Melasma & Hyperpigmentation

Hyperpigmentation is a general term that refers to spots or patches of skin that are darker than one’s natural skin tone. There are several common types of hyperpigmentation, including sun spots, melasma, and post-inflammatory hyperpigmentation. While common, hyperpigmentation may induce feelings of self-consciousness, causing a prematurely aged appearance. Luckily, many non-invasive treatment options are available at Dr. Michele Green’s private dermatology office in NYC for reducing the different types of hyperpigmentation and achieving and maintaining a clear, radiant, even-toned complexion.

The treatment options that are best suited to your skin condition will ultimately depend on your skin type, skin tone, and the severity and type of hyperpigmentation affecting you. Although they present in similar ways, melasma and hyperpigmentation are skin conditions that require different interventions to resolve safely and successfully. A board-certified dermatologist like Dr. Green can evaluate your skin condition and recommend a combination of in-office treatment options, specially formulated skincare products, and prescription topicals best suited to your unique needs. Some of the most popular treatment options for hyperpigmentation and melasma at Dr. Green’s include hydroquinone, chemical peels, brightening skincare products, laser treatments, and microneedling.

Dr. Green is an expert in treating sunspots, melasma, discoloration, and other hyperpigmentation disorders in her private NYC Upper East Side office. A board-certified dermatologist with over two and a half decades of experience, Dr. Green is uniquely skilled at removing sunspots and facial hyperpigmentation and is always on the cutting edge of safe and effective treatments. Dr. Green takes a holistic approach and embraces a less-is-more philosophy when it comes to facial rejuvenation. She will help you obtain and maintain even, beautiful, clear skin by creating a customized treatment plan and incorporating the best treatment options, skincare, and broad-spectrum sunscreen. Castle Connolly, New York Magazine, Super Doctors, and the New York Times consistently identify Dr. Green as one of NYC’s best dermatologists for her dedication to her patients and expertise.

Is melasma hyperpigmentation? Is it the same?

Hyperpigmentation is a broad term to describe general areas of skin discoloration that are darker in tone than the surrounding skin. There are many types of hyperpigmentation, including sun spots, age spots, melasma, post-inflammatory hyperpigmentation (PIH), freckles, and acne scars. Hyperpigmentation occurs when there is an overproduction of melanin. Melanin is the pigment that gives the skin its color and tone, and they are produced by melanocytes or pigment-producing skin cells. Melanin also protects the skin from the sun’s harmful UV rays.

Melasma is a skin condition that is a more specific type of hyperpigmentation characterized by patches of skin that are brown or brownish-gray in color. Melasma is hyperpigmentation, but not all hyperpigmentation is melasma. Melasma is triggered and exacerbated by various factors that differ from other types of hyperpigmentation, so it is important to seek guidance from an experienced, board-certified dermatologist like Dr. Green to help you choose the appropriate treatment safe for your skin type.

What is the difference between melasma and other types of hyperpigmentation?

Melasma: Melasma is a type of hyperpigmentation that presents as skin patches darker than the surrounding skin tone. Melasma most commonly occurs on the face, such as the forehead, across the nose bridge, upper lip, and cheeks. It can sometimes occur on the body with frequent sun exposure, such as the neck and arms. Melasma typically appears symmetrically, meaning the pigmented patches on both sides of the face have a similar pattern. Certain risk factors are known to exacerbate melasma, such as sun exposure, tanning beds, hormonal changes (i.e., pregnancy and oral contraceptives), certain medications, skin tone, genetics, and thyroid disease.

Sun Spots/Age Spots: Sun spots, also called age spots, liver spots, and solar lentigines, are flat brown spots varying in size and shape that appear on sun-exposed areas like the face, shoulders, arms, and hands. Sunspots are extremely common and completely harmless; however, the appearance of dark spots and uneven complexion can be distressing and aging.

Freckles: Freckles are small brown spots commonly appearing in areas with frequent sun exposure, such as the face. UV radiation from the sun stimulates the skin to produce melanin as a form of protection, resulting in small, flat brown spots on the skin. One type of freckle called ephelides is the common type that people usually think of when they hear “freckles.” Another type of freckle called solar lentigines develops during adulthood, commonly known as sun spots and age spots.

Post-Inflammatory Hyperpigmentation (PIH): Post-Inflammatory hyperpigmentation refers to the dark spots or skin discoloration left behind after an acne lesion, injury, or other inflammatory skin condition, such as eczema or psoriasis. The color of the discoloration associated with post-inflammatory hyperpigmentation can vary from brown, black, red, pink, or purple patches of skin, depending on the patient’s skin tone. During the natural healing process of the skin, certain skin cells involved with healing also contribute to excess melanin production, leading to the development of PIH. Although this type of hyperpigmentation may fade on its own over time, it’s more efficient to have treatment with a board-certified dermatologist, like Dr. Green in New York.

What is melasma?

Melasma is one of the most common skin conditions characterized by brown or gray-brown skin patches darker than the surrounding skin tone. This type of hyperpigmentation commonly occurs on the face, including the upper lip, forehead, bridge of nose, and cheeks, and is often symmetrical on both sides of the face. Melasma can also be present on the body, commonly in areas with frequent sun exposure, such as the forearms, neck, and shoulders. Melasma occurs due to an overproduction of melanin by melanocytes, pigment-producing cells in the skin. Melanin is the pigment that provides the skin with its color and tone, and the production of melanin can be triggered by various factors, most commonly the sun and its UV rays. Melasma is often called the “mask of pregnancy” as it affects 15-50% of pregnant women. Melasma can also affect men, although it occurs at a lower rate than in women.

What is the main cause of melasma?

Melasma is a type of hyperpigmentation that presents as brown or brown-gray patches of skin darker than the surrounding skin. This is caused by an overproduction of melanin by melanocytes in the epidermis. The exact cause of the overactive melanocytes is not yet known, although there are various risk factors known to exacerbate melasma:

Sun Exposure – Sun exposure is the most common trigger for melasma. The sun’s UV rays trigger melanocytes to produce melanin to protect the skin from the sun, which can worsen or trigger melasma. It is crucial for anyone experiencing melasma to wear broad-spectrum sunscreen with a minimum of SPF 30 daily. Sun exposure can even cause a recurrence of melasma that has been treated with dermatologic treatments.

Hormonal Changes – It is commonly reported that birth control pills, oral contraceptives, pregnancy, and hormone replacement therapy can trigger melasma. In fact, melasma is often referred to as the “mask of pregnancy” for this reason. The onset of melasma from hormonal changes can be attributed to an influx of estrogen and progesterone, which are female sex hormones. As a result of increased estrogen and progesterone, melanocytes increase in number and become more sensitive to the sun’s UV rays.

Genetics – It is believed that genetics may play a factor in someone developing melasma, as those with a family history of melasma are more likely to develop this skin condition. Additionally, identical twins often share symptoms of melasma, further suggesting that genetics are involved in the development of melasma.

Skin Tone – Melasma is more common in light to medium brown skin tones (Fitzpatrick III and IV) and darker skin tones (Fitzpatrick V and VI). This occurs because there are naturally more melanocytes present in darker skin, so there is a greater potential for making more melanin than in fairer skin.

Thyroid Disease – Melasma and thyroid disorders may be linked, as the frequency of thyroid disease is four times higher in patients with melasma compared to the general population. Studies have shown elevated serum TSH, anti-thyroid peroxidase, and anti-thyroglobulin antibodies in patients suffering from melasma. However, more extensive clinical studies are needed to confirm a true link between thyroid disorders and melasma.

Medications – Certain oral antibiotics, cardiac medications, and other photosensitizing medications can cause melasma or exacerbate its severity. These medications include nonsteroidal anti-inflammatory drugs, antipsychotics, and anti-seizure medications.

Melasma and Hyperpigmentation on Dark Skin

Melasma and hyperpigmentation should be treated cautiously, especially in patients with darker skin tones, as mistreatment of any skin discoloration can worsen the existing hyperpigmentation. Dr. Green has treated melasma and hyperpigmentation on patients of all skin types and skin tones for over two and a half decades in her private, New York City-based dermatology office and can help you safely achieve and maintain a brighter and more youthful complexion and restore your confidence.

What are the symptoms of melasma?

Symptoms of melasma include patches of discoloration. Melasma presents as patches of skin that are darker in color than the natural skin tone. It typically occurs symmetrically on the face, meaning there may be matching dark patches on both sides of the face. Melasma can also be present in other areas of the body, especially the areas frequently exposed to the sun, such as the shoulders, neck, and forearms. Melasma is not harmful and is not associated with other symptoms like itchiness, burning, or pain. However, the appearance of discoloration and skin pigmentation can be disheartening for many people. Furthermore, Melasma can be difficult to differentiate from other types of hyperpigmentation, and it is crucial to have any new discoloration checked to ensure it is not skin cancer. It is best to seek guidance from an expert, board-certified dermatologist like Dr. Green for the safest and most effective melasma treatment options.

Will melasma go away?

Melasma can sometimes go away on its own if it is triggered by pregnancy or medication. Many people will find that their melasma fades after giving birth or after stopping a medication or birth control pills. Unfortunately, melasma can also last years or even a lifetime for many people. In these cases, Dr. Green will recommend safe and effective melasma treatments for your skin type, such as the Cosmelan peel, and revise your skin care products to focus on skin lightening, skin brightening, evening out skin tone, and decreasing melanin production.

What is the difference between melasma and hyperpigmentation?

All melasma is hyperpigmentation, but not all hyperpigmentation is melasma. Hyperpigmentation is a generalized term to describe any form of discoloration of the skin darker than the natural skin tone. There are various forms of hyperpigmentation, including sun spots, age spots, acne scars, melasma, and post-inflammatory hyperpigmentation. Hyperpigmentation is caused by an increase in melanin in the skin. Melasma presents as dark patches of skin, often symmetrically on the face, that are triggered by various factors like hormonal changes, sun exposure, medications, and genetics.

It can be difficult to differentiate melasma and hyperpigmentation because they present similarly, and an overproduction of melanin causes both. A clue that can help distinguish between melasma and hyperpigmentation is if you have a history of hormonal changes, pregnancy, oral contraceptives, or hormone replacement therapies, which may suggest the discoloration may be melasma. Hyperpigmentation may be sun damage and sun spots if you have a history of chronic sun exposure and tanning. Melasma often presents as broad patches of discoloration, whereas sun spots and other forms of hyperpigmentation may look like small circles or focused dots.

Melasma and hyperpigmentation should be treated cautiously, especially on darker skin tones, as mistreatment of any discoloration can worsen the pigmentation. Dr. Green has treated melasma and hyperpigmentation on all skin types and tones for over two decades in her private, New York City-based dermatology office. If you are frustrated with spending a fortune on heavy, full-coverage concealers to hide your melasma and hyperpigmentation, consult with Dr. Green in NYC, who can help you achieve a brighter and more youthful complexion and restore your confidence.

Melasma and Hyperpigmentation Treatments

Cosmelan Peel

The Cosmelan peel is a special chemical peel designed to reduce melasma and hyperpigmentation. Cosmelan works by accelerating epidermal renewal to remove the accumulation of melanin, blocking the transfer of melanin from the melanocyte to the keratinocyte (inhibiting the migration of pigment to epidermal layers of skin), and reducing the synthesis of melanin inside melanocytes.

The Cosmelan depigmentation treatment consists of the professional application of the Cosmelan 1 peel, followed by at-home maintenance with Cosmelan 2 and other recommended skincare products. At her NYC office, Dr. Green will apply the Cosmelan 1 cream to the affected areas and determine how many hours you will need to wear it based on your skin tone and the severity of the melasma or hyperpigmentation. Once the designated amount of time has elapsed, the Cosmelan 1 cream should be removed at home by the patient using a gentle cleanser.

At home, patients are instructed to apply the Cosmelan 2 depigmenting cream once or twice a day to the affected areas for four weeks, depending on their ability to tolerate the product. It is important to note that Cosmelan 2 contains both hydroquinone and retinoids. It is essential to use Cosmelan 2 daily to achieve optimal results. However, if the cream causes skin irritation, it should be discontinued for several days until it resolves. Failure to comply with these instructions can cause increased irritation and hyperpigmentation. After four weeks of using Cosmelan 2 at home, there is a follow-up appointment with Dr. Green so she can assess the progress and make any necessary adjustments to your protocol so you can best maintain healthy-looking skin and prevent the recurrence of hyperpigmentation. Cosmelan is an incredibly effective treatment option that produces a long-lasting, even-toned, radiant complexion with minimal downtime.

Mesopeel

Delicate areas of the body, such as the face, inner thighs, groin, axillae, face, and under the eyes, may be impacted by hyperpigmentation. Still, they can not be treated with traditional chemical peels, which are far too irritating for use on sensitive skin in these areas. Mesopeels are a type of chemical peel designed to gently yet effectively treat the appearance of skin discoloration, dark spots, and photoaging in such areas. Usually, patients are recommended to have a series of mesopeels at an interval of 3-6 weeks apart to achieve optimal cosmetic results. The exact number of mesopeels that will be required for your treatment may depend on the area of the body being treated and the severity of the initial hyperpigmentation. Mesopeels can be especially good for treating patients who have areas of hyperpigmentation as a result of incorrect laser treatment.

TCA Chemical Peels

A trichloroacetic acid (TCA) peel is a type of chemical peel offered in varying strengths to treat an array of skin conditions, including acne breakouts, fine lines and wrinkles, hyperpigmentation, dullness, and sun damage. A TCA peel removes the surface layers of the epidermis, encouraging increased skin cell renewal to reveal a healthier, brighter, and smoother complexion that is more even in tone and texture. Dr. Green frequently incorporates TCA chemical peel treatments, in conjunction with hydroquinone creams and tretinoin, into her patients’ treatment plans with melasma. This combination approach helps to exfoliate the skin and enhance the skin-lightening results from a chemical peel treatment.

Microneedling with Depigmenting Solution

Microneedling, or collagen induction therapy, is a non-invasive treatment option for rejuvenation. Dr. Green uses a handheld device containing tiny, insulated needles to create micro-injuries in the epidermal layers of skin. The microchannels in the skin that are created during the microneedling treatment allow for enhanced absorption of specialized serums. For patients that are primarily interested in treating hyperpigmentation, pairing microneedling treatment with a depigmenting serum provides exceptional skin lightening results. Whether it be melasma, sun spots, or pigmented acne scars, a microneedling facial treatment with depigmenting serum is a safe and effective treatment option for achieving a more even-toned complexion. The depigmenting serum used in the private dermatology office of Dr. Michele Green is a unique blend of powerful yet gentle skin-brightening agents that work against melanocyte activity in the skin. The result is an even-toned complexion with an observable reduction in hyperpigmentation. Patients enjoy that after their microneedling treatment with depigmenting serum, their skin is more radiant and has a lasting healthy glow. If you are struggling with the appearance of pigmented acne scars, melasma, sunspots, or post-inflammatory hyperpigmentation, consult with Dr. Green regarding microneedling with depigmenting serum.

Hydroquinone topical skin-lightening treatment

Hydroquinone is an ingredient in skin-lightening creams that helps to lighten areas of hyperpigmentation and melasma. Hydroquinone is no longer available in any over-the-counter products. However, Dr. Green can provide her patients with prescription-strength Hydroquinone creams, from a specialty compounding pharmacy, as part of their melasma and pigmentation treatment plan. Hydroquinone creams can be compounded with Retin-A or other active ingredients in different strengths. The strengths of hydroquinones vary from 4% up to 10% to treat some difficult pigmentation. Hydroquinone is not designed for extended use, and patients should regularly follow up with Dr. Green when prescribed hydroquinone so she may adjust your skincare protocol for hyperpigmentation as necessary.

Laser Treatments

• Clear + Brilliant is a resurfacing laser treatment often used to minimize dark spots and sun damage. Clear + Brilliant was FDA approved in 2011 to treat the visible signs of aging, sun damage, and skin texture. Clear + Brilliant laser treatment works via fractionated laser technology which is designed to create millions of tiny microscopic treatment zones to stimulate new collagen formation and replace damaged skin. The Permea handpiece is specifically designed to remove facial pigmentation in 4 to 6 treatments.
• AlexTrivantage Laser is used in Dr. Green’s office for reducing the appearance of undesired age spots, sun spots, freckles, and birthmarks. The laser can safely target the to target hyperpigmentation while leaving the surrounding tissue unharmed in patients with darker skin tones.
• VBeam is a laser treatment that is often used to reduce post-inflammatory hyperpigmentation. The VBeam works by releasing a burst of light at a wavelength of 595 nanometers to target variations of red pigment in the skin. The energy is converted into heat and absorbed by the atoms which are responsible for pigment. As a result, the VBeam laser does not interact with other parts of the skin and successfully treats the redness in patients suffering from post-inflammatory hyperpigmentation. Typically, 4 to 6 laser treatments will help reduce the inflammation from melasma and other hyperpigmentation disorders.

• Fraxel is a resurfacing laser treatment that Dr. Green often calls the “magic eraser” for its unique ability to target various skin concerns. The Fraxel laser creates controlled, microscopic wounds in the skin through the application of highly concentrated laser pulses. As the skin repairs these wounds, new collagen is produced, new skin cells grow, and the damage from the sun begins to heal, revealing a brighter, more radiant complexion that is even in tone. The Fraxel laser used by Dr. Green has two wavelengths, 1927, which is ideal for treating hyperpigmentation and sun spots, and the 1550 wavelength, which treats wrinkles, stretch marks, and acne scars. Fraxel effectively diminishes the appearance of dark sunspots in the face, neck, chest, arms, or legs with little downtime.

It is important to remember that melasma is a type of hyperpigmentation that should never be treated with laser treatments. Melasma can be even more difficult to remove after a laser has been used to treat it because the laser causes the hyperpigmentation to become even more entrenched in the deeper layers of the skin. Dr. Michele Green specializes in treating patients whose melasma and hyperpigmentation have been worsened by ablative and non-ablative laser treatments. Dr. Green prefers to treat melasma with Mesopeels, chemical peels, VBeam laser treatment, and Cosmelan peels to prevent any exacerbation of the already existing hyperpigmentation.

Topical Skincare for Melasma and Hyperpigmentation

Sunscreen is essential in any skincare routine, especially for patients with hyperpigmentation and melasma. Sun exposure is the most common trigger for melasma. The sun’s UV rays trigger melanocytes to produce melanin, which can trigger or exacerbate melasma. It is crucial those with melasma wear a broad-spectrum sunscreen with a minimum of SPF 30 daily. Dr. Green recommends layering two types of sunscreen and reapplying every ninety minutes. A chemical sunscreen should be applied first, followed by the application of a mineral sunscreen. Sun exposure can even cause a recurrence of melasma that has been treated with dermatologic treatments.

Retinol, Retinoids, and Tretinoin are topical derivatives of vitamin A that increase the rate of skin cell turnover, sloughing off discolored, dead skin cells and encouraging young, healthy, new skin cells to reach the surface of the skin more quickly than they would on their own.

Tranexamic Acid is a treatment option for hyperpigmentation that is available as an oral supplement or topical cream. It is a synthetic lysine derivative prescribed as an antifibrinolytic agent and FDA-approved to treat bleeding disorders. Researchers have discovered that tranexamic acid inhibits the plasminogen/plasmin pathway, which inhibits the interactions between melanocytes and keratinocytes. Various clinical studies have shown that tranexamic acid is effective in treating refractory melasma with little to no side effects.

Kojic Acid is a naturally derived topical hyperpigmentation treatment that inhibits excess melanin production.

Azelaic Acid is a topical tyrosinase inhibitor. Tyrosinase is an enzyme involved with the first step of melanin production. By inhibiting tyrosinase activity, azelaic acid interferes with the process of producing melanin and decreases hyperpigmentation. This topical treatment option also has anti-inflammatory properties and can be very effective in treating rosacea.

Vitamin C is a powerful antioxidant skincare ingredient that improves skin tone and texture. Dr. Green’s MGSKINLABs Vitamin C formulation, the Vita-C serum, is designed to promote skin cell renewal and collagen synthesis, resulting in reduced appearance of dark spots and an improved overall complexion. Dr. Green’s Vitamin C serum is her office’s most popular topical skincare product. Vitamin C also enhances protection against the sun’s UV rays and, as an anti-inflammatory ingredient, has soothing properties that make it a great treatment option for rosacea.

Glycolic Acid is a chemical exfoliant that has been shown in studies to enhance the effectiveness of other melasma treatments. Glycolic acid encourages an increased rate of skin cell renewal, exfoliating away discolored, dead skin cells and promoting the generation of healthy, new skin cells that are more even with the surrounding skin tone.

Niacinamide can be used to reduce hyperpigmentation by inhibiting enzymes responsible for producing melanin and blocking melanosome transfer from melanocytes to keratinocytes. Studies have demonstrated that consistent use of niacinamide is an effective topical treatment option for lightening dark spots. Niacinamide can be found in many over-the-counter skincare products.

Cysteamine is a topical hyperpigmentation treatment available in many over-the-counter skincare products. Cysteamine works by inhibiting the production of enzymes needed to produce melanin and boosting antioxidants. Dr. Green may recommend cysteamine as a bleach-free alternative to hydroquinone. A study published in J AM ACAD Dermatol demonstrates that cysteamine is a viable treatment for melasma for patients that do not wish to be treated with hydroquinone.

It is important to consult with an experienced board-certified dermatologist before adding any skin-lightening skincare products into your regimen to guarantee their safety and efficacy for your skin type, skin tone, and specific concerns. When you consult with board-certified dermatologist Dr. Michele Green in her office in Manhattan’s Upper East Side neighborhood, she will work with you to create a customized treatment plan for your melasma or hyperpigmentation that best suits your unique needs and personal aesthetic goals.

Does melasma come back after hydroquinone?

Yes, melasma and other types of hyperpigmentation can come back after using hydroquinone. Hydroquinone is a skin-lightening agent that works by decreasing the number of melanocytes and inhibiting melanin production by the melanocytes. Hydroquinone can be used as a treatment for melasma and other forms of hyperpigmentation, such as acne scars, freckles, dark spots, sun spots, and age spots. Hydroquinone is not for long-term use; strict sun protection maintains the desired effect. Melasma and dark spots can return after stopping hydroquinone, especially if exposed to the sun. Dr. Green always emphasizes the daily use of broad-spectrum sunscreen to protect the skin against UVA and UVB rays and wearing sun-protective clothing such as a wide-brimmed hat. Dr. Green also recommends discontinuing hydroquinone during the summer or if you plan a sunny vacation.

Who gets melasma?

Anyone can develop melasma, but certain groups have a higher risk of developing melasma. Melasma is often called the “mask of pregnancy” because it occurs commonly in pregnant women. It is reported that 15 to 50% of pregnant women develop melasma, as hormonal changes are one of the main contributing factors that trigger its onset. Melasma is also more common in medium to darker skin tones because of the naturally high number of melanocytes in the skin. Melasma appears more commonly in females than males: according to the American Academy of Dermatology, only 10% of melasma cases affect men.

When does melasma start?

It is difficult to predict when melasma will first occur, but it is more common during reproductive years and is rare before puberty. Melasma affects women more than men and commonly affects women between the ages of 20 and 40 because of the hormonal changes that naturally occur. During pregnancy, melasma can occur at any time but most commonly starts in the second or third trimester as hormonal changes increase. Melasma can affect men at any age, typically between 18 and 70.

When does melasma appear during pregnancy?

Melasma is extremely common in pregnant women, so much so that it is often called the “mask of pregnancy.” Melasma can occur at any point during pregnancy, but it commonly appears in the second or third trimester when hormones increase significantly. More specifically, the increase in estrogen and progesterone is the main cause of melasma during pregnancy.

Does melasma affect men?

Yes, melasma is a common skin condition affecting men and women of all skin types. Melasma occurs more commonly in women and those with darker skin tones, including men of Asian, Hispanic, and African heritage. Melasma presents similarly in both men and women, although researchers have noted that a malar pattern (across the nose bridge and cheeks) is more common in men. In contrast, centrofacial pattern (forehead, cheeks, across the nose bridge, and chin) is more common in women. The treatment of melasma is similar in both men and women, and daily use of broad-spectrum sunscreen should be emphasized to prevent the worsening of the pigmentation.

Is melasma permanent?

Melasma is a chronic skin condition that can last many years or even a lifetime for many people. There is no cure for melasma at this time, and the discoloration can be troubling for many people. This is why many patients seek guidance from Dr. Green to safely lighten the pigmentation and ensure the treatment results are prolonged using the appropriate skincare products and sun avoidance. If melasma was triggered by hormonal changes during pregnancy or with birth control pills, it could fade after giving birth or after stopping the medication.

Will melasma fade on its own?

If the melasma is triggered by factors such as hormonal changes during pregnancy or birth control pills, it may fade on its own after giving birth or stopping the medication. However, depending on the circumstances, stopping birth control pills may not be the best option. For many people, melasma is a chronic skin condition that can last years, if not a lifetime. The appearance of discoloration on the face can be frustrating for many, and over-the-counter skincare products and natural remedies may not achieve the improvement you are looking for. Dr. Green has offered safe and effective melasma treatments in her NYC-based office for over 25 years, with Cosmelan peel being the most popular.

What can you do to prevent melasma?

Melasma cannot be completely prevented as you cannot control genetics or how your skin reacts to hormonal changes. However, you can take steps to prevent melasma from getting darker. Sun avoidance, broad-spectrum SPF, and sun-protective clothing are very important first steps to prevent the worsening of melasma. When they contact the skin, the UV rays stimulate the melanocytes to produce melanin to protect the skin. The increase in melanin is what produces and worsens hyperpigmentation and melasma. Tanning beds can also worsen pigmentation, so they should be avoided. Sunscreens should be of at least SPF 50 and have broad-spectrum protection that protects the skin from UVA and UVB rays. Sunscreens should also be reapplied every 90 minutes after getting out of the water or sweating for adequate protection. In conjunction with sunscreen, wide-brimmed hats are highly recommended. Sun-protective clothing is often labeled with UPF or Ultraviolet Protection Factor. The sun is the strongest between 10 AM and 4 PM, so try your best to avoid direct sun exposure during these hours or take extra precautions with sunscreen and a hat.

Skin inflammation can worsen hyperpigmentation and melasma because the skin’s response to irritation and damage is to produce more melanin. Therefore, skin care products should be gentle and fragrance-free if you have melasma, as irritation can darken pigmentation. Avoid any products that cause burning or stinging. Waxing may also cause inflammation, so it’s best to be avoided in areas with melasma or hyperpigmentation.

What is the difference between melasma and age spots?

Melasma and age spots are types of hyperpigmentation but are different skin conditions. Melasma commonly presents as patches of hyperpigmentation and appears symmetrically, meaning if it is present on one side of the face, it will likely appear on the other side as well. Melasma most commonly occurs on the face, such as the forehead, cheeks, upper lip, and across the nose bridge. Melasma is more common in women than men and in darker skin tones such as those of Hispanic, African, and Asian heritage due to the naturally high concentration of melanocytes. Fluctuating hormones, as occurs during pregnancy, are one of the main triggers of melasma. Melasma is often called the “mask of pregnancy” for this reason.

Age spots, also known as sun spots, liver spots, and solar lentigines, are also caused by an overproduction of melanin and overexposure to the sun. As the name suggests, age spots appear as small pigmented spots darker than the surrounding skin. Unlike melasma, age spots may appear as a cluster or a single spot and are unlikely to be symmetrical. Age spots are more likely to appear on those with fair skin, unlike melasma, which commonly affects those with darker skin tones. Age spots are more common in older people. Both melasma and age spots worsen with sun exposure, so sun protection is the first preventative step for both skin conditions.

The treatment plan differs on whether the hyperpigmentation is melasma or age spots. Lasers such as Fraxel, Picosure, and IPL are to be avoided when treating melasma because they often worsen melasma and embed the pigment deeper into the skin, making it more difficult to treat. Cosmelan, chemical peels, Mesopeels, and various skincare ingredients like hydroquinone are just some of the treatment options Dr. Green recommends for melasma. Sunspots, however, can safely and effectively be removed with resurfacing lasers like Fraxel, AlexTrivantage, and Clear + Brilliant. Dr. Green has over 25 years of experience treating melasma, sunspots, and other types of hyperpigmentation on all skin types. Using her expertise, Dr. Green can distinguish the discoloration as melasma, sunspots, or other types of hyperpigmentation with a simple physical assessment. She is also an expert in treating post-inflammatory hyperpigmentation from various causes, including acne breakouts, an unwanted side effect of laser treatments, or other inflammatory skin conditions such as eczema or psoriasis.

How do I get started on melasma and hyperpigmentation treatments today?

Hyperpigmentation is a broad term that refers to patches of skin that are darker in color than the rest of the surrounding skin. There are many types of hyperpigmentation, including melasma, sun spots, post-inflammatory hyperpigmentation, and freckles. For many, hyperpigmentation may induce feelings of self-consciousness or low self-esteem. The treatment options best suited to your hyperpigmentation will ultimately depend on your skin tone, skin type, and the severity and type of hyperpigmentation you have. Consulting an experienced board-certified dermatologist, like Dr. Green in New York City, is the fastest and safest way to understand and treat the type of hyperpigmentation affecting you.

Dr. Michele Green is an internationally renowned board-certified cosmetic dermatologist with over two and a half decades of experience providing some of the world’s most discerning men and women with the best non-invasive treatment options available, including for hyperpigmentation and melasma. Castle Connolly, New York Magazine, Super Doctors, and The New York Times consistently identify Dr. Green as one of NYC’s best dermatologists for her dedication to her patients and expertise. Dr. Green takes a holistic approach and embraces a less-is-more philosophy regarding facial rejuvenation, customizing her patient’s treatment plans to suit their specific concerns and ideal aesthetic goals. To start treating your melasma or hyperpigmentation today, schedule a consultation with Dr. Green by contacting us online or calling the NYC-based office at 212-535-3088.