Melasma is a chronic skin condition that causes symmetric brown patches most commonly on the cheeks, nose, forehead, and upper lip, although it can appear in other areas. It can be exacerbated by UV exposure, heat and visible light. It can also appear due to hormonal triggers like oral contraceptive pills, IUDs, hormone therapy and pregnancy.
It is important to be evaluated by a board-certified dermatologist to first accurately diagnose the underlying cause of hyperpigmentation prior to pursuing any treatments or products.
There are many ingredients used to improve existing hyperpigmentation. The most common and effective ones are hydroquinone, kojiic acid, azelaic acid, ascorbic acid, glycolic acid (AHA or alpha hydroxy acids), tranexamic acid, licorice root extract, and Vitamin A derivatives (ie retinol, all-trans retinoic acid). Most of these ingredients work mostly by inhibiting melanin synthesis or exfoliating excess superficial pigmentation
Topical therapies are often used alone and in combination with office based treatments. One of our first line of treatments is our signature La Suite x Union Square Laser Dermatology Brightening Pads. These pads are formulated with a combination of antioxidants and lightening ingredients that produce the most consistent results without overly irritating the skin.
The most important topical protection is sun protection. Sunscreens are essential to prevent melasma from darkening due to UV exposure, visible light, and blue light from our electronic devices. The best sunscreen for melasma is physical sunblock with SPF 30 or higher that contains zinc oxide or titanium dioxide as the active ingredient.
For best results, we recommend a combination approach of chemical peels, with or without microdermabrasion, and laser treatments. The Clear+Brilliant Permea, Fraxel Restore Dual, Q-Switched lasers, Pico lasers, and Intense pulsed lasers have been used successfully to treat hyperpigmentation.
Chemical peeling agents resurface the skin by inducing a controlled wound and thus removing superficial layers of the skin. As a result, chemical peels promote the growth of a new healthy top skin layer and improve skin problems like hyperpigmentation, fine lines and wrinkles, uneven texture and skin impurities.
Our dermatologists will often recommend our Permea treatment, which combines the Clear and Brilliant laser with a topical antioxidant treatment. The special Permea handpiece is optimized for brighter more even skin tone and enhanced skin permeability. The Permea treatment is combined with Skinceuticals CE Ferrulic antioxidant for synergistic effect which takes advantage of the increased skin permeability to achieve maximum benefits.
Most patients will see improvement with these courses of treatment. However, these require multiple sessions to see maximum effect. Lastly, there is also an oral medication- tranexamic acid- which has been shown to be effective in the treatment of melasma. The largest study on the use of oral tranexamic acid for treatment of melasma was a retrospective review of 561 melasma patients treated with tranexamic acid. More than 90% of patients received prior treatment for their melasma, including bleaching creams and laser treatments. Among patients who received oral tranexamic acid over a 4-month period, 90% of patients demonstrated improvement in their melasma severity. Tranexamic acid has been shown to be safe but is not recommended for a long term use. It is also contraindicated in patients with personal or family history of clotting disorders, personal history of deep vein thrombosis (DVT), or patients who are currently pregnant or are preparing to conceive.