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Melasma is one of the most common reasons which patients consult Dr. Michele Green in her private NYC dermatology office. Dr. Green is known to be one of the best dermatologists in the United States for treating melasma and disorders of pigmentation, and skin discoloration.  In the past, it was extremely difficult to find any successful melasma treatment, and patients were forced to just use makeup to cover up their dark patches and brown patches for their skin condition. In Dr. Green’s NYC dermatology office she has the best, most powerful and effective treatment options, ranging from tretinoin  and hydroquinone based products to chemical peels, skin lightening procedures, Cosmelan, and laser treatments.

What are the symptoms of melasma?

Melasma is a common skin condition which causes dark patches and discoloration on your face and chest.  Melasma predominately appears on the upper lip, the bridge of the nose, forehead, and cheeks.  Melasma is also called the mask of pregnancy or chloasma and ninety percent of cases appear in women and only ten percent in men.  Melasma may also appear on sun exposed areas of the forearms, neck, and shoulders. Patients with darker skin, such as those people who are Latin/Hispanic, African, Mediterranean, or Middle Eastern decent, are much more likely to suffer from melasma. Patients with white skin may develop melasma but it is much less noticeable than patients with darker skin types and skin tone, especially in patients who have brown skin. 

How to diagnose melasma?

Melasma is generally considered to be a clinical diagnosis. There may be times, to identify the depth of the melasma, whether it is epidermal or dermal, a wood’s light that emits UVA may be used.  It is usually unnecessary to perform a skin biopsy to diagnose melasma, as it is generally not confused clinically with a skin cancer, or other skin problem.

What is the cause of Melasma?

There is not a clear understanding of what causes melasma.  In general, melasma is caused by an increase in melanin, which are produced by the melanocytes that live in the skin. It is not known why these melanocytes are stimulated to make an overproduction of melanin. There are, however, 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 30 or higher.  It is critical to avoid the damaging effects of these UV rays and prevent the recurrence of melasma after it is treated. Even small amounts of sun can cause a recurrence of your melasma.  Some patients even have a family history of melasma.   Patients whose close relatives have melasma have a genetic predisposition to suffer from melasma and are more likely to develop it themselves.
  • Hormones:  It has been found that use of birth control pills, oral contraceptives, pregnancy, and hormone replacement therapy, can all trigger 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 and worsen the appearance of melasma. 
  • Oral Medications: Certain oral antibiotics, cardiac medications, and other photosensitizing medications can cause melasma or exacerbate its severity.

What is the best treatment of melasma in NYC?

Topical products used to treat melasma

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

  • Kojic acid is derived from fungi and its primary use is for skin lightening and also has some antimicrobial effects as well.  Kojic acid is often compounded with other ingredients to fight hyperpigmentation and melasma.
  • Retinoids are Vitamin A derived products which work by increasing skin cell turnover and aid in treating acne as well as hyperpigmentation and melasma. There are different strengths of retinoids, and depending 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 carry a two percent version of this bleaching cream.  Increased strengths of hydroquinones are available by prescription through the office of Dr. Michele Green.  MGSKINLABS, Inc.’s line of products carries both a 5% and 8% Hydroquinone, but in addition to that a hydroquinone specially compounded with tretinoin for added exfoliating effects.  
  • Vitamin C serum is a powerful antioxidant which acts by decreasing redness and pigmentation without irritation.
  • 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 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.

What cosmetic procedures are best used 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 cannot tolerate more than a medium strength peel, 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.
  • 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. 
  • 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 you 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. 
  • 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 two products, along with sunscreen, 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.

Which sunscreen should patients with melasma use?

When choosing a sunscreen for patients with melasma, it is best to use an SPF of 30 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, create a physical barrier on the skin which filters out  and defects the damaging UV rays.  Physical sunblocks generally contain titanium dioxide or zinc oxide. Chemical sunblocks absorb and scatter the UV rays and are generally water resistant, and generally don’t leave a white reside behind.  Common active ingredients used in chemical sunblocks are oxybenzone, azobenzene, octinoxate, and octisalate, among others. When choosing an SPF is is always wise to choose one that is non-comedogenic, oil- free, paragon free, and fragrance free.

It is very important to limit sun exposure, wear a broad brimmed hat outside, and discontinue hormones when possible, in treating melasma. Reapplying sunscreen is essential to do every few hours when outdoors or after swimming or rigorous exercise.

Which procedures should I avoid with melasma?

It is extremely important to avoid any 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.

Additional information on Melasma

There is a wealth of information on melasma available from The American Academy of Dermatology’s web site.  In addition, if you google Dr. Amit Pandya, you can learn more about melasma treatments as Dr. Pandya has authored many papers on the treatment of melasma with topical agents, peels, and lasers.

To find out more about how you can treat Melasma, contact us online for an appointment or call 212-535-3088 to learn more about why Dr. Green is a trusted source for melasma treatment in New York City. 

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