Skin discoloration can be broken into a few categories.
1. Melasma
2. PIH (post inflammatory hyperpigmentation such as acne marks)
3. Sun/UV damage
Of these, melasma is the hardest to treat and even when improvements are made, that hard work can be undone in a matter of hours.
What is melasma?
It is a hormonally derived skin condition that causes skin discoloration.
Melasma has 3 categories - superficial, deep, and a combo of both depths within the skin.
Because this kind of discoloration is driven by hormones, it is very hard to manage especially long term. Triggers for melasma are almost everything from pregnancy, stress, birth control medications, acne medications, LED masks, thyroid disease, genetic predisposition, inflammation from perfumes, dyes and more, changes in temp, changes in humidity, UV exposure, blue light exposure and so on.
Because it is triggered by so many external and internal factors, the hormones that react to these triggers release an excessive amount of melanin and does so in large patches, versus small freckle-like spots.
How to manage melasma?
I am asked about this often and the answer can be a bit complex.
First, I recommend seeing a Dermatologist and getting a prescription for hydroquinone but also to verify it is melasma and not a fungal disorder masking as melasma.
If you don't have a derm you like, you can dry the online skincare pharmacy called MUSELY and get their prescription hydroquinone for about $30 a month.
Can Laser Help?
Lasers can make it worse especially with those with more melanin rich skin. While there may be short term improvements with laser, often times, months and even years later the melasma is back and far worse than it was before, and it is usually far more stubborn and harder to get rid of. So, laser is my last choice.
So what else is there?
Over the counter serums? A WASTE OF MONEY. I don't even sell this stuff because it will cost you money and time and deliver almost nothing. Over the counter serums will not improve melasma. They barely improve sun damage.
What about treatments?
I have great success with our Korean non-acid peels for melasma. These can be done all year, and are safe for all people, including those who are pregnant or breastfeeding.
You can try acid peels but you really need to find someone who understands skin tones and acids because some acids when used with darker skin shades, can create more discoloration and worsen melasma by creating too much inflammation in the skin. This inflammation then causes the skin to release more melanin.
I use a few acid peels for melasma but I will only do acid based treatments over the Fall and Winter for those with melasma.
What Can I Do If I Have Melasma?
Now, we are heading into hotter months and everything about spring and summer is a multi-wave melasma trigger party.
Over the spring and summer, you can use hydroquinone but talk to your derm about the best use of it over summer and if you plan any beach trips or travel to tropical locations.
- Don't laser, don't do acid peels
- Wear SPF every day, all day even when INSIDE
- Get UV/UPF protective hats and garments to help minimize exposure
That is really all you can do and the hardest part of all, is you can spend months working on melasma and get it nearly gone, then it will be back over one weekend away at a beach.
Just know that it is hormonal and it will ebb and flow, it might look bad this summer but summer is not forever so, try to not stress too much. Be careful and mindful but don't hide away.
It can always be managed come Fall.