Randy Jacobs, M.D. Patient Education

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Melasma appears as a blotchy, brownish pigmentation on the face that develops slowly and fades with time. Melasma usually affects women but occasionally is seen in young men who use after-shave lotions, scented soaps, and other toiletries. Melasma is especially common in young women and affects the forehead, cheeks and upper lips. It occurs frequently during pregnancy and is more common in dark skins than in fair skins. Often called "the mask of pregnancy", melasma is more pronounced during the summer months as a result of sun exposure. It usually fades a few months after delivery. Repeated pregnancies, however, can intensify the pigmentation. Melasma also occurs as a side-effect of taking contraceptive pills and injected depot contraceptive preparations. It may also be noticed in apparently healthy, normal, non-pregnant women where it is presumed to be due to some mild and harmless hormonal imbalance. Sun exposure, following the use of deodorant soaps, scented toiletries, and various cosmetics can also produce this mottled pigmentation. This is called a phototoxic reaction and is due to ultraviolet radiation being absorbed by the chemical substance (perfume, cologne and other types of fragrance) on the skin. This pigmentation often extends down to the sun-exposed areas of the neck and may be more pronounced on the right side of the forehead, face and neck due to sun exposure while driving a car.



If you have melasma, seek specialist treatment. If you are on hormonal contraception, consider stopping this if possible. However any benefit from changing hormonal preparations is usually slow to become apparent. Sun protection: This is very important. Use a broad-spectrum very high protection factor sunscreen of reflectant type and apply it to the whole face. Alternatively, use a make-up with a sunscreen in it. Avoid irritating the facial skin: No strong soaps or abrasive cleaners - use only a mild  cleanser for washing.


Bleaching creams: Bleaching creams such hydroquinone, which inhibits formation of new pigment. Bleaching creams must be applied for at least 3 months to obtain a worthwhile lightening of pigmentation. Even then, just a "whiff" of summer sun can darken the pigment again and spoil months of hard work. Follow the instructions in the packet insert carefully. Apply a small amount of cream daily to a small "test" area of melasma on the side of the face then, if there is no redness, itching or scaling, after, say, 5 days, apply the cream twice a day to the area. If still well tolerated, apply the cream accurately to all the melasma areas twice a day. Avoid applying bleaching cream to normal skin as this will lighten as well. When using a sun screen, apply the bleaching cream first then the sunscreen on top. For melasma, the sun is your biggest enemy.


Tretinoin cream: If progress is slow using a hydroquinone cream alone, tretinoin cream (a prescription medicine) may be used. Tretinoin always causes a degree of pinkness and peeling of the facial skin which can be controlled by starting with a little then building up. It may fade freckles, improve acne and smooth wrinkles. A sun screen must be applied as well. Tretinoin MUST NOT be used in pregnancy. Triluma is a wonderful topical medica  tion that combines tretinoin, a steroid, and hydroquinone.


Azelaic acid cream: Azelaic acid inhibits formation of pigment and is also effective against acne. Try it first on a small test area of the melasma as described above for bleaching creams. There can be mild stinging after putting it on, followed by a little peeling. This will settle with continued use of the cream. As with the bleaching creams, it takes several months to see worthwhile lightening of the pigment. It is currently recommended azelaic acid cream not be used for more than 6 months.


Camouflage cosmetics: Another approach to Melasma is to use special camouflage cosmetics. Ask your cosmetic counter representative at your favorite department store. Results take time. It pays to be patient! If you don’t see desired results after two or three months, ask Dr. Jacobs about the Salicylic Acid peel.