Chipping Away at Melasma- Kristin Scord, PA-C

Hyperpigmentation can plague both men and women, as well as skin of any color. If you’re reading this, you may have struggled with this personally or know someone who does and are eager for some helpful advice. It can take several months to see improvement once you’ve begun a process so stick with it–it’s best to think of it as a process of chipping away at the ice-block, followed by preventing that ice from forming again. 
What is Melasma? 
Melasma is a particularly difficult form of hyperpigmentation due to overproduction of melanin by the pigment cells, melanocytes; that can have various influences and causes. In particular, this disorder of pigmentation typically presents as chronic patchy brownish facial pigmentation that may have differing patterns that typically affects the cheeks, forehead, bridge of nose, and upper lip. It most commonly occurs in ages 20-40 years old, but can happen in earlier or later years. 

Why does it occur? 
Melasma is usually tied to levels of estrogen and progesterone and most patients will have a genetic predisposition, but there are potential other factors at play. Given that triggers for melasma center around genetics, hormones (such as in pregnancy, OCP or HRT), heat and UV exposure, it can be a long term and challenging issue.
What can you do?
The best treatments for melasma are centered around combinations of in-office treatments and maintenance routines at home.
Key Places to Start:

  • SUN:  Wear sunscreen year-round.  Physical sunscreens with zinc oxide and/or titanium dioxide are best and prolongs your benefits of any in-office procedures as well.
  • HEAT:  As best as you can, avoid sun and heat.  Wear sunscreen, hats, minimize exposure time and seek shade.
  • HORMONES:  If possible, discontinue any outside hormonal influences such as contraceptives or hormone replacement (if not essential).

Add Actives (at-home treatment and maintenance with topicals):

  • SUPPRESS:  Inhibit new pigmentation formation with tyrosinase inhibitors such as Hydroquinone, Kojic Acid, Azelaic Acid, or Arbutin.
    • Our Favorites:
      • Hydroquinone:  We love Obagi’s CRx system or compounding this agent for higher percentage prescription options if appropriate.  Requires breaks and is not for use in pregnancy/lactation. Requires prescription. Please call for pricing/purchase
      • Kojic Acid and Arbutin:  Both are in AlumierMD’s Intellibright Complex!  Ok for use during pregnancy/lactation. 
      • Azelaic Acid:  Typically prescribed and pregnancy/lactation safe.


  • PREVENT:  Vitamin C helps impede melanin production leading to brighter and more even skin tone.
    • Our Favorite:
      • Vitamin CAlumierMD’s EverActive C&E+Peptide


  • LIFT/RESURFACE:  A retinoid such as prescription Tretinoin, Azelaic Acid (can be used for sensitive skin types or those who are pregnant or nursing), and Kojic Acid are great exfoliators to enhance the results of the above treatments by increasing cellular turnover.

Take it a step further: Discuss with your provider.
In-Office Treatments:

  • Adding in-office treatments have been shown to accelerate your desired results.
  • Note: Avoid lasers that use heat as they may trigger hyperpigmentation.  Caution should be taken with peels as there is a risk of post-inflammatory hyperpigmentation as well. Safer options are as follows and can be discussed with your provider to see if they would be right for you. 


    • PICOSURE LASER:  A non-heat focused laser using energy-delivery to vibrate and break down unwanted pigment.
    • VI PEEL:  A pharmaceutical-grade chemical peel.

Oral Medication:

  • Oral Tranexamic Acid may be an option for very stubborn cases and requires some bloodwork evaluation prior to starting treatment.

The outlook for melasma is getting better and better with long-term and safer treatment options becoming more available. Melasma related to pregnancy or outside-hormonal influence can sometimes resolve post-pregnancy or by stopping the offending agent. Melasma can last a lifetime or may re-arise with recurrent hormonal factors, in summer or sun-filled months, or with heat exposure. 
Remember that it can take several months to see improvement. We are happy to meet with you and find what combinations are best for your unique case to help you start chipping away!

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