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Face the Facts: Demystifying Melasma from a Board-Certified Dermatologist’s Perspective

What is Melasma?

Melasma is a skin condition characterized by hyperpigmented patches on sun-exposed areas. Common sites of involvement include the forehead, cheeks, and upper lip but can be identified on the body, most notably the arms. Melasma is more common in women than in men, with a typical onset between the ages of 20 and 40 years. Individuals with darker skin types are more commonly affected.

What Causes Melasma?

Melasma is a complex condition, and its pathogenesis is not fully understood. Factors implicated in the development of melasma include UV radiation exposure, visible-light exposure, hormonal influences, and genetic predisposition.

Can You Treat Melasma?

In some cases, melasma may undergo spontaneous remission. However, because of its complex pathogenesis, most cases are chronic in nature and necessitate behavioral and medical intervention for the best results.

Sun Protection

Year-round, life-long sun protection is paramount to the success of treatment. Protective measures include using a broad-spectrum sunscreen, avoiding peak UV radiation hours (10 am and 4pm) and wearing a broad brimmed hat. It is important to be aware that visible light can pass through windows. Therefore, one can be exposed to visible light even without direct sun exposure by sitting next to a window, or driving a car.

Here is a recent development that may explain why when doing all the right things, your melasma rebounds – studies have shown that skin on your body that isn’t sun protected can trigger melasma on the face through Melanocyte Stimulating Hormone (MSH). Be sure to practice proper sun protection on all exposed areas.

HOT TIP: Broad-spectrum tinted sunscreens, containing iron oxide block visible light as well as UVA/UVB rays. Many non-tinted sunscreens do not block visible light.

Topical Therapy

Hydroquinone is often regarded as the gold standard in melasma treatment. It serves as a depigmenting agent by inhibiting tyrosinase, an enzyme in the melanin synthesis pathway. It can be prescribed on its own, but it is often compounded with other agents such as azelaic acid, kojic acid, tretinoin or ascorbic acid for the best results. Treatment cycles should be carefully monitored and tailored to the individual.

Demystifying melasma at Kingsway Dermatology

Chemical Peels

Chemical peels with glycolic acid or alpha-hydroxy acids work by removing the superficial layer of the skin that contains excess pigment. The effects of a chemical peel are temporary but can be repeated on a maintenance schedule. Chemical peels carry a risk of post inflammatory hyperpigmentation and should only be performed under the care of a professional.

Laser Therapy

Fractionated lasers can be used with caution when executed with precision and expert care. Pretreatment with hydroquinone is often recommended to reduce the risk of worsening melasma.


Microneedling is a minimally invasive procedure whereby a device is used to create controlled injury to the skin. Microneedling has been shown to be a useful adjuvant to topical therapies for melasma by improving transcutaneous delivery of topical agents.

Melasma Treatment at Kingsway Dermatology

Melasma is a complex dermatological condition that often requires a tailored treatment regimen. Successful treatment requires long-term commitment, often combining photo-protection, prescription therapy, and in-office treatments in order to achieve the best outcomes. To learn more about melasma and what we can do to treat it, contact the experts at Kingsway Dermatology today.

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