How come some of the most common skin conditions are so difficult to successfully treat and prevent? In this article, we will be exploring that question by discussing the skin pigment condition, melasma. With so much confusing and conflicting information about melasma treatment available to us, finding the right protocol for you can become as frustrating as the treatment itself. Today we want to help reduce the overwhelm and discuss useful steps towards preventing and supporting melasma with your daily skincare.
By: Hayley Wood L.E., N.T.P
IN THIS POST:
- Understanding melasma
- Melasma causes
- Traditional melasma treatment
- How to prevent melasma
- Skincare treatments and supportive ingredients to treat melasma
- Products we recommend for melasma treatment
- A final note about treatment of melasma
As an esthetician for the past 16 years, the melasma cases I’ve treated stand out as some of the more complex cases I’ve encountered. This is because the cause(s) of melasma can vary drastically for each individual, making no two cases alike. It requires a lot of education, personalized care, time, and of course, patience to get it right.
However, difficult does not equal impossible! It simply means that it’s tricky if we don’t take the time to properly address it. Just like any other skin health topic, in order to understand how to treat the condition, we need to begin by identifying the causes—put plainly, we need to try to understand melasma as a condition.
Before we dive in, it is important to remember that there is no one-size-fits all when it comes to long-term holistic skin care. The outcome of trying to understand more about the cause of a skin condition is that it helps build realistic and personalized habits for supportive, ongoing results. The information shared here includes resources to explore, but please remember that if you are experiencing melasma, the personalized care and support of a skin care professional can be extremely beneficial.
TNK Team note: Before we dive into this much-asked-about topic, we want to acknowledge that talking about melasma feels extremely layered. Yes, it’s a diagnosable “condition,” but even calling it that can be a slippery slope that leads to elevating one skin tone over others. Every time we think we know the “best” way to talk about it, we remember that at the core of this argument, we are still talking about how to lighten unwanted dark skin.
On top of that, people with darker skin tones have long been targeted for “lightening” agents that are a) unnecessary and allude to the need to conform to racially motivated societal norms, and b) have potentially dangerous side effects.
All that said, we’re trying to be aware of the language we use as we discuss this topic. In the case of the skin support and products we recommend in this article, there are different classifications of ingredients that fall under “brightening” vs. “lightening,” as the first helps suppress melanin and the second essentially bleaches the skin. We will be using “brightening” as the technical term, and its definition is intended to support an EVEN skin tone, whatever that tone is—not lighten all skin to a certain tone.
Lastly, if you experience melasma, we’re not implying that you NEED to do any of these treatments. Melasma isn’t a dangerous condition and it’s usually temporary, so letting it run its course is also an option. But if you do want a holistic, skin-supportive way to treat melasma, consider this your guide.
Melasma, otherwise known as a “pregnancy mask” and previously known as “chloasma,” is defined as bilateral hyperpigmentation on the face. This discoloration can range from shades of brown to dark gray and blue tones, depending on the depth of pigment in the epidermis and/or dermis. It is an acquired skin condition that can be tied to a variety of possible causes, including UV ray exposure as well as hormonal fluctuations (more on those causes later).
The areas where melasma will appear are usually on the forehead, nose and upper lip, but can also be found on the cheeks and chin. The majority of cases are found in women, especially for those in their reproductive years, as well as women with darker skin tones. Melasma is also a temporary and benign skin condition as most cases can resolve themselves over time. Thankfully, there is no health risk to having melasma.
RELATED: Lisa’s current skincare routine.
Considering melasma impacts many people during different stages of their lives we have to ask ourselves, why is it so hard to successfully treat?
The short answer is because it’s a complicated human skin condition. Melasma has many possible culprits, many of which are unforeseen for most people until after the melasma becomes present. The following list includes the most common causes for melasma:
- Exposure to UltraViolet rays
- Hormone imbalance (typically with high estrogen and progesterone)
- Certain medications such as anti-epileptic medications, retinoids, birth control pills, blood pressure medications and some antibiotics
- Thyroid autoimmunity
According to the National Library of Medicine, “Studies have confirmed that both melanocytosis (increased number of melanocytes) as well as increased melanogenesis (increased production of melanin) are responsible for the hyperpigmentation in melasma.” It usually is the right combination of the above mentioned causes that can slowly turn pigmented cells, aka melanocytes, into melasma over time.
Translation: Melasma may feel like it shows up overnight, but in reality, it can take a while for it to present itself.
Traditional melasma treatment
Though melasma is usually easy to spot due to its appearance on the skin, it can be valuable to get diagnosed by a dermatologist or evaluated by a licensed esthetician to determine the depth of your specific condition. This will help support your treatment plan because the depth of your melasma will change how you go about treating it.
👉Melasma that manifests as a lighter brown pigment is an indication of epidermal melasma, which can be treated with the right topical plan.
👉Darker pigmentation varying in gray and blue tones indicate that melasma is located deeper into the dermal layers of the skin and can require a more in-depth professional care plan.
Skincare ingredients can play a valuable role in melasma prevention and treatment. However, the traditional treatments for melasma often have their own side effects and risks. While these traditional procedures and prescriptions may be an option for some melasma cases, they are not ideal for others commonly affected by this condition.
The most commonly prescribed topical care for melasma is prescription hydroquinone, known as a skin whitener, which has many potential side effects and is a banned ingredient in many areas including the EU, Japan and Australia (and it makes our NO THANKS list).
Other common melasma treatments include photosensitizing procedures such as peels, intense pulsed light (IPL) therapy, aka photofacials, and fraxel lasers that may require down time to heal, and complete avoidance of the sun for periods of time.
Many of these procedures have potential risks for individuals with darker skin tones, which happen to be the skin tones that are more likely to get melasma in the first place. These procedures are also costly, as they require multiple visits for maintenance and may not be accessible to everyone.
How to prevent melasma
Melasma is an acquired skin condition, so awareness and prevention are a big part of treatment. In order to possibly prevent melasma from forming, here are a few things to consider:
Get to know your prescription medication side effects
Especially if you have multiple prescriptions you are on including topical care, making sure you understand the potential side effects of your prescriptions is key to helping prevent melasma. Some may state that they can cause photosensitivity or an overall sensitivity to skin. If this is the case, discuss with your doctor any concerns you may have. You can ask your doctor, pharmacist or use a site like this one to better understand side effects.
Avoid excessive UV exposure and heat
UV rays, including blue light on your screens, and excess heat can be culprits of melasma.This includes heat-based exercise classes and spending too much time outside on an extra hot day. The light and heat can create a vascular response in the skin that stimulates more melanocyte pigment and inflammation, both of which can turn into melasma over time. Remember to stay hydrated and cool as well as protected with SPF daily. Check out our 2022 list of favorite mineral sunscreens.
And if you’re reading this like, Are you saying I have to skip my hot yoga?!, keep reading…
It’s such a bummer I know—but imagine being on a birth control pill, using photosensitizing skincare AND going to hot yoga… It’s a trifecta I have seen in many melasma clients, so I think it’s just best to avoid if you are looking to prevent melasma. However, if you do your best to cool off your skin after a hot yoga class, that can be really helpful for vascular flares.
Ultimately, melasma can still show up when we least expect it. There are certain scenarios where prevention isn’t possible or foreseeable, such as pregnancy-related melasma, which occurs in 15-50% of pregnant patients. We want to encourage you to continue to implement prevention habits to help support your skin whether or not melasma is present.
Skincare treatments and supportive ingredients to treat melasma
One of our favorite ways to target melasma treatment is to focus on supportive ingredients. This should include a balance of barrier supportive ingredients, such as antioxidants, and gentle brightening agents. Finding supportive skincare ingredients can take some time depending on your case and your melasma triggers. Once you identify the ingredients needed, the key to successfully treating melasma is consistency with your skincare routine. (Have we said that before? Yes.)
Please note that there are many ingredients to consider implementing into your routine for short- and long-term support with melasma. This following list of ingredients examines a few that are beneficial for all skin tones and can be successfully paired together.
Antioxidants help build skin’s resilience to external aggressors, along with providing protective and restorative properties to your skin. Here are a few antioxidant-rich ingredients to consider incorporating into your AM skincare routine for melasma support:
- Niacinamide – This is an antioxidant B3 vitamin known to help support the skin’s barrier function by working as an anti-inflammatory, which is essential to helping calm the skin’s responses that can turn pigment into melasma. It can be used to help prevent and treat melasma.
- Vitamin C – From ascorbic acid to vitamin C-rich plant ingredients like kakadu plum, the benefits of vitamin C are incredible. It is an antioxidant that provides natural brightening, protecting and tightening properties to the skin. Recommended for AM routine and works wonderfully with other vitamins such as vitamin E and ferulic acid.
- Zinc Oxide – Zinc is known as a common mineral SPF ingredient, but it is also considered to be a wonderful anti-inflammatory ingredient for daily use. It is recommended to use daily for defense against melasma triggers like UV and inflammation.
Gentle exfoliating and brightening ingredients
It’s very easy to fall for the thought process that melasma should be treated with a lot of strong, exfoliating, active ingredients. However, considering melasma typically warrants a long-term plan and is exacerbated by inflammation, it is best to incorporate gentle brightening agents known to naturally even the skin tone instead. Here are a few gentle ingredients to consider for your PM routine:
- Kojic acid – Naturally occurring in ingredients like shiitake mushroom, Kojic acid works well to help naturally and gently exfoliate the skin. It has been found to lift hyperpigmentation by inhibiting the enzyme for melanin production, while also having some antioxidant properties. It is also heavily researched for melasma treatment on individuals of Asian descent.
- Bearberry leaf – Bearberry leaf is a natural brightening agent. It is rich in arbutin, which is known as a natural version of hydroquinone to help inhibit tyrosinase, which will prevent pigment from forming. It also is filled with antioxidants to support the skin.
- Azelaic acid – Azelaic acid is commonly used to treat conditions like acne and rosacea because of how gentle of an acid it is. The use of azelaic acid is an option for those with epidermal melasma rather than dermal melasma (epidermal are your top 5 layers of your skin, dermal consists of the 2 layers under the epidermis). Azelaic acid works by inhibiting tyrosinase to prevent pigment formation, along with providing anti-inflammatory support.
A note about retinols, which seem like a solution, given all the positive benefits we’ve talked about before: Retinol can help but only if you also avoid other contraindications such as certain medications, excess UV exposure, etc. It also doesn’t work as effectively in all skin types so I wanted my recommendations to be useful for all skin tones.
Products we recommend for melasma treatment
For Vitamin C
For Bearberry Extract: Vitamin C, Kojic Acid, Bearberry Extract
For Kojic Acid: Skin brightening acids rich in mushrooms
Pumpkin Enzyme, Mushroom, Algae
Niacinamide: Vitamin C, niacinamide
Azelaic Acid: Vitamin C, Azelaic Acid
Bearberry Extract, Vitamin C
A final note about treatment of melasma
There are many other natural ingredients such as turmeric, aloe, pumpkin enzyme and lactic acid that are additionally supportive in fading skin discoloration in general. But understanding your melasma triggers can help determine which ingredients are best to introduce or exclude from your melasma treatment plan. Again, this is why consulting with a licensed esthetician or dermatologist is super beneficial to your treatment plan.
A holistic approach to treating melasma may also include determining certain vitamin and mineral deficiencies, which can be addressed through nutrition and supplementation as well.
The biggest takeaway is to understand that there is no one size fits all approach to treating melasma. Working with a licensed esthetician with experience in treating melasma can help support your skin’s long-term needs through personalized recommendations. You don’t have to do this alone, but we hope that this information helps you feel more confident and empowered with the knowledge you need to get the proper care for your skin.
Have you dealt with melasma? What’s worked for you?
Medical Disclaimer: While the author is a Nutritional Therapy Practitioner, she is not a doctor, and these recommendations are only guidelines for reference, not medical advice. Please seek additional support or treatment from your doctor.
TNK Team Note: This article contains affiliate links. TNK uses affiliate links as a source for revenue to fund operations of the business and to be less dependent on branded content. TNK stands behind all product recommendations. Still have questions about these links or our process? Feel free to email us.
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