April 2, 2020 Is Melasma Curable And What Are Your Best Treatment Options?
Melasma treatments can help patients brighten up their skin and effectively manage this condition, which affects an estimated 5 million people in the United States each year. While it doesn’t typically cause symptoms such as pain or irritation, melasma can have a profound impact on the quality of life of those who have it.
Can Melasma Be Cured?
Melasma, also known as chloasma, is a skin pigmentation disorder characterized by symmetrical dark patches on your skin. This condition generally shows up on the face, but can also develop on your arms and neck, often in conjunction with birth control pills, pregnancy, and/or sun exposure. Although this condition does not negatively impact your health, may want to know how to cure melasma permanently.
In order to understand and discuss the options for ‘curing’ melasma, we have to take some time to understand what causes it in the first place. The overall mechanism of the condition involves the pigment-producing cells in the skin, the ‘melanocytes’, becoming overactive and producing too much pigment (melanin).
While we don’t have a complete understanding of what exactly makes these cells start behaving in this way, there is strong evidence that UV rays from the sun play a large part in triggering them.
Those who have melasma may notice that their dark patches typically begin either after a period of sun exposure, or get worse during the summer and improve during the winter.
We also know that a hormonal balance in the body is another trigger that makes these melanocytes become overactive. Pregnancy, a time in which the body experiences large hormonal changes, is notorious for causing flares of melasma – so much so that the condition has earned the nickname, ‘the mask of pregnancy’.
So, if we take ‘cure’ to mean a ‘complete and full reversal of the condition where it will not flare again’, then we have good news and bad news for you. The bad news is that melasma is a chronic condition that isn’t currently curable.
The good news is that the dark patches this condition causes do fade over time and can be effectively managed. With the right combination of sun protection measures and topical fading creams, dramatic improvements in melasma can be achieved so that it is no longer visible with the naked eye.
Because there is still some uncertainty about the exact mechanism by which these pigment producing cells become overactive, any treatment that you read about online that claims to ‘cure’ melasma is presenting a misleading picture or is using a looser definition of the word ‘cure’.
Why Treat Your Melasma?
If melasma can’t be cured, then why treat it?
Well, there are many reasons you may want to treat your melasma. You might have a big event coming up, like a wedding or an important presentation at work. You might be tired of using filters and photo-editing apps to hide the dark spots on your face. You may have even noticed that your melasma has negatively impacted your self esteem.
Many studies have shown that melasma isn’t just simply about annoying dark patches on your skin. Although melasma isn’t a life-threatening condition, it can still negatively impact your quality of life.
One study found that people with melasma can refuse to leave their houses, incessantly think about their melasma, and feel inferior to others due to their skin condition (Jiang).
More than 40% of individuals who participated in another study reported that they were depressed, frustrated, and embarrassed as a result of their melasma.
Yet another study found that individuals reported feelings of shame and low self-esteem.
Fortunately, there is good news.
Other studies have determined that patients who treat their melasma can significantly improve their quality of life (Balkrishnan). A regimented plan that combines melasma treatments with sun protection can help you manage your melasma and brighten up your complexion.
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Best Available Melasma Treatments
There are many types of melasma treatments. These options can be used on their own or in conjunction with each other, as determined by your dermatologist. The most common treatments for melasma include the following:
Chemical facial peels
A chemical peel uses a special solution to ‘peel off’ the topmost layer of skin. This process removes discolored patches and the skin pigment melanin, as well as promotes new skin growth. Chemical facial peels for melasma are most effective in combination with a topical skin lightener. This ensures a more uniform penetration of the peel and reduces the risk of post-inflammatory hyperpigmentation (where the skin actually gets darker instead of lighter).
Light Amplification by Stimulated Emission of Radiation, more commonly known as a laser, is a focused beam of light energy used to heat and destroy precise targets in the skin. The targets in lasers for skin lightening are called chromophores, which include melanin. Conservative (low-energy) treatments are generally recommended in order to reduce the risk of rebound pigmentation, where the skin gets darker instead of lighter. As a result, lasers are considered second or third-line treatment options for the treatment of melasma.
Microneedles are very small needles that typically measure 0.1–1 mm in length. They can be used to create pores in the topmost layer of skin to allow the ingredients in topical creams to penetrate into the layers of the skin where blood vessels and pigment cells are located. Microneedling is most effective when used in conjunction with topical creams. The use of microneedling on its own does not have a strong evidence base for improving melasma.
Prescription medicated topical creams
Prescription medicated topical creams combine ingredients proven to lighten the skin, stop the production of melanin, decrease skin inflammation, and stimulate skin exfoliation into a cream that you apply to the affected area. Kojic acid, tranexamic acid, and hydroquinone are all common ingredients in these types of creams. Topical creams are applied daily at intervals recommended by either your dermatologist or the package (depending on your product of choice).
Melasma treatment at home
There are many at-home melasma treatment options, particularly over-the-counter melasma creams that are applied one or more times daily, depending on the manufacturer’s instructions. The ingredients in these over-the-counter options are not as strong as prescription creams, meaning that they are less effective – if they are effective at all.
Other melasma treatments at home include essential oils, turmeric, apple cider vinegar, and more. These treatments are not well studied, however, and should only be used after consulting with your dermatologist.
What Permanent Melasma Removal Options Are There?
If you have wondered how to remove melasma permanently, then we unfortunately have bad news for you. Since this condition is chronic and does not currently have a cure, that means you may experience melasma flare-ups throughout your life. Fortunately, melasma can be lightened and managed, and you can maintain long-term results with diligent treatment and sun protective measures.
Sun Protection And Melasma Treatment
You can undo all of the positive effects of melasma treatment by exposing yourself to too much sun.
UV rays from the sun trigger pigment-producing cells (melanocytes) to start producing more pigment, thus making dark patches on your skin more noticeable.
In individuals with melasma who already have overactive melanocytes, that means even a short duration of time in the sun without protection can cause significant worsening of dark patches. That’s why a complete approach to melasma treatment should also include a focus on sun protection.
Wearing wide-brimmed hats and generally avoiding being outdoors at peak sun exposure times (the middle of the day) is one strategy, but, of course, it is impossible to do this all the time. That’s where sunscreen comes in. Sunscreens can either be what we call ‘physical blockers’ or ‘chemical blockers’.
- Chemical blockers contain chemicals that absorb UV rays and convert these to low-level heat energy.
- Physical blockers contain minerals like zinc or titanium that, as the name suggests, physically block UV rays from reaching your melanocytes. Since physical blockers are faster acting (immediately upon application), have a broader range of UV ray protection, and have lower rates of allergic responses, these are typically more highly recommended than chemical blockers.
How Long Will It Take For My Melasma To Clear Up?
No treatment will work overnight. It can take a few weeks to see some improvement and up to several months until you reach your desired result. Melasma that has been present for a long time may be slower to respond to treatment. Sun exposure, whether through work or exercise, can contribute to melasma recurrence.
If you consistently use melasma treatments, such as a customized prescription skin lightening regimen, you will notice clearer skin more quickly. Regular sun protective habits will further improve the speed and effectiveness of treatment.
So, What Is The Best Treatment For Melasma?
Whether you are treating melasma without medication, with over-the-counter options, or with prescription-strength medication creams, there’s one important thing to keep in mind: melasma can be slow to respond to treatment, but that doesn’t mean it won’t go away.
Prescription creams are generally considered the gold standard for Melasma treatment. Yet everyone has unique skin so consulting a dermatologist is the best first step. As your melasma responds to treatment, your plan will change too. Your personal dermatologist will regularly check in with your progress and revise your prescription as needed to ensure your prescription is always just right.
- Balkrishnan R, Kelly AP, McMichael A, Torok H. Improved quality of life with effective treatment of facial melasma: The PIGMENT trial. J Drugs Dermatol 2004;3: 377–81. https://www.ncbi.nlm.nih.gov/pubmed/15303781
- Jiang J, Akinseye O, Tovar-garza A, Pandya AG. The effect of melasma on self-esteem: A pilot study. Int J Womens Dermatol. 2018;4(1):38-42. https://www.ncbi.nlm.nih.gov/pubmed/29872675
- Sheth, Vaneeta M. et al. Melasma: A comprehensive update. Journal of the American Academy of Dermatology, Volume 65, Issue 4, 689 – 697. https://www.jaad.org/article/S0190-9622(11)00309-4/fulltext
About the author
Brandon Kirsch, MD, FAAD, is a board-certified dermatologist specializing in clinical drug development and medical innovation. He is the founder of Kirsch Dermatology in Naples, Florida and is also the Chief of Dermatology at the ...