What is it?

Brown patches that appear typically on the face, often during sudden hormone fluctuations (which is why it is sometimes referred to as “pregnancy mask”) and is induced and worsened by sun exposure. Melasma is very distressing because a dark patch on the cheeks, upper lip or forehead is highly visible and cosmetically difficult to camouflage. Even small or incidental amounts of sun exposure can make it worse, that is why it is so challenging to fade or clear. Even if topical and/or laser or energy based treatments are successful in making it look cleared, exposure to sun can make it reappear in the exact same pattern, or even spread to a larger area.

Many lasers or (any light source) can actually make melasma worse, which is why it is imperative to have proper diagnosis and a treatment plan customized to each unique situation.

Lifestyle Factors

Avoiding sun exposure is imperative to fading melasma and preventing recurrence. Skincare is the first and most important factor. Hats, umbrellas, and seeking shade during prolonged sun exposure periods help to also prevent melasma from worsening. In some cases, compliance to proper skincare regimen can improve the melasma enough that laser procedures are not needed.

Skincare Adjuncts

Daily broad spectrum sunscreen should be worn even on cloudy days, ideally 15% zinc oxide or higher, like the Cyberderm Every Morning Sunwhip. UVA, which darkens melasma patches, transmits through clouds, window glass and is highly reflective off almost any surface. A retinoid product or exfoliator such as glycolic acid, and some form of pigment lightener, such as Emblica are essential elements to the regimen. Vitamin C and other antioxidants that are skin brighteners are also helpful.

Treatment Options

Treatment Option	Key Benefit	Average Number of Treatments	Amount of Downtime	Comfort Measures
Fraxel Restore	For deep melasma that is unresponsive to skincare, well suited for lighter skintypes	4 sessions, once every 3 months	5-7 days, redness and moderate swelling followed by exfoliation	Topical anesthetic, oral sedation/analgesics
Q-Switched 1064 laser	For melasma on all skintypes. Very safe and gentle treatment, low risk of complications	10 sessions, 1 week apart	none	none
Combination therapies: BBL and fractional RF	For resistant melasma non-responsive to other modalities, low risk of complication	1-3 sessions, 1 month apart	Mild redness for 1 day, mild exfoliation by day 4-5	Topical anesthetic