Dermal (skin) melasma is a skin condition related to pigmentation. Most commonly on the face, dark spots of intense pigmentation appear on the nose, cheeks, forehead and chin. Melasma is more common in those with a darker skin because they already have higher pigmentation in their skin. Only 10 percent of cases are men, so women comprise most of those seeking treatment. This is perhaps because it is a condition where dark brown spots appear on the very noticeable parts of the face. Also, certain hormonal changes like pregnancy and birth control pills can cause this condition. Treatment research is ongoing, but a few of the treatments are cited below.
Bleaching Agents
Bleaching agents do just that -- bleach the layers of the dermal tissue and eventually lighten the dark spots. Hydroquinone is the most widely used and can be in a solution of 2 to 4 percent when prescribed. But this ingredient also is used in what qualifies as more "cosmeceutical" that are over-the-counter products sold in non-prescription formula. Kojic acid is another bleaching agent but has more cases of irritation than hydroquinone. Research has shown that after six months of one treatment for bleaching, it can be best to switch to another solution as the skin can begin to essentially ignore the bleaching agent it has become familiar with.
Retinoids and Steroids
Fluorinated steroids such as betamethasone valerate has been effective in treating melasma, as has tretinoin 0.1 percent. But users are finding that it is a combination therapy of retinoids and steroids combined with bleaching agents that gives a satisfying result.
Chemical Peels and Dermabrasion
Another approach is to essentially remove the darker pigmented skin with chemicals or the intense treatment of dermabrasion. Both simply remove the skin's top layer and continues to do so with each treatment. As the layers of skin continue to peel off, the underneath layers are clearer and brighter with less spots of pigmentation. A dermatologist can prescribe and administer the best combination of these therapies.
Lasers and IPL (Intense Pulsed Light)
Once seen as a possible new hope for melasma, research has shown that too often with lasers or IPL, the inflammation after treatment is too great. Many dermatologists and researchers are ruling out these light sources as an effective treatment for melasma.
Sun Protection
Sunscreen, sunscreen, sunscreen. We hear it so often but it always bears repeating. Sunblock and shade will provide the best possible protection from ending up with melasma. Women especially should wear an SPF of 30 or higher on the face. If you already have deeper spots of pigmentation, cover those spots with the most sunblock. Zinc oxide and titanium oxide are essential ingredients in sunblock for those with melasma, since they are a physical blockage of the sun. And try self tanner on your face if you have spots. A darker shade that matches the dark spots can be tried for a more even appearance.
