and are geared towards the cause of hyperpigmentation as well as your individual skin type. For example, TCA-based peels work best for sun damage in lighter skin tones whereas salicylic acid based peels are best for Melasma and post-inflammatory hyperpigmentation in darker skin tones as it’s the least inflammatory. This is a good in-office treatment that won’t break the bank and has little to no downt-time. Always be sure to see a licensed professional for this type of treatment.

Tip #4: Lasers and Light devices

IPL (Intense pulse light) and BBL (broad based light) are light devices that target melanin in the skin lifting sun spots off the skin. They turn into little coffee grinds that flake off over a few days. These are best for lighter less melanated skin tones. Other lasers such as the V-beam, Excel V, Picosure, and the Alex Laser work similarly by targeting melanin in the skin and selectively removing it.

Non-ablative resurfacing lasers such as the Halo penetrate into the deeper skin layer, the dermis. By delivering microscopic columns of heat, areas of pigmentation are removed and replaced with newer, more even toned skin cells. 

However, some lasers can worsen Melasma and pigmentation, particularly in darker skin tones, as the inflammation and heat can trigger melanin worsening hyperpigmentation. You should always see a trained professional when seeking laser treatment options. I always recommend checking the American Society of Dermatologic Surgeons for a trained professional in your area.

If you currently live in the southern California area, you can look into joining our SkinBRIGHT® program at my practice. SkinBRIGHT® brings transformational results to people who are suffering from pigmentation, discoloration, and breakouts, helping them regain confidence and brighten their complexion. You can find more information through this link.

You can learn more on Melasma, sun spots, discoloration, and in-office treatment options by tuning into our More Than A Pretty Face Podcast episode over this topic! 

Dr. Azi’s Recommended Products

DERMABRIGHT Pads

Formulated with natural plant derived skin lighteners including kojic acid, Arbutin, Emblica, and Bearberry along with vitamin C are freshly mixed at the time of order for maximum benefit.  Fast-absorbing, easy-to-use pads with the option to add hydroquinone for greater potency.  Suitable for all skin types to brighten the skin and lighten hyperpigmentation.

Skinceuticals Vitamin C Ferulic acid Serum

A stable and potent vitamin C serum helps lighten discoloration to brighten your complexion.  With powerful antioxidants it also helps repair oxidative damage from UV rays.

Azelaic10 Serum

Azelaic acid 10% paired with plant derived Arbutin to lighten discoloration and reduce inflammation in a hydrating serum with Hyaluronic acid. Gentle enough for those with sensitive skin and a great option for those who are also prone to other skin conditions such as acne or rosacea.  It helps soothe inflammation and gently exfoliates the skin.

Cerave's Skin Renewing Nightly Exfoliating Treatment

An affordable option formulated with a blend of glycolic and lactic acids to promote cellular turnover and licorice root to calm inflammation to help lighten and brighten hyperpigmentation.  It’s lightweight yet hydrating suitable for most skin types.

Drunk Elephant T.L.C Framboos Glycolic Night Serum

A trio of glycolic, salicylic, and lactic acids for those who can’t tolerate retinols to help reverse dark spots and fine lines from sun damage.  Formulated with plant derived raspberry extract, citric and tartaric acid that work well together in fading hyperpigmentation

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MEET THE DOCTOR BEHIND IT ALL

Dr. Azadeh Shirazi, MD is a Board-Certified Dermatologist.

Specializing in medical, surgical, and cosmetic dermatology, Dr. Shirazi received her undergraduate and medical degrees from the University Of Kentucky College of Medicine. After doing a Research Fellowship at Harvard Medical School at the Wellman Center for Photomedicine, she completed her residency training in Dermatology and Cutaneous Surgery at the prestigious Mayo Clinic in addition to completing her training in dermatology and cosmetic surgery at the University of California San Diego.

She has received multiple research scholarships from iconic institutions including Harvard University and the University Of Texas Southwestern Medical Center and has several peer-reviewed publications to her name.