Treating Melasma: A Guide to Melasma Treatment Options and Avoiding Common Pitfalls

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There are a number of effective options for treating melasma including topical products, in-office treatments, and oral supplements. The most effective treatments are combination therapies that are customized to an individual’s specific needs. Although treatments can be very effective, given the complex and not fully understood nature of the skin condition, it is very common for melasma to reoccure. For personalized guidance and help finding a trusted medical skincare professional near you, click here.

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A note from the author

Over the course of the 21 years that I’ve been working in medical skincare, the landscape of melasma treatments has evolved. There are more safe and effective treatment than ever before, but given the abundance of information and options, there are common pitfalls that often keep people from getting the best result possible.

As we continue exploring melasma together, I thought it would be helpful to provide a guide that breaks down treatment options and helps you steer clear of common pitfalls.

Good skin days ahead!

-Veronica

Melasma Treatment Options

Melasma treatment options include topical treatments, in-office procedures, and oral supplements. The most effective treatment strategy often involves a combination of these approaches, tailored to an individules specific skin and needs. Here is a guide to the most common and effective melasma treatments.

Topical Ingredients

Tretinoin, Retinol, And Other Vitamin A Derivatives

Vitamin A derivatives like retinol and tretinoin increase the rate that our skin naturally sheds dead cells. When this happens, hyperpigmented cells shed more quickly, reducing the appearance of melasma. Vitamin A derivatives have been widely studied and are proven effective for many types of hyperpigmentation, including melasma. They’re safe when used as directed, though for many people they may cause skin irritation.

Hydroquinone (HQ)

Hydroquinone is one of the most well-known treatments for melasma. It works by reducing an enzyme called tyrosinase, which is crucial in the production of melanin (skin pigment). Although it has a reputation as an effective option for the treatment of hyperpigmentation and melasma, it’s become controversial in recent years and even outlawed in some parts of the world because it’s been shown to be potentially unsafe for long-term use. HQ is highly effective but should be used under the supervision of a qualified professional and shouldn’t be used for extended periods of time.

Corticosteroids

Corticosteroids are used to reduce inflammation, which is present in the skin during a melasma flare-up. Corticosteroids are especially effective when combined with other active ingredients but are usually only recommended for short-term use because of the potential of adverse side effects.

Creams That Combine The Above Ingredients 

Often refered to as “triple-cream treatments”, these creams combine tretinoin, hydroquinone, and a corticosteroid for an effective multi-pronged approach. They're commonly prescribed by dermatologists and are shown to be more effective than single-ingredient treatments. They work, but not everyone can tolerate the higher potency of active ingredients and many people end up discontinuing use due to skin irritation and sensitivity.

Tranexamic Acid

Tranexamic Acid has been used for years as a medication for preventing blood clots in surgery, but has gained popularity in skincare recently because of it’s ability to reduce melanin production. Tranexamic Acid has been studied and is considered safe, but because it’s a relatively new treatment for melasma, long-term studies don’t yet exist.

Glutathione

Glutathione is an antioxidant that’s naturally made by our bodies. It’s been gaining attention in recent years as a skincare ingredient, but it’s efficacy for the treatment of melasma is mixed. Because of the inconsistent results and the lack of studies, it’s not often recommended as a first-line of treatment, but rather as an alternate option for people who aren’t tolerating other treatments well, or as part of a combined approach.

Azelaic Acid

Azelaic acid is a naturally occurring acid that is well known for it’s ability to slow melanin production. It's less potent and effective than hydroquinone but has fewer side effects and can be a good alternative for those with sensitive skin or for long-term use.

Mandelic Acid

Mandelic acid naturally occurs in bitter almonds and is in the family of acids called Alpha-Hydroxy Acids (AHAs). Mandelic acid promotes skin cell turnover and studies show it’s ability to minimize the appearance of melasma. It's gentler than some other common acids, making it a good option for for sensitive skin.

In-office Procedures

Laser Treatments

Laser treatments utilize specific wavelengths of energy to target melanin in the skin, breaking up the pigment and helping to reduce the appearance of melasma. Different kinds of lasers can be used, but not all lasers are appropriate for malasma, and opinions on treating melasma with lasers are mixed. There are some lasers that are very effective for melasma, but it's crucial to have these procedures administered by an experienced professional with the right equipment. The wrong lasers on the wrong skin can make the melasma worse. Find a qualified professional and discuss with them if you’re a good candidate, potential side effects and downtime.

Chemical Peels

Chemical peels aren't as scary as they sound. They typically use naturally-occurring acids like AHAs to exfoliate the skin and stimulate skin cell turnover. Peels have been utilized for decades to minimize the appearance of melasma but chemical peels are not all the same— the strength and technique should be customized based on your specific needs. When performed by a qualified professional with experience in treating melasma, chemical peels are safe and effective.

Oral supplements

Polypodium Leucotomos Extract

Polypodium leucotomos is a type of fern that's been studied for its potential skin benefits, especially when it comes to protecting against damage from the sun—a key trigger for melasma. Taking this extract in supplement form may help to reduce the risk of melasma flare-ups, but it's not a standalone solution and should be used in conjunction with other treatments and sun protection.

Anti-Inflammatories

Since inflammation can contribute to melasma, taking oral anti-inflammatory supplements can help manage the condition. Supplements can include ingredients like omega-3 fatty acids or turmeric, among others. They're generally safe but should be used under the guidance of a healthcare professional to ensure they don't interfere with other medications or health conditions.

Antioxidants

Oral antioxidant supplements, including vitamins C and E, may also be beneficial for melasma. These antioxidants help protect cells from damage and can support overall skin health. However, while they can complement other treatments, they're unlikely to make a noticable difference on their own.

Maintaining Realistic Expectations: Progress, Not Perfection

Treating melasma is not just about seeing initial improvements, but maintaining those gains over the long term. As you consider treatment, it's important to bear a few things in mind:

• It’s common to experience "rebound pigmentation" - a common occurance despite promising initial results.

• Change takes time. You might see a shift in your skin's condition in as little as 10 days, but it's the prolonged, consistent improvement that truly signifies progress.

• Consistent daily habits keep melasma at bay - this means avoiding sun exposure, following your regimen, protecting your skin with sunscreen, and keeping regular appointments for professional treatments.

Avoiding Pitfalls in the Treatment Process

Avoid The Temptation To Self-Treat. Get Professional Guidance

The skincare market is flooded with products and treatments claiming to solve the melasma puzzle, but the condition can be difficult to navigate alone. With the right guidance you can successfully treat and significantly improve the appearance.

Embrace a Comprehensive Approach

Treating melasma is not about placing all your hopes in a single product or procedure. Each treatment addresses only one aspect of the multifaceted condition. While marketing may position certain treatments as miracle cures, remember, melasma is a complex condition with numerous contributing factors. Only a comprehensive approach, tackling the condition from various angles, will ensure success.

For personalized guidance and help finding a trusted medical skincare professional near you, click here.