How Melasma Became One of The Most Common Skin Conditions To Rule 2020
About six million other Americans of all genders, skin types, and ethnicities are currently experiencing it, which means the time is right to find the most modern, safe, and forward-looking options for treating it, preventing it, and simply working with it.
What triggers melasma
The condition is one of the most prevalent dermatologic complaints on the planet. “Melasma happens when the pigment-producing cells, or melanocytes, in the skin are triggered to get bigger and produce more pigment,” explains Purvisha Patel, MD, a board-certified dermatologist and the founder of Visha Skincare. “We are all born with the same number of melanocytes, they are more active in darker-skinned people, and are not evenly distributed in everyone, so when they get big or hyperactive, this results in uneven pigment on the skin.” Limiting the triggers that activate the melanocytes is key to halting the discoloration.
“Melasma is triggered by three primary factors: hormones, UV radiation, and heat,” says Dr. Weiser, adding that studies have shown that heat increases pigment production by dilating underlying blood vessels. “It is crucial for patients prone to melasma to be diligent in avoiding heat and UV light, as much as possible, and to cool the skin surface quickly when it becomes heated to minimize the duration of heat on the skin surface.” But avoiding heat isn't as simple as it seems. Saunas, hot baths, exercise, and even something as simple as cooking over the stove can cause problems. The newest at-home treatments take the issue into account, like Priori UnveiLED Flexible LED Light Therapy Mask ($395), which delivers temperature-controlled near-infrared rays to the face, ones that don't provoke pigment production, in order to improve tone and texture without the risk of overheating skin (a common complaint associated with early versions of LED tech).
And there are other hidden pigmentation stimulants. “Blue light emitted from your smart device or laptop has been shown to increase pigmentation on the face, making melasma worse,” says Orit Markowitz, MD an associate professor of dermatology at the Icahn School of Medicine at Mount Sinai. Skin-care products with irritating ingredients can also be problematic. "Even sunscreens can make melasma worse if they contain chemical ingredients that irritate the skin," she adds. This happens because these formulas work by converting the UV radiation to heat within the skin so that you don't get burned, but in this process, that heat can trigger pigment cells in those with melasma.
Exposure to heat, light, and irritants are things you can at least try to control. Hormones, on the other hand, are harder to manage. “Hormones influence vascular flow to the surface of the skin, and blood flow influences inflammation in the skin, two factors that also contribute to melasma,” explains Dr. Markowitz. And while melasma has been called the “mask of pregnancy,” hormonal fluctuations aren’t limited to childbearing. Birth control pills, IUDs, estrogen hormone therapy, and thyroid disorders can also exacerbate melasma. Even elevated stress levels can cause a cortisol spike that may lead to estrogen imbalances and trigger a flare-up.
How to treat melasma
When treating melasma, it’s important to think about the long game, because it’s a lifetime relationship. If you're able to see a dermatologist, there are several prescription remedies for melasma. Dr. Markowitz often prescribes a cocktail of Retin-A, hydroquinone, and a mild steroid to treat it; however, hydroquinone does have its downsides. “Hydroquinone is available over the counter in 2 percent formulation and as a prescription in 4 percent formulation,” explains Dr. Patel. “This drug effectively lightens the pigmented skin, but if used over a long period of time, can be dangerous and create hyperpigmentation as a side effect—the opposite of what we want to happen.” It’s also rumored to thin the skin and, interestingly, it's not safe to use if you're pregnant.
For patients who are pregnant or simply want to avoid hydroquinone, Dr. Patel suggests a prescription topical with azelaic acid, which soothes irritation and treats dark spots in tandem. The ingredient is widely available in non-prescription strength, especially now that its unique versatility has been recognized within the beauty industry. For example, Visha Skincare Mommy Brightener ($65) was made specifically for use during pregnancy and nursing, and it contains a patented ingredient blend, dubbed Illuminotex technology, that is “tested to work the same as hydroquinone without the side effects, thanks to natural tyrosinase inhibitors such as azelaic acid, kojic acid, niacinamide and licorice, as well as salicylic and glycolic acid," according to Dr. Patel. Glo Skin Beauty Brightening Serum ($30) offers a mix of acids including azelaic, while Arbonne SuperCalm Skin Relief Serum ($50) blends azelaic acid with tiger grass to soothe skin while evening out its tone. Unsurprisingly, The Ordinary has already captured a cream-gel option for under $8 in their Azelaic Acid Suspension 10%.
For those ready to try medical-grade, non-prescription alternatives, the future looks bright. Cyspera has emerged as a star in its field thanks to the active ingredient cysteamine hydrochloride, which has been used to treat melasma for about half a decade with results that rival hydroquinone. “In studies, topical cysteamine showed significant efficacy in decreasing melanin content in the skin. Cyspera contains 5 percent cysteamine hydrochloride which is a powerful aminothiol antioxidant with multiple benefits in patients with skin discoloration,” says Dr. Weiser, adding that it “has been shown to improve the appearance and minimize the recurrence of hyperpigmentation.” Applied over makeup or existing skin care (to create a gentle barrier), the light, moisturizer-esque formula is rinsed off after just 15 minutes. Smelling a bit like a 90s perm, the sensation is negligible with no stinging or burning. And unlike hydroquinone or retinol, it works well for particularly sensitive skin.
Another non-prescription ingredient gaining popularity is tranexamic acid. “More recently, topical tranexamic acid 2 percent has emerged as a longterm treatment and maintenance option to control pigmentation and has been shown to be as effective as topical hydroquinone in the treatment of melasma,” Dr. Weiser points out. Plus, products with tranexamic acid are easier to find than ever. The Inkey List Tranexamic Acid Night Treatment ($15) sports Sephora’s “clean” seal of approval, while Acaderma Star Light Spot Corrector ($78) blends their exclusive ingredient MelaMorin (designed to inhibit melanin synthesis) with tranexamic acid, and the brand-new Murad Rapid Dark Spot Correcting Serum ($72) incorporates tranexamic acid into its formula designed to brighten pigmentation in two weeks.
How to prevent it
Even if improvement can be seen in under a month, Marisa Garshick, MDCS, reminds us that while treatments can help, many cases of melasma are considered chronic, which calls for a lifetime of care. “There’s always the chance of recurrence,” she says. For UV protection, it’s more complicated than just applying the most elegant formula. You want a broad-spectrum product that guards against UV and blue light from screens and doesn't contain irritating chemicals. “Moisturizers or sunscreen products containing iron oxide [to] help prevent the hyperpigmentation caused by blue light have been shown to be an effective treatment,” says Dr. Markowitz. Iron oxide has also proven to be an effective visible light protectant for darker skin tones, which are often more susceptible to melasma.
“Not all sunscreens are able to block against blue light, so it is important to look for ones containing certain blue-light protecting ingredients such as iron oxide which can be found in some tinted sunscreens, antioxidants which can help protect against the free radical damage caused by blue light, and red algae,” Dr. Garshick continues. Skinbetter Science Tone Smart SPF 68 Sunscreen Compact ($55) is easy to apply and is a great option for reapplication throughout the day, she suggests. And blending zinc oxide with Indian ginseng to protect from blue light, Dr. Loretta Urban Antioxidant Sunscreen SPF 40 ($50) doubles as a primer. “Even once it improves, it is important to remain vigilant about sun protection and maintenance strategies,” reminds Dr. Garshick. One such strategy would be adding more blue-light-blocking elements into your skin-care and cosmetic routines, like Chantecaille Blue Light Protection Hyaluronic Serum ($150) and Payot Blue Chrono-Regenerating Balm ($58).
Vitamin C is a derm-approved hero ingredient for fighting environmental damage without triggering melasma, and can even benefit the treatment process. “Antioxidants such as vitamin C are helpful for those with melasma, as it not only can be helpful to fight free radical damage, it can also help to brighten the appearance of the skin.” Perricone MD’s just-launched CCC + Ferulic Brightening Complex 20% ($159) uses a unique phospholipid delivery system to send three different versions of vitamin C (plus antioxidants like Vitamin E and ferulic acid) into the skin's deepest surface layer. Algenist Blue Algae Vitamin C Dark Spot Correcting Peel ($85) includes gentle glycerin humectants to make it safe for all skin types and tones, and FEMMUE Lumière Vital C Serum ($88) uses a UV-resistant version of vitamin C along with vitamin E and safflower seed oil to reduce inflammation and block pollutants for a derm-sanctioned bonus.
“Skin of melasma has been studied to show increased markers for oxidative stress and inflammation,” says Dr. Patel. “Pollution has also been shown to contribute and make melasma worse, as this further inflames the skin.” Native Atlas Zahara Vitamin Serum ($60) incorporates a spectrum of antioxidants to protect against environmental aggressors, and Avegan Beauty Plant Based Balance Toner Vitamin Spray($34) includes vitamin C, carotenoids, and vitamin E within its patent-pending FortiSomes complex for a protective top-up that can be misted on throughout the day.
How to cover melasma
Whatever you choose, it can often take months to see results. “Because many of the treatments can take time to see improvement, I always review the option of cosmetic camouflage with products such as Dermablend or It Cosmetics,” says Dr. Garshick, who appreciates that the lines make an effort to match all skin tones.
Ilia True Skin Serum Concealer ($30) blends in albizia julibrissin bark extract to protect against environmental aggressors, and Kosas Revealer Super Creamy + Brightening Concealer ($28) calms skin with arnica and panthenol to help counteract inflammation. Maybelline Instant Age Rewind Concealer is considered America's best-selling drugstore option at just $10, while NARS Radiant Creamy Concealer ($30) sits at the top of prestige sales. New to the market this week, makeup artist Monika Blunder, who works with celebs like American Ferrera and Gemma Chan, released Blunder Cover ($52), a clean concealer-foundation hybrid infused with antioxidant-rich edelweiss and rosemary extract (which doubles as a natural preservative). For straightforward clean foundations, Credo’s new 43-shade EXA High Fidelity Foundation ($38) uses hyaluronic acid and protective microalgae actives to create buildable liquid coverage that reads like real skin, while BareMinerals Complexion Rescue Defense Radiant Protective Veil SPF 30 ($39) is infused with cacao to further help protect against that blue light radiating from every device in your life (and some of your energy-efficient fixtures).
With or without makeup, your real skin, your bare skin, your hyperpigmented skin, is great skin. If you choose to engage with melasma in a lifelong battle, do your complexion the kindness of double-checking the active ingredients in the products you coat it with so that you protect–rather than punish–your first line of defense.
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