It starts out so barely noticeable, most people ignore it. When they do first see it, they hope it’ll just go away on its own. But it doesn’t. And then, all of a sudden, it’s really noticeable: melasma. This condition is often called “the mask of pregnancy” because the blotchy, brownish patches most often appear on the foreheads, upper lips and cheeks of women 20 to 50 years old who have been pregnant. But melasma does not discriminate.
True melasma patches are symmetrical, appearing on both sides of the face, which is what differentiates it from common age spots. Everyone who has it would like to get rid of it, but experts discourage attempting to treat it with over-the-counter remedies because though rare, a few melanomas can look like melasma. It would be hard, if not impossible, for someone who’s not a medical professional to tell the difference, cautioned Veronica Taylor, owner of SKIN by Veronica in Southampton.
Also, melasma is often concurrent with thyroid disease, which should be ruled out as well. A few top local experts weigh in on the most frequently asked questions about this disorder.
How big a problem is melasma?
Six million people in the United States suffer from it. According to the American Academy of Dermatology, 90% of those are women. “I see many patients with darker skin tones having melasma,” said Dr. Joshua Fox, medical director of the Advanced Dermatology offices in Albertson and West Islip. It doesn’t cause any discomfort, but “managing the psychosocial stress can be challenging for some patients.”
What causes it?
A genetic predisposition is likely, since more than 40 percent of patients reported having relatives affected by the disease, said cosmetic dermatologist Kenneth Mark of East Hampton.
The exact mechanisms that cause it to appear in some people and not others are unknown, but it’s believed that something triggers pigment-making cells called melanocytes to become “hyperfunctional” and make too much pigment, or melanin, explained Dr. Seth Wilentz, a dermatologist in Jericho. Triggers seem to be hormones (especially from pregnancy and hormonal birth control methods), drug sensitivities and sun exposure. Many women first notice melasma at the tail end of pregnancy.
Can it be prevented?
Though the exact causes of melasma are largely unknown, what is known is that sun exposure worsens it. Fox noted seeing more melasma patients in his offices in the summer months. “Our recommendation is that you apply a sunscreen of SPF 30 or above 20 minutes prior to going outside and wear a wide brimmed hat, especially between 10am to 3pm,” he said. “Heat in general and friction also worsens it, avoid saunas and facial scrubs.”
Sunglasses year-round are a must, since the tops of cheeks are commonly affected. Also, stay away from photosensitizing medications (ones that increase skin sensitivity to the sun), if possible. Those include some antihistamines and oral acne medications. Always ask a doctor or pharmacist to find out about a prescription prior to taking it.
What are the top treatments on Long Island?
What works for one person may not work for another. Preferred treatments vary by practice, as well as patient needs and preferences.
Fox said his offices have achieved “high success rates” with the Fraxel laser, a skin resurfacer that has the ability to penetrate deeply and eliminate cells producing too much pigment. Fox also noted a combination approach—the Fraxel laser and chemical peels—works on most patients who don’t have success with lasers alone.
One unique melasma treatment is employed by East Hampton dermatologist Dr. Mark. He pre-treats patients with a bleaching compound that has a combination of ingredients known as the Kligman formula, followed by a customized Mixto laser peel. “I typically use the bleaching compound after the Mixto laser peel as well,” Mark said. “I have not had one patient with significant hyperpigmentation that was not managed with this treatment in approximately 10 years.”
The first line of defense in Wilentz’ Jericho office is the VI Peel, containing salicylic acid, Glycolic acid and other proven ingredients and he has found the results to be excellent.
SKIN by Veronica is the only facility on the east coast to offer the Carboxy Therapy Sparkling C Facial, especially for melasma. “It’s antimicrobial, oxygenating and detoxifying, which lightens and brightens pigmentation with powerful doses of antioxidants like Vitamin C,” Taylor said. “It also feels amazing!”
A holistic option exists as well. “Restore” is an internal wellness treatment offered at Pure Envy Aesthetics in Blue Point. Taken under the tongue, it combines modern technology with an ancient Chinese medicinal herb. “A well-researched, specialized extract of sweet wormwood increases the strength of the immune system,” said Pure Envy’s owner, Christine Curley-Morales. “Restore removes toxins, reduces inflammation and repairs protein damage. We’ve seen great results with our clients after three months.”