Dr. Bonnie Marting

The first thing I ask women who come in my office with patches of discoloration on their faces is, “Could you be Pregnant? or the other extreme, “Are you Postmenopausal and receiving progesterone treatments?”

These questions are asked because hormone changes in the body are known to create what is commonly referred to as “The pregnancy Mask.”
Once those factors are removed, we can begin to look at the other main reason that Melasma occurs- Sun exposure.

I receive the majority of melasma complaints during the fall season when most people begin staying in more, and start losing their tan and realize their face has gotten excessively darker in places. The patches have become more apparent as the rest of their skin lightens up, and now they want a fix. That’s where I come in. But first you need to realize that Melasma can be an unruly animal and must be dealt with accordingly.

Many topical Retinoids (Retin-A, Tazorac, and Differin) used with a lightening cream (hydroquinone) – Try saying that five times fast…will help pull some of the darkness out; but it won’t remove it completely. One popular ready-made combo is called Tri-Luma and though it works on lightening the area, as soon as you get back in the sun, that topical cream will lose the battle. The discoloration will return.

It’s quite ironic to think that the best way to treat Melasma is with a Light Treatment. I tell people that the sun’s bright rays got them here, and now I want to light them up with an IPL (Intensed Pulsed Light) to help them. Right now, this is the gold standard for Melasma treatment.

I must note that if you had IPL and the discoloration returned because of vascularization (when new blood vessels form in the skin), there are ways to prevent that from happening. Many technicians are going one step further and targeting the vessels immediately after an IPL treatment with a vessel laser. This is done by using the appropriate laser designed to target the vessels and requires one treatment only (you still need follow up visits to check the vessels). It has a target of hemoglobin which contains the 1064nm frequency needed. (Without getting too clinical on you, this basically means we treat the skin and the blood vessels underneath it.)

Other things you must realize if you’re prone to melasma is you must wear excellent sunscreen. You may also need to take a stabilizing hormone if your progesterone or estrogen levels are too high. (This is why pregnant women are more susceptible to Melasma- our hormones are all over the place during these months.)

You also may be simply genetically predisposed to having melasma. Those with a darker complexion and darker eyes are most often affected.
The pictures above feature a woman of Latin-Italian descent who displays melasma. One day after the treatment, you’ll notice a “sunburned look”. This is normal. See the picture from 10 days later and you’ll see the amazing difference.

The last thing I want to leave you with is some good news. Melasma is not life threatening or dangerous in any way. It is simply a discoloration of your skin due to uneven pigmentation based on the melanin you are producing. We can help you diminish the appearance of it if it bothers you. But at least you can sleep calmly knowing it really is on the surface and not dangerous to your health.