Tackling stubborn skin discoloration associated with melasma

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pregnancy,” but melasma’s patchy brown, tan or blue-gray skin discoloration doesn’t just occur in expectant mothers. Fortunately, a variety of treatments can minimize this often-embarrassing condition, according to Jennifer Wong, PA-C, of Advanced Dermatology P.C. 

About 90% of people with melasma are women between the ages of 20 and 50, and this skin spotting—typically appearing on the nose, cheeks or jawline—is more common during the hormone-fueled months of pregnancy, says Wong, a physician assistant with comprehensive experience in medical and cosmetic dermatology for all ages. 

But sun exposure and genetics are also leading contributors to melasma, which the American Academy of Dermatology estimates affects about 6 million women in the United States. 

“Diagnosing melasma isn’t difficult, with a health care provider often able to pinpoint its presence just by looking at your skin,” Wong explains. “… The vast majority of melasma patches are harmless, though dismaying to live with.” 

Treatment options 

It may be encouraging to know that melasma can sometimes fade on its own, given time and patience. But waiting it out might be a good approach, Wong notes, when the condition’s trigger has been identified and will soon end, such as pregnancy, oral contraceptive use or excessive time in the sun. 

If you wish to take a more aggressive treatment path, there are both at-home and in-office options available, Wong says. Melasma treatments can include: 

Hydroquinone: This medication, which is available in cream, lotion, gel or liquid forms, lightens the skin. Over-the-counter versions can be found, but your doctor can prescribe stronger concentrations if needed. 

Corticosteroids and tretinoin: When added to hydroquinone, these medications can enhance skin-lightening effects. Some products are called a “triple cream” because they include all three ingredients. 

Other topical medications: Skin-lighteners such as azelaic acid or kojic acid work by encouraging cell turnover to rid the skin of unsightly marks and promoting healthy new skin cell development. 

In-office procedures: Topical medications are usually the first line of treatment, but if they don’t do the trick, your doctor can try in-office procedures such as a chemical peel, microdermabrasion or dermabrasion. These treatments slough off the top layers of the skin, where melasma occurs. 

No matter what treatment you try, results likely won’t be instantaneous, Wong cautions. 

“It simply takes time for stubborn pigmented cells to turn over,” she says. “And whatever you do, don’t think you can scrub them off at home. This can actually worsen melasma by irritating the skin and leading to more pigment production.” 

Prevention is key 

Unfortunately, melasma isn’t necessarily gone forever once skin patches lighten. Wong says the condition can easily return, requiring both vigilance and persistence to keep at bay. 

Prevention, then, is the watchword for melasma management. Wong recommends these prevention approaches: 

Sunscreen use: Yes, everyone should use broad-spectrum sunscreen with an SPF of 30 or higher when out in the sunshine. But this habit is even more important for those with melasma, for whom a main risk factor is sun exposure. 

Hats: “A wide-brim hat can do wonders to keep the worst of the sun’s rays off your face,” Wong says. 

Gentle skin care: Don’t use facial cleansers that sting, burn or irritate, since they can make melasma worse. 

By Jennifer M. Wong, PA-C Physician Assistant with Advanced Dermatology PC. Ms. Wong has comprehensive experience in medical and cosmetic dermatology for all ages. 

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