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Q&A Interview

Melasma Q&A with Dr. Jennifer Herrmann

Posted on: August 15th, 2019 by Dr. Jennifer Herrmann

Melasma is a common skin problem. Melasma causes brown to gray-brown patches, usually on the face. Most people get Melasma on their cheeks, bridge of their nose, forehead, chin, and above their upper lip. It also can appear on other parts of the body that are exposed to the sun, such as the forearms and neck.

Melasma is most often diagnosed clinically by your dermatology consultation. Melasma treatment can be challenging depending on where the pigment is located on your skin. Pigment closer to the skin’s surface is more easily treated, while deep pigment can be very persistent. In this Question and Answer interview Dr. Jennifer Herrmann address frequently asked questions about Melasma.

What is the primary cause of Melasma?

If we had a precise understanding of what causes melasma, we would have more effective treatments. Unfortunately, its cause is poorly understood, although we do know that hormones, especially elevated levels of estrogen, progesterone, and melanocyte-stimulating hormone in combination with UV exposure contribute to the disease. Genetics also play a role in the likelihood of developing melasma and those with darker skin types have higher risk as well.

What is the difference between Melasma and Hyperpigmentation?

Melasma is characteristically seen as gray-brown patches on the forehead, cheeks, and upper lip and is UV and hormonally-driven. Hyperpigmentation is a more general term for brown patches anywhere on the skin, and it may have multiple causes. The most common is post-inflammatory hyperpigmentation, which means skin darkening after a rash or other injury to the skin. In these cases, melanocytes (pigment producing cells) are hyper-activated by the inflammation/injury and deposit pigment into the deeper layers of the skin. Overtime, post-inflammatory hyperpigmentation almost always fades whereas in melasma, pigmentation may be much more stubborn.

What is the best approach to treating Melasma?

The best approach is always a combination of treatments. Wearing a broad spectrum sunscreen with an SPF of >30 daily is critical as protecting against UV and is the easiest modifiable factor (changing hormones can be much more challenging!). In addition, topical prescription-strength brightening creams, which compound agents that help block pigment synthesis or pigment transfer to the skin are important. These work synergistically to tackle discoloration. I also often recommend light laser treatments with either our Clear + Brilliant laser or our Piqo4 picosecond laser to help lift pigment. It is very important that such treatments are gentle and generate minimal heat as heat in the skin can exacerbate melasma. Devices like IPL are often tried but these frequently cause paradoxical worsening of pigmentation, so I do not suggest them. Finally, in some cases, I also recommend an oral medication called tranexamic acid, which with other treatments can be helpful in some.

Does Melasma fade overtime?

As hormones change and a person’s exposure to UV changes, yes, melasma can fade over time. But, if UV exposure is increased or a person’s hormones rise (if someone becomes pregnant, for instance), melasma can recur.

Is there anything one can do to prevent Melasma?

Vigilant sun protection is the best bet, and if someone has a high risk, avoiding certain birth control pills can be helpful. Seeing a board-certified dermatologist early can be helpful as getting on a treatment regimen early can help prevent the condition from getting very noticeable and more difficult to treat.


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