Melasma - Patients ask, Dr. Ringpfeil answers
Please feel free to use the blog below to share information about Melasma or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
Philadelphia and Mainline Center of Dermatology and Cosmetic Surgery
Melasma - Hyperpigmetation
Melasma, often called the mask of pregnancy, is induced by hormones found in pregnancy and certain birth control pills paired with UVA exposure.
Melasma responds to topical fading agents. The chance of recurrence can be reduced only by meticulous use of a broad spectrum UVA filtering sunscreen.
Melanage - A new revolutionary solution for Melasma
Melanage peel can significantly reduce the pigmentation after only one treatment. Traditionally, microdermabrasion in conjunction with topical fading agents has also been very successful in the treatment of melasma. Peels such as glycolic acid or even Trichloracetic Acid can help but as solo treatments are inferior to the previously mentioned treatments.
Melasma Types
| Superficial (type 1) |
Intermediate (type 2) |
Deep (type 3) |
|
|---|---|---|---|
| Skin layer affected | epidermis (upper most) | epidermis and upper dermis | Epidermis and Medium and deep dermis |
| Ease of treatment | +++ | ++ | + |
| Ease of maintenance | Extreme discipline | Extreme discipline | Extreme discipline |
| Frequency | most common | less common | rare |
| Ethnic distribution | Mediterranean, Latino, Middle and Far Easten | Predominantly Far Easterns | |
| Gender distribution | 90% women | 90% women | 90% women |
Related treatments
Melasma Treatment Options
| Melanage peel + kit | PicoSure® Focus Array | Microderma- brasion + topicals | Micro- derma- brasion | Q-switched Nd:YAG | FRAXEL | Topicals | |
|---|---|---|---|---|---|---|---|
| Works on melasma types | 1,2 | 1,2,3 | 1,2 | 1,2 | 2,3 | 2,3 | 1,2 |
| Efficacy | +++ | ++ | ++(+) | + | + | + | ++ |
| Downtime | 2-10 days | none | none | none | 1 day | 2-3 days | none |
| Number treatments | 1 | 3-5 | 6 | 6-10 | 2-4 | 4 | daily |
| Time to results (months) | 1 | 1-2 | 4 | 4-8 | 4 | 4 | 6-12 |
| Preparation | none | none | 1 month of fading agents before 1st treatment | none | none | topical numbing medicine | none |
| Risks | none | none | none | none | none | Paradoxical darkening of the treated area | None if used as instructed |
| Total Cost | Call for price | $2000 | $850-$1200 | $600-$1150 | $800-$1600 | $2400-$4000 | $500-$1500 |
The key for sustainable results
The key in maintaining these results over time is to meticulously follow a post procedure skin care regimen for life.
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Post Melasma Treatment
Post melasma treatment always includes the use of a sunscreen. It must be applied daily, regardless of sun, cloud, rain or snow because UVA rays travel through anything including your car windows. It cannot just be any sunscreen but must be able to block or filter the entire UVA spectrum. If ever in doubt or you cannot find your usual sunscreen, use sunscreens that contain zinc or titanium dioxide.
If you are committed to a lifetime without melasma. Call us today to schedule a free melasma treatment consultation to learn which melasma treatment fits you best.
Post Melasma Care (topical)
| Pigment suppression/ dispersion | Limitation of use | Source | Use during pregnancy | |
|---|---|---|---|---|
| Sunscreen with UVA filter | +++ | none | drugstore | yes |
| Hydroquinone 2-5% | +++ | 6-9 months, can be restarted after hiatus | drugstore (2%), prescription (4% and 5%) | no |
| Botanical fading agents | +++ | none | physician dispensed | yes |
| Glycolic acid | + | none | physician dispensed | yes |
| Kojic acid | + | none | physician dispensed | yes |
| Mandeleic acid | + | none | physician dispensed | yes |
| Vitamin C | + | none | drugstore | yes |
| Azelaic acid | + | none | prescription | yes |
| Retinoids | ++ | pregnancy/nursing | prescription | no |
I met with Jill regarding my melasma and she recommended microdermabrasion. I am planning on starting a series of six this coming autumn, and would like to schedule appointments in advance. I forgot to ask her how many weeks should you have in between sessions? Thanks so much! PS– Jill is a great asset to your practice!
The intervals between microdermabrasion treatment are only 2 weeks. Go ahead and schedule accordingly.
I was recently given a bottle of Clinique’s Even Better Clinical Dark Spot Corrector to use before I try microdermabrasion, but I have a couple of concerns. I have been on the same brand of birth control for about 10 years and over the last 2 years, I began seeing melasma develop. I am concerned that if I try this topical treatment and it fades the darker melasma spots, when I discontinue taking birth control, will those same areas look bleached? I would rather have the melasma spots for a few more years than have several bleached spots on my face forever. Secondly, if I use this topical treatment, will it make those areas where my melasma is worst, even more sensitive to sun from that point forward? I do understand, however, that sunscreen is vital to reducing the appearance of melasma. Thank you in advance for your time!
Melasma occurs often because of a combination of sunscreen and an increased estrogen level such as with oral contraceptives or during pregnancy. Melasma is not known to fade by itself when you discontinue birth control or after giving birth. Those who do not like the darker areas typically work hard to remove them and work even harder to make them stay away. Once you have developed mealsma it easily come back after treatment if do not practice immensely diligent sun protection against UV rays.
Fading creams that helps with melasma are not known to make the treated areas lighter than your normal surrounding skin. It also does not render these areas more sun sensitive.
Is it possible to have filler injections into the cheeks (Radiesse) and the Melanage peel done in the same visit? I am hoping to get them both done at the same time..
Thank you
You can have both treatments on the same day. Make sure when you book the appointment that the front desk is aware that you are interested in both treatments so enough time will be allocated for your appointment.
I have a red face all day long. i don’t know what to do any more. i’ve done my research and think it may be rosacea, but since i am not a doctor i am not sure. What are your recommendations for reducing redness on my dry face. Also,do you accept Keystone health plan east?
I am a 41 year old male with what appears to be melasma on my forehead and cheeks. I’ve had the condition for two years and it worsens in the sun. Since it first appeared, I regularly wear sun protection but I am curious if this will go away on its own or if i need to do something about it. I’ve read this predominantly effects women so how did I come down with it?
Melasma is indeed far more common in women than in men. Occasionally, it resolves once you wear sunscreen diligently. Most of the time, however, it needs treatment to fade away. After treatment, meticulous sun protection is essential, too, as with any lapse in sun protection, it comes back.
In general, the treatment is regarded easier than the prevention of relapse after treatment.
I am getting married in 6 weeks. I started with melasma last year on my forehead and chin, but it’s more pronounced on my forehead. My dermatologist gave me Hydroquinone, etc., to lighten it, but it hasn’t worked at all. I wear a #50 sunscreen with titanium and zinc and a sun visor. I’m wondering if I can possibly get rid of the melasma at least on my forehead before the wedding, and what is the best, quickest treatment? My assumption is microdermabrasion is out, and I should opt for a Melanage Peel, but I’m wondering, will that cause more damage to my face before the wedding??? Thank you, Gina
Melanage peel would probably be the best yet the redness and scaling after Melanage can last up to 4 weeks which would increase your nervousness factor and is therefore undesirable. I would do a few microdermabrasion treatments every 10-14 days and continue hydroquinone. You should see some improvement until your wedding.
Question for the doctor…
My Melasma began when I started the pill 2 years ago. I am a 37 year old women. If I stopped the pill would the melasma evidentually go away 100%, if I did topical therapy for the current brown spots?
Most melasma can be treated with topical creams or a combination of topicals and in-office procedures. Keeping melasma away is typically a much bigger project than removing it from the skin. Sun screen should be truly broad spectrum. Therefore, the physical sunscreens containing zinc oxide and titanium dioxide are most commonly recommended. Few other sunscreens that are truly broad spectrum contain molecules that stabilize their UVA filters.
In addition to sunscreens, pigment production can be regulated with herbal fading creams, topical hydroquinone, glycolic acid, vitamin C and others. In order to reduce your skin’s ability to produce melasma, it is recommended that you avoid increased estrogen levels that occur with many birth control pills and during pregnancy.
After a melanage peel, can one wear makeup to hide the redness?
In the first 3 days, make up is very difficult due to the scaling that starts. Afterwards it is possible.
Hi,
I am 37 year old asian female – have been using obagi hydroquinone and tretinoin products for about 3-4 years, have tried kojic acid, chemical peels and fraxel once for consistent melasma/freckle problems. I inherently do not have thick skin, but I feel like my skin may be getting thinner and more susceptible to sun exposure… I am considering melanage next but is there anything that could be done about the thinning skin to help make it thicker?
It is very unusual to develop thinned skin from retinoids (tretinoin), hydroquinone or any of the other fading agents, when thinning refers to a state that is thinner than nature provides. Retinoids can bring your skin to the level it was when you were young and had no sun exposure yet but they do not thin your skin beyond its physiological state. When we are exposed to the sun over our lifetime, skin thickens to protect itself from the sun.
This process is described by some as “leathering” and in a cosmetically conscious person, this is not a desired state.
Therefore, the glow of skin that has the same smooth and even texture and color as skin that has never seen the sun comes at a price. The skin must be protected from sunlight as it does not have any natural sun protection to UVA light, the light that drives melasma and leathers and ages us. Sun protection can be carried out with physical sunscreens including sun protective clothing and hats with very wide brims or topically applied zinc oxide and titanium dioxide or by chemical sunscreens and or by any combination thereof.
When you have melasma, life-long UVA protection is essential or the melasma could come back immediately. A number of different treatment options including Melanage peel reduce melasma. If you feel you have abnormally thin skin, you should be evaluated. Rare medical conditions should be excluded before you receive any further treatment.
I have melasma and am currently trying some OTC lighting creams my question is when using sunscreen does it have to contain zinc oxide and titanium oxide or is zinc oxide 7.5% alone good enough? The reason I ask is it is very hard to find sunscreen with both zinc and titanium oxide and the one I did find with both is so greasy my make-up cakes on my face.
In fact, zinc oxide 7.5% is sufficient. There are some sunscreens that contain much less than 7.5% zinc oxide and then augmentation with titanium dioxide is crucial. Titanium dioxide by itself at concentrations above 10% is also fine.