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For many patients, discoloration or pigmentation of the skin can be cause for concern. Whether pigmentation is triggered by too much sun exposure or other causes, it’s important to carefully observe dark-colored or brown patches on the skin to ensure that there is no risk of melanoma or skin cancer. Additionally, even when pigmentation is not a sign of something more insidious, inconsistencies in skin tone can make patients feel self-conscious about how their skin has changed.

One common darker pigment condition that can develop on the skin is that of melasma. Melasma is a common skin disorder that leads to brown or gray-brown patches on the surface of the skin. Melasma is linked to an overproduction of melanin in concentrated cells on the skin via melanocytes (melanin-producing cells). This condition can be exacerbated or triggered by a variety of causes, and is more common among women than men–in fact, 90% of instances of melasma occur in women, according to the American Academy of Dermatology. Regardless of gender and skin type, patients with melasma often feel self-conscious about these concentrated pigment patches. Thankfully, there are a variety of in-office treatments that can help to reduce the appearance of melasma, including chemical peels, topical treatments, and Cosmelan treatment.

If you’re frustrated by the appearance of melasma or other forms of pigmentation on the skin, board-certified dermatologist Dr. Michele Green is here to help. Dr. Green is an expert in treating melasma and other forms of pigmentation from sun exposure. Whether the melasma is a result of the mask of pregnancy, laser treatments, or ultraviolet light in combination with birth control pills, Dr. Green has been successful at treating theses forms of hyperpigmentation. Dr. Michele Green has been voted as one of the best dermatologists in NYC for her cosmetic dermatology treatments which range from chemical peels, laser treatment, cosmetic injectables and non-invasive skin tightening procedures.

What is melasma?

Melasma is a common skin condition which causes dark patches and discoloration on the face and chest. Melasma predominately appears on the upper lip, the bridge of the nose, forehead, and cheeks, and is often symmetrical on both sides of the face. Melasma (chloasma) is also called the mask of pregnancy, as it affects between 15-50% of pregnant women. In general, 1.5-33% of the general population have melasma, and it’s most common among women between the ages of 20 and 40.

Melasma typically appears on the face, but may also appear on areas of the forearms, neck, and shoulders. In general, when it appears on other parts of the body, it’s along areas that have had excessive sun exposure. Patients with darker skin, such as those of Latin/Hispanic, African, Mediterranean, or Middle Eastern decent, are statistically much more likely to suffer from melasma. Patients with white skin may develop melasma, but it is often much less noticeable than among patients with darker skin types and skin tone, especially in patients who have brown skin.

N.P 45yrs 3 weeks Before and After Cosmelan ANGLER MGWatermark

Cosmelan treatment – 3 weeks before and after

Though melasma typically develops due to overproduction of melanin by melanocytes that rely in the epidermis, melasma can cause pigmentation in multiple layers of the dermis. There are three main types of melasma: epidermal melasma, dermal melasma, and mixed melasma. In cases of epidermal melasma, the pigmentation occurs in the top layer of the skin (along the skin’s surface), creating dark brown patches of skin that have a well-defined border. With dermal melasma, the pigmentation has a light brown or bluish color surrounded by a blurry border, and is more difficult to treat as it affects the dermal or middle layer of the skin. The most common form is mixed melasma, which includes bluish and brown patches of discoloration (essentially a combination of both epidermal and dermal melasma).

Though melasma is not harmful and does not put a patient at risk for skin cancer, this form of pigmentation can make patients feel self-conscious about their skin tone, significantly decreasing a patient’s quality of life. There are a variety of treatments that can be used to reduce the appearance of melasma on the surface of the skin, but certain pigmentation treatments can actually exacerbate melasma among darker skin types. For this reason, it’s important to have your skin carefully examined by a board-certified healthcare professional who specializes in dermatology before engaging with any skin resurfacing treatments.

How can you diagnose melasma?

Melasma is typically diagnosed via a visual exam of the affected area, or the area where the pigmentation or discoloration is present. Dr. Green has a vast amount of patients who have melasma and is incredibly knowledgeable on this skin condition. For many patients, a visual exam is all that’s needed to diagnose this specific skin discoloration patterning, though additional tests can be used to pinpoint specific causes of melasma.

For some patients, Dr. Green may rely on additional tests to confirm diagnosis. Wood’s lamp examination is a common skin diagnosis treatment, which uses a specialized light to examine several dermal layers. Through this method, Dr. Green can observe the depth of the affected area of skin, as well as check for bacterial or fungal infections. In certain cases, it may be prudent to do a biopsy of the affected area. This involves removing a small piece of the discolored skin for testing to rule out any more harmful skin conditions.

cosmelan melasma 57 LEFT

Cosmelan treatment for Melasma – before and after

What Causes Melasma?

There is not a clear understanding of what causes melasma.  In general, melasma is caused by an increase in melanin, which is produced by overactive melanocytes that live in the skin. It is not known why these melanocytes are stimulated to make an overproduction of melanin, ending in areas of concentrated pigment. However, there are certain triggers which are known to exacerbate melasma.

  • Sun exposure: The most common trigger in producing melasma is direct exposure to the sun.  Ultraviolet light, UVA and UVB rays from the sun, stimulate the melanocytes to produce more melanin. It is so important to practice complete sun protection and use sunscreen daily, with an SPF of 50 or higher. It is critical to avoid the damaging effects of these UV rays to prevent the recurrence of melasma after it is treated. Even small amounts of sun can cause a recurrence of your melasma.
  • Tanning Beds: Just like direct sunlight, tanning beds contain harmful UV rays as well as visible light that can aggravate pigmentation on the skin, as well as increase a patient’s risk for skin cancer.
  • Hormones:  It has been found that use of birth control pills, oral contraceptives, pregnancy, and hormone replacement therapy can all cause melasma to flare. This is why melasma is often referred to as the mask of pregnancy, due to an increased amount of melanin and hyperpigmentation occurring on the faces of pregnant women. Dr. Green often recommends discontinuing oral contraceptive pills in patients with melasma in order to improve the appearance of this skin disorder.
  • Skin care products: Certain over the counter products can worsen the appearance of melasma. This is particularly common for harsh exfoliants, as well as skin care products that create photosensitivity, such as certain acne medications. Additionally, scented soaps are linked to worsening of melasma.
  • Oral Medications: Certain oral antibiotics, cardiac medications, and other photosensitizing medications can cause melasma or exacerbate its severity. These medications include non steroidal anti-inflammatory drugs, antipsychotics, and anti seizure medications.
  • Thyroid Disease: Currently, it is thought that thyroid disease may be a cause of melasma in some patients, as many patients with thyroid disease are diagnosed with melasma.
  • Genetics: Some patients even have a family history of melasma. Between one third and one half of melasma patients have a family history of melasma. Additionally, identical twins commonly share symptoms of melasma. Patients whose close relatives have melasma have a genetic predisposition to suffer from melasma and are more likely to develop it themselves.

What is the best prevention and treatment of melasma in NYC?

One of the best treatments for melasma is that of preventative treatment, which typically comes down to avoiding excess sun exposure, and discontinuing use of medications and skin care products that may be causing melasma. In order to prevent pigmentation on the skin, including not only melasma but also age spots, sun spots, and hyperpigmentation, Dr. Green always recommends wearing a daily broad-spectrum sunscreen with an SPF of 50 or higher. The best way to prevent unwanted pigmentation, signs of aging, or risk of skin cancer is to protect the skin from harmful UV rays.

For patients who have unwanted melasma or pigmentation on the skin, the best treatment available is a combination of topical treatments and in-office procedures, such as Cosmelan peels. A custom treatment plan that combines routine skin care with non-invasive in-office treatments can help to reduce the appearance of melasma and prevent further pigmentation. Additionally, some oral medications, including tranexamic acid (typically used to treat women with heavy or painful menstrual cycles), are currently being studied for their effectiveness in treating melasma. When you work with Dr. Green, she’ll be able to carefully assess your medical history, current skin condition, and individual needs and goals to develop a comprehensive treatment plan that’s best for you.

Topical products used to treat melasma

There are both over-the-counter skin lotions and prescription creams that treat the hyperpigmentation caused by melasma. The following are some of the ingredients available to fight melasma:

  • Kojic acid is derived from fungi and its primary use is for skin lightening, though also has some antimicrobial effects as well.  Kojic acid is often compounded with other ingredients to fight hyperpigmentation and melasma.
  • Retinoids and Retin-A are Vitamin A-derived products which work by increasing skin cell turnover and aid in treating acne as well as hyperpigmentation and melasma. Retinoids are popular to use for a variety of skin texture and discoloration issues, including melasma, sun spots, fine lines and wrinkles, and acne. There are different strengths of retinoids and, as the appropriate concentration depends on your skin’s sensitivity, it is best to start with the lowest dosage and increase gradually as your skin is able to tolerate it.
  • Azelaic acid is derived from grains and brightens pigmentation. It is useful for the treatment of rosacea, melasma, and other skin disorders.
  • Hydroquinones are bleaching agents which lighten the areas of hyperpigmentation and melasma.  Over-the-counter products containing hydroquinones are no longer available for purchase.  Hydroquinones of 4 percent, or greater, are available by prescription only through a qualified dermatologist, like Dr. Michele Green in NYC.
  • Vitamin C serum is a powerful antioxidant which acts by decreasing redness and pigmentation without irritation. Dr. Green’s MGSKINLABS has developed its own Vitamin C formulation, Vita-C Serum, which is designed to promote cell renewal and collagen synthesis to reduce the appearance of brown spots and improve skin texture.
  • Cosmelan is an amazing product formulated with high strength hydroquinone and retinoids to treat melasma and overall skin lightening.
  • Vitamin K cream treats a wide variety of skin conditions including broken capillaries, bruising, hyperpigmentation, and skin irritation.
  • Glycolic Acid is the smallest alpha hydroxy acid and is effective at removing the outermost layer of dead cells from your skin, treating skin discoloration, hyperpigmentation, fine lines and wrinkles, and acne scars.
  • Corticosteroids and tretinoin are two topical treatment options that are available within lotions, gels, and creams. Corticosteroids can only be safely used for a short period of time in combination treatment, as topical steroid creams can thin the skin.  Tretinoin creams, like Retin-A, are effective at lightening dark patches on the skin, including pigmentation from melasma.

FS advanced serum

Which cosmetic procedures are best to remove melasma?

For many patients, in-office procedures are the best method to effectively reduce the appearance of melasma on the skin. Dr. Green offers a variety of non-invasive dermatological treatments that can work to reduce issues of hyperpigmentation and discoloration on the skin, including melasma.

  • Cosmelan Peels are Dr. Michele Green’s gold standard for treating hyperpigmentation and melasma. The Cosmelan Depigmentation peel is a two part chemical peel which is performed in Dr. Green’s NYC office to treat your facial melasma and other areas of pigmentation on the face and body. Dr. Green will decide how many hours the Cosmelan peel will be left on your face. Generally, the darker your skin type, the longer the peel needs to be left on your skin. There are additional skin lightening products, along with sunscreen and moisturizer, that you must use daily at home to help treat the melasma and prevent it from recurring. Dr. Green considers the Cosmelan peel to be the best peel available for dermatologists in NYC to treat melasma.
  • Chemical Peels are an excellent way to rejuvenate the skin by helping to exfoliate the outer layers of skin, the epidermis.  A chemical solution of glycolic acid or trichloroacetic acid is applied to the skin to remove the top layers.  Dr. Green utilizes chemical peels in conjunction with hydroquinones and tretinoins to exfoliate the skin and provide the best result from your chemical peel. There are different strengths of chemical peels and Dr. Green will customize your protocol based on your skin type and your degree of pigmentation. Patients with darker skin types should not tolerate more than a medium strength peel in order to avoid other potential side effects such as hypopigmentation. Chemical peels can treat acne scars, fine lines and wrinkles, hyperpigmentation, and melasma. Side effects of chemical peels are dryness and peeling, and some irritation which can last for several days.  Lotion and hydrating moisturizers should be used after the chemical peel, along with sun protection of an SPF of 30 or greater.
  • Microdermabrasion is a procedure which mechanically exfoliates and removes the superficial layer of dead skin cells with a hand held device. Microdermabrasion sprays aluminum oxide or sodium bicarbonate crystals with a vacuum and suction to exfoliate the stratum corneum, or top layer of the skin. In addition to melasma, microdermabrasion treats fine lines, wrinkles, enlarged pores, sun damage, blackheads, acne and acne scars, and evens out skin tone and texture.
  • Hydrafacial is a three-step 30 minute procedure of cleaning, exfoliating, and extracting your skin.  At the same time as your skin is cleaned, serums are infused into your pores with the HydraPeel tip.  Dr. Green utilizes skin boosters designed for the Hydrafacial® such as Britenol ® , which brightens the skin and minimizes hyperpigmentation.
  • Microneedling with Melanostop tran3x is an in-office treatment that combines traditional microneedling with a depigmenting serum in order to brighten patches of melasma. Microneedling, also known as collagen induction therapy, uses micro-needles to prick the surface of the skin. This process not only activates the body’s natural wound-healing properties to smooth over rough skin texture, but also creates micro-channels in the skin that can absorb nourishing gels and serums. When Microneedling is combined with Melanostop tran3x treatment, the affected area is treated deeper within the dermal layers.
  • Mesopeels are specially-formulated chemical peels that are able to address a wide variety of hyperpigmentation, discoloration, and melasma, helping to control melanocyte activity. Mesopeels use a process of chemoexfoliation which not only helps to revive the surface of the skin like a traditional chemical peel, but also induces new collagen and elastin production in the skin. Mesopeels are safe to use on a wide variety of treatment areas on the body, and can be combined with melanostop tran3x in order to remove pigmentation from the skin.
  • Clear and Brilliant  is commonly called a “baby Fraxel” because it uses gentle technology to exfoliate the fop layer of skin, remove dead skin cells, and stimulate new collagen.  Clear and Brilliant treats hyperpigmentation without any downtime. The Permea handpiece of the Clear+Brilliant ® was designed solely to treat hyperpigmentation for patients of all skin types and tones.
  • V-Beam Laser is a pulsed-dye, skin resurfacing laser that has long been popular among patients looking to reduce the appearance of redness and pigmentation on the surface of the skin. Recent studies have confirmed that the V-Beam Laser is a safe and successful treatment to reduce the redness and hyperpigmentation of melasma, specifically, helping patients to restore their skin.

AC Cosmelan 10weeks before after FRONT 1 MGWatermark

Cosmelan – 10 weeks before and after

Which sunscreen should patients with melasma use?

When choosing a sunscreen for patients with melasma, it is best to use an SPF of 50 or higher.  In addition, Dr. Green recommends a combination of a chemical and a physical sunblock.  Melasma patients are much more sensitive to the sun and layering both types of sunscreens can provide you with the best possible sun protection.  Physical sunscreen, also called mineral sunscreen, creates a physical barrier on the skin which filters out and defends from the damaging UV rays. Physical sunblocks generally contain titanium dioxide or zinc oxide.

Chemical sunscreens absorb and scatter UV rays, are generally water resistant, and are less likely to leave a white residue behind.  Common active ingredients used in chemical sunblocks are oxybenzone, azobenzene, octinoxate, and octisalate, among others. When choosing a sunscreen formulation, it is always wise to choose one that is non-comedogenic, oil- free, paragon free, and fragrance free.

During melasma treatment and beyond, it is very important to limit sun exposure, wear a broad brimmed hat and protective clothing when outside, and discontinue hormone use when possible. Reapplying sunscreen is essential to do every few hours when outdoors, as well as after swimming or rigorous exercise.

Which procedures should I avoid with melasma?

It is extremely important to avoid the majority of laser treatments, such as the IPL, Fraxel, or Picosure laser in treating facial melasma.  Dr. Michele Green has years of experience in treating melasma and feels that the most difficult cases of melasma to treat are those which have undergone these laser treatments.  These lasers seem to “burn the pigmentation” into the skin and make it much more difficult to remove this hyperpigmentation. There are only a choice few laser treatments that are gentle enough to treat melasma, such as the Clear + Brilliant and V-Beam lasers.

If you are being treated for melasma, it’s best to start with non-invasive techniques, such as the Cosmelan peel, Mesopeels, Microneedling, Hydrafacials, or Microdermabrasion. Additionally, it’s important to treat melasma under the careful supervision of a board-certified dermatologist. Dr. Green often encounters patients who have attempted to treat pigmentation at medical or aesthetic spas and, in many cases, these attempted treatments can make the appearance of melasma much worse. Dr. Green understands the importance of accurately diagnosing and treating pigmentation the first time around, and the safety and satisfaction of her patients is her top priority.

Which hormone causes melasma?

If you’re curious what hormone causes melasma, it’s important to consider which hormones are linked with the development of melasma. In general, hormones that are commonly used in oral birth control (such as estrogen, progesterone, and synthetic versions of these hormones) are linked to the development of melasma in many patients. As progesterone is a naturally-occurring hormone that vastly increases during pregnancy, it has been greatly linked to pregnancy-induced melasma or the “mask of pregnancy.” In general, any melanocyte-stimulating hormone could lead to the development of melasma.

Does estrogen cause melasma?

Estrogen is a hormone that is commonly linked to melasma, as it’s frequently used in hormone therapies and oral contraceptives. Though there is no clear cause of melasma, the use of estrogen in the body can exacerbate brown patches of melasma on the skin.

Do birth control pills cause melasma?

Birth control pills may not be the sole factor behind the development of melasma, but there is a strong correlation between change in hormone intake and the development of melasma on the surface of the skin. For this reason, when patients develop melasma, Dr. Green will encourage them to discontinue use of any birth control pills or hormone therapies, if possible. In some patients, the simple discontinuation of oral contraceptives can cause the melasma to subside.

What causes melasma during pregnancy?

For many pregnant women, the development of melasma can be a frustrating part of pregnancy. Though it’s not entirely clear why melasma is so commonly linked to pregnancy, current research suggests that increased hormones in the body can lead to the development of melasma. These hormones include increased estrogen, progesterone, and melanocyte-stimulating hormones during a pregnant patient’s third trimester. However, thankfully for most patients, pregnancy-induced melasma does tend to dissipate naturally after the pregnancy has concluded and the body’s hormones return to normal levels. Additionally, if you’re suffering from melasma during pregnancy, there are safe and effective topical treatments that can be used to minimize the pigmented areas on the skin.

Can hypothyroidism cause melasma?

Recent study has indicated that thyroid disease, classified by two thyroid disorders known as  hypothyroidism and hyperthyroidism, may be linked to the development of melasma. Hypothyroidism, a disorder that causes an underactive thyroid, prevents the body from receiving a standard level of hormones from the thyroid, which in turn can cause issues of hormonal balance and thus may lead to the development of melasma on the skin. Additionally, hyperthyroidism, a disorder that causes an overactive thyroid, seems to also affect the development of melasma. Though the exact melasma-causing mechanism is not clear, it seems that these hormones can change the production of inflammatory cytokines in the body, thus leading to pigmentation on the surface of the skin. For this reason, if you are diagnosed with melasma, you may also be tested for thyroid disorders to determine if an imbalance in thyroid-producing hormones is behind the discoloration.

What causes melasma in males?

Melasma is much less common in men than women; among patients with melasma, only 10% are male. However, there are a variety of environmental and biological factors that can lead to melasma in male patients. These factors include too much sun exposure, hormonal shifts, genetics, irritating skin care products, photosensitizing medications, thyroid disorders, parasitic infestations, and stress, among others. In general, the process for treatment of melasma in male patients is quite similar to that of female patients. A combination of topical treatments and in-office procedures, such as chemical peels or microdermabrasion, can successfully reduce the appearance of melasma on male patients.

What deficiency causes melasma?

Though different nutritional deficiencies are not indicated as a cause of melasma, some scientific evidence has suggested that deficiencies in iron, vitamin D, and vitamin B-12 are linked to the development of melasma. For this reason, your healthcare provider may inquire about your dietary habits to determine if there are any vitamin deficiencies that may be an underlying factor in the development of pigmentation. Additionally, to help support healthy skin, it’s always good to prioritize foods that are rich in Vitamin D. These foods include meat, dairy milk, almond milk, eggs, mushrooms, orange juice, yogurt, and mushrooms. Lastly, certain vitamins are linked with helping to restore pigmented skin after melasma has developed. Vitamin-C serums, Vitamin K creams, and Retinoids (Vitamin-A derived) can all be used to help improve skin tone and texture, as well as lighten the brown patches associated with melasma.

What causes a melasma mustache?

In many cases of melasma, a patient will notice that the discoloration characteristic of this skin condition appears above the upper lip. This particular form of melasma is commonly referred to as a melasma mustache. Typically, the causes of a melasma mustache are like any other case of melasma, and could be due to various factors including sun exposure, hormonal shifts, genetics, thyroid disease, or certain medications. Additionally, patients who live in high altitudes may be more likely to develop melasma, though research on this particular relationship is ongoing. A melasma mustache can be treated with the same topical and in-office treatments as most standard melasma patches, which can offer relief to many patients who experience this unwanted pigmentation.

45 54 cosmelan before mid after SIDE MGWatermark

45-54 year old woman, Cosmelan treatment before and after

Will melasma go away on its own?

So, can melasma go away on its own? The answer to this question will vary from patient to patient, depending on the initial cause of melasma and its development. For patients who experience melasma during pregnancy or while taking oral birth control or other hormonal therapies, melasma may subside naturally either after pregnancy or after these medications have left the patent’s system, respectively. However, for many patients, melasma will require some type of intervention in order to fully resolve the pigmentation on the skin.

How do I get started with the best Melasma treatment today?

Dr. Michele Green is an expert in treating disorders of hyperpigmentation, including facial melasma, discoloration, and sun spots. Dr. Green is an expert in cosmetic dermatology and an international expert in treating melasma. With the best cosmetic peels, microneedling, skin care, Cosmelan peels, and laser treatments, Dr. Green is consistently voted one of the best dermatologists in New York City. Whether it be sun damage, age spots, discoloration, wrinkles, or melasma, Dr. Green has developed the best customized approach to treat your skin care concerns. To find out more about how you can treat Melasma, contact us online for an appointment or call 212-535-3088 today.

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