Melasma: The Mask of Misery
So many women come to me with brown splotches on their faces that they cover with heavy make up to leave the house. Melasma is the diagnosis (mask of pregnancy but believe me it doesn't mean that you are with child!!!). I think it is better labeled as "mask of misery". All of the creams and potions promoted on late night TV just don't do it. All the home remedies your grandma will tell you about don't cut it. So, sentenced to spackling your face to look presentable? Not necessarily.
Melasma is a living breathing thing, not a stain that can be erased. You have to gently coerce it to behave. Any heavy handed moves and it will come back with a vengeance to spite you. Melasma happens because you stimulate your cells with hormones, heat, inflammation or sun (tanning bed). Your melanocytes are cells programmed to generate pigment. Your body is trying to protect itself (from sun) or flaunt itself (I guess mask of pregnancy was attractive to prehistoric man). Once the pigment is made it is transferred to skin cells. Over time the cells grow old and are shed, getting rid of the pigment. Of course those darn melanocytes keep making more pigment.
How to fix melasma: it isn't easy. In a roomful of the most prominent dermatologists in the world, the question was asked: Who hates treating melasma? The overwhelming response was a deafening "I hate it!" Why? Because as doctors we want to make patients happy with quick and easy solutions. The cure to melasma is neither quick nor easy. And it takes a lot of participation by the patient....always a wildcard.
Here is what you have to do.
- stop stimulating pigment cells
- stop pigment from forming and transferring to skin cells
- remove pigment as fast as possible
You need a specific and serious plan and you have to buy into it. Without commitment there is little chance of success.
A. Stop stimulating pigment cells.
- Avoid sun, I mean be neurotic about it. SPF 50 every day, I don't care if it is snowing, you want to beat this don't you! And reapply every 2 hours, yes I said every 2 hours.
- Avoid heat, not easy in AZ in August, but you really don't have to do hot yoga, do you??
- Avoid inflammation that means irritating or harsh treatments are counterproductive.
B. Stop pigment from forming and transferring to skin cells.
- This requires outside help. There are a number of chemicals, some natural and some manufactured, that block pigment formation and transfer at various stages. The most notable is the prescription medication know as hydroquinone. It blocks an enzyme called tyrosinase. Oddly this chemical is not approved in much of the world because it is derived from benzene. There has never been a cancer reported as a result of hydroquinone. There are many other products contained in commercial creams such as Lytera (SkinMedica) and Even Up (Colorescience) to name a couple that safely block pigment.
- Religious use of twice a day topical creams or lotions that block pigment (see #1) is crucial.
C. Remove pigment as fast as possible.
- Peels at the med spa can help with shedding layers of dead skin which helps remove pigment laden cells. Be careful though about who does your peels, they require some expertise to be safe and effective.
- Retinols are available that are the great-grandchildren of prescription Retin A. They are cheaper, better tolerated and not prescription. Retinols increase cellular growth and turnover which allows for faster shedding of pigment laden cells. Physician lines (available at the dermatologist) are generally stronger and more effective than the drug store lines.
- Gentle resurfacing lasers like clear and Brilliant (Solta) remove pigment without traumatizing the skin like the stronger lasers. The treatment takes about 20 minutes and you are red for the day. A pigment blocking agent can be applied by the health care provider during the treatment to enhance results.
Once your skin is where you want it to be, which will take several months, you have to continue with good skin habits. Sunscreen, pigment blockers and peels/Clear and Brilliant Laser will become part of your routine.
One week in Cabo without your sunscreen can undo months of good behavior!