Melasma At Home Treatment Protocol

Melasma Treatment
Because melasma is a chronic condition, the goal of treatment is to get the lighten the skin and maintain its clarity.  Melasma can last for years and years.  We can control melasma, but any strong exposure to sun, heat, or a change in hormones can bring melasma back.  All treatment programs involve strict sun avoidance and maintenance use of a bleaching agent.  Therefore, if you are a sun worshipper and plan to go out into the sun regularly, know this: you will not be able to successfully manage melasma and it will always be a problem.  

How can you lighten the skin? 

Please read:  This section of the blog is meant for informational purposes only.  I STRONGLY recommend that you get the guidance of a professional when undergoing any type of melasma treatment.  I've seen too many cases of do-it-yourself patients with severely damaged skin, who have listened to a friend of a friend, or purchased some sort of cream over the internet, or who have used too much Obagi...you know who you are.  The first thing they tell me is "I've tried EVERYTHING and nothing works."  So do yourself a favor: if you are researching this disease that's step 1 in your favor. Step 2 would be to find a professional who can help guide you through treatment. 

First line therapy: Topical bleaching protocol 

For patients who have never tried any products or services to treat their melasma, the first line of treatment is the use of topical creams. This is the most cost effective method and you should begin to see results within 4-6 weeks if you have simple epidermal melasma or mixed melasma. 

The protocol involves using a bleaching cream to suppress the expression of melanin, used in conjunction with a vitamin-A derivative (retinol, retrinal, retin-A) peeling agent, which will accelerate skin exfoliation, with vigilant sun avoidance/protection.

AT-HOME MELASMA TREATMENT PROTOCOL

This is the ONLY protocol I can safely advise you to do at home without supervision. It involves the use of over the counter products only (products available without a prescription)

STEP 1. Cleanse Skin (Day and Night)

Cleansers I recommend by skin type: 

• Normal Skin:  Cetaphil gentle cleanser 
• Oily Skin:  La Roche Posay Toleriane Foaming Cleanser or Avene Diacneal Gel Cleanser
• Sensitive Skin:  La Roche Posay Toleriane Dermo Cleanser 
• Dry Skin: La Roche Posay Toleriane Dermo Cleanser or Hydraphase Cleanser

STEP 2.  Apply Toner (Day and Night)

Toners I recoomend by skin type

• Normal/Dry/Sensitive skin:  La Roche Posay Thermal Spring Water
• Oily Skin:  La Roche Posay Effaclar Toner

STEP 3.  Apply any product with 2% hydroquinone  (Begin at night for the first week, then if no irritation, you can apply day and night as 3rd step)

•  Recommended:  La Roche Posay Mela-D 

STEP 4.  Apply a product with retinol or retinaldehyde.**  (Night time only.  Apply every other night for the first week, then every night if no irritation)

• Normal Skin:  Use a retinol product like La Roche Posay Retinol 60, or Avene Retrinal .05%,  or Vichy Reti-C
• Oily Skin (no senstive skin):  Avene Retrinal .05% or .1%
• Sensitive skin/Dry skin:  Use a retinol product like La Roche Posay Retinol 30 or Avene Retrinal .05% (test a patch near your ear or chin and let on overnight to see if too much irritation develops. If it does, you cannot use these products and can ONLY use the bleach).

** these products can cause irritation, redness, and flakiness... this is normal. You don't want too much redness/discomfort/irritation. If your skin begins to flush or is noticeably red, you are apply too often!  In this case, decrease the frequency of use to every other day, every 2-3 days as tolerated.  When your face is red, apply an OTC hydrocortisone cream (like Cortaid) 2x/day until redness is gone before applying more product.  Hydrocortisone should only be applied as needed, and you should stop as soon as redness/irritation is gone.

STEP 5. Moisturize as needed for dry skin (Day and Night)

• Recommended
• Oily Skin:  La Roche Posay Toleriane Fluide
• Normal Skin/Sensitive Skin: La Roche Posay Toleriane Lotion
• Dry Skin:  La Roche Posay Hydraphase

STEP 6.  Apply Sunblock (DAY only)
Instructions:

Every day use:  Apply SPF 30 or above. 

Apply Sunblock 60 or above if you anticipate direct sun exposure. 

Reapply every 90 minutes you are out in the sun.  

• Recommended sunblocks:
• Oily Skin: La Roche Posay Anthelios 60 (shaka bottle)
• Normal/Dry Skin: La Roche Posay Anthelios 60 cream
• Sensitive Skin: DCL Chemfree SPF 30 or Elta MD Chemfree SPF 41 (tinted)

2-3 Times a week

A few times a week, buy a facial scrub or an enzyme exfoliator to exfoliate your skin. The facial scrub should be used at the end of a warm shower, when your skin is warm and dead skin cells can come loose easily. If you have very sensitive skin, do not use a scrub, but use a lotion that contains an exfoliating enzyme.  

-  Recommended products:  St Ives Apricot Scrub or Oil of Olay Heated Scrub

-  Enzyme exfoliator:  La Roche Posay Exfozyme

RESULTS

If you are using birth control pills or any type of hormone therapy, you should discontinue use as soon as possible, and for best maintenance results, you should not take these types of hormones while you have melasma.

If you follow this at-home-treatment-protocol strictly and avoid the sun and unnecessary exposure to heat, you should begin to see lightening of your skin in about 6 weeks.  If you don't see improvement by week 8, you probably have dermal melasma and will need a stronger treatment alternative, which will be discussed in my next post. 

The products recommended in this post are products I am familiar with and carry in our office.  The La Roche Posay line is a favorite of mine because very few people experience irritation, and it is reasonably priced.  Note that this at-home-protocol is an over the counter protocol, therefore if you cannot find the products I recommended you should be able to find similar/comparable items at your local Walgreens. 

Feel free to post questions or visit our website at www.medispainstitute.com if you need help finding these products. We carry all the products I mentioned and can mail order them to you.

What is melasma and why do I have it?

What is melasma? 

Melasma is a chronic, benign hyperpigmentation of the skin, which usually occurs on sun exposed areas of the face.  The specific condition is called hypermelanosis, meaning that the cells that produce pigment are hyperactive and produce too much pigment.  Melasma is caused by many factors, the main factors being hormones, sun exposure, and heat exposure/ redness of the skin.  Melasma has many patterns, appearing most prominently on both cheeks, or on the cheeks, forehead, and upper lip as large patches of flat brown pigment with an irregular sometimes jagged border.  Melasma is also more prevalent in races with lightly colored skin:  Asians and those of Hispanic/Latin descent who live in warm climates are more susceptible to melasma.  People often say they feel like their face is "dirty" because of the unwanted pigment; melasma is a genuine cosmetic concern for many women, although men are known to have melasma as well.

Melasma can be subclassified into epidermal, dermal, and mixed melasma. In my experience, most people have mixed melasma, wherein the excess pigment sits in both the epidermis and the dermis.

Why does someone get melasma?

As I mentioned above, melasma is caused by many factors, some of which are unknown. We know that hormones, sun exposure, and heat/redness of the skin can make melasma worsen or darken.  Genetic predisposition in women of color (Asians/Hispanics) also plays an important role. Many women first get melasma when they are pregnant. This form of melasma, called cholasma is known as "mask of pregnancy." One of the classic signs of hormonally related melasma is pigmentation on the upper lip.  Melasma may start as a small area the size of a quarter and can spread to cover the entire face.