Melasma – Common, Frustrating but Treatable

Melasma, a condition primarily seen in women, involves increased pigmentation (hyperpigmentation) of the skin on the face. Frequently associated with hormonal upheaval, it often occurs during pregnancy or with the use of oral contraceptives.

Thought to have an incidence of 50-70% in pregnant women, the onset of melasma is usually during the second half of pregnancy. It also occurs in at least 20% of women taking birth control pills which means, of course, that the condition has increased in frequency now that the use of oral contraceptives is more widespread amongst women. The age of onset is also becoming lower as women in their early teens often use oral contraceptives. Melasma can also occur in women who have never been on birth control pills and who have never been pregnant. The skin condition occasionally occurs in children too, as well as in men, with the estrogen and progesterone hormones in the human body involved in stimulating melanocyte activity (i.e. increasing production of the pigment melanin).


1)      As previously mentioned it is known that increased estrogen levels associated with pregnancy and oral contraceptive use are the main triggers for Melasma. However, ultraviolet radiation exposure is the next major cause of the condition, either through exposure to SUNLIGHT or from tanning beds.

2)     Around 25-30% of those with Melasma are thought to be genetically predisposed to the condition.

3)     Perfumed ingredients in cosmetics, creams, lotions and cleansers also appear to play a significant role in Melasma development. Therefore, it is wise to avoid the use of such agents on the skin of the face and hands so as to minimize sensitivity and reduce the risk of exaggerated photo-reaction to UV light exposure resulting in increased melanocyte activity.

Clinical Features

Hyperpigmentation can occur on any part of the body, although Melasma tends to follow a specific pattern as it develops on the face, giving rise to the longstanding name the ‘mask of pregnancy.’ Melasma generally presents as an asymmetrical, irregular brown or tan discoloration on the face, albeit with rather sharp borders. The coloration varies from very light to dark brown and this tends to be dictated more by the natural undertone of the skin. It can start out very subtle and barely noticeable but with each year the affected area is further affected by sun exposure as the cells retain the memory of the previous effects leading to the discoloration darkening and increasing in scope.

Various Treatment Options

Dr. Bakken has been treating this condition in her dermatology practice since 1978. For decades the mainstay of treatment has been the application of topical ‘bleaching agents’ of which the main one has been Hydroquinone. Hydroquinone is an enzyme inhibitor that works on three different melanin production pathways. Over time, Dr. Bakken has incorporated this long used inhibitor with other enzyme inhibitors in various formulas for better effect. The Circadia peel offered by Laser and Skin Care Medspa for the past several years includes two of these known enzyme inhibitors, Mandelic Acid and Retinoic Acid (vitamin A). This formulation continues to offer great success in treating some of the superficial Melasma.

In addition to the use of Circadia there are other topical options that Dr. Bakken may suggest during your consultation.

Fractional Lasers

Over the last decade there have been great advances in the development of technology in the successful treatment of Melasma. A special category of lasers, called fractional laser systems, have been designed, as the name implies, to break up sub particles in the skin and create pigmentation changes. Refinement of these lasers and techniques has revealed one of the three main types of laser, the Irbium- YAG laser as particularly adept in Melasma treatment. Laser and Skin Care Medspa has been providing this advanced laser alongside the Palomar system since 2007 as part of our anti-aging technology.

The great thing about this advanced treatment is that there is little to no downtime required afterwards and the skin can be protected with water based products such as Skin Medica Total Defense & Repair SPF 50, Alyria SPF 45 or the Jane Iredale makeup line. In most cases it is necessary to repeat the treatments at monthly intervals until the Melasma is cleared. Dr. Bakken often recommends the use of a topical preparation for one to two months prior to use of the fractional laser, having found that this leads to a higher success rate overall with fewer treatments required and increased patient satisfaction.

Spectra Laser

Spectra (nanopulse Nd: YAG laser) was introduced in 2012 for the treatment of Melasma, and has shown to be very effective in reducing the appearance of the condition.  It is important to be diligent with sunblock application as Melasma can reappear with sun exposure. The laser energy targets the pigment which breaks it down and ablates it. The body’s immune system then naturally removes the pigment particles.

Preventing Recurrence

Avoiding further pregnancy and the use of birth control pills is not, unfortunately, sufficient to avoid the return of Melasma. All it takes is one day of unprotected sun exposure and the hyperpigmentation can all come back as before. The key, then, to preventing Melasma in the first place, and minimizing the risk of recurrence, is the diligent use of SUNBLOCK. Elsewhere on the site I have discussed the difference between chemical and physical sunblock and why physical barriers are safer and more effective. (See blog -The Confusing Story of Sunscreens and Sunblocks) Physical blocks are more effective for sun protection as they reflect UV light, as opposed to absorbing UV light and then chemically treating it, which is what chemical sunscreens do. Controlling Melasma requires a dedicated lifestyle change to include an effective physical sunblock as part of your daily routine. Laser and Skin Care Medspa carries several physical sunblocks, such as, Total Defense & Repair SPF 50 or Alyria SPF 45 among our cosmetic medical dermatology lines which are easy to wear and which do not aggravate acne or sensitive skin.

It should go without saying that it’s a good idea to avoid spraying and applying perfumes or perfumed cosmetics/toiletries to the face to reduce the risk of Melasma recurrence and to prevent initial onset of Melasma.

MELASMA is essentially an aesthetic condition that is undesirable and can affect self confidence and self-esteem. That blotchy complexion tends to add years to the appearance when you may be trying hard with other skin treatments to rejuvenate the face. The good news is that the majority of those affected can be effectively treated and offered a long term Melasma management plan to prevent the condition recurring.

Sprucing Up Your Skin For Spring

There’s snow on the ground and only the faintest signs of spring but even though you’re probably still bundled up in layer upon layer of clothing, now’s the time to be thinking about sprucing up your skin. Eating skin-nourishing foods and making use of powerful medical grade skin care now can make sure that when those sweaters and ski-pants come off you’ll have glowing, healthy-looking skin.

It’s also the perfect time to address pigmentation problems and to experience the benefits of laser hair removal as ultraviolet light radiation is still at a low level and you’ll want to avoid sun exposure immediately after treatment.

Intense Pulsed Light (IPL)

Laser hair removal using Intense Pulsed Light (IPL) is a lasting solution for unwanted hair and much more effective, comfortable, and long-lasting than shaving, waxing, and electrolysis. Able to treat larger areas of skin such as the back or legs, as well as the upper lip and under-arms, IPL laser hair removal is quick, pain-free and totally safe and there’s no need to let hair grow out between treatments like there is with waxing and shaving.


Sunlight, environmental factors, medical conditions and the natural passage of time all contribute to the development of dark spots, skin pigmentation and freckles. Your face, hands and chest are the first parts of the body to show signs of ageing because they receive so much sun exposure. Age spots, skin pigmentation and freckles are forms of pigmented lesions. They are caused by excess production of melanin in the skin by cells called melanocytes.

Skin pigmentation (melasma) can also occur in pregnant women due to the associated dramatic changes in circulating hormones during pregnancy. In some cases, skin pigmentation in pregnant women disappears after child birth, but for some women the melasma may worsen with further light exposure and skin ageing.

Lasers and Intense Pulsed Light (IPL) devices have been used with great success to remove problematic skin pigmentation. This state of the art technology selectively emits charged light energy to target the pigmented areas and this energy is absorbed by the melanocytes, sparing the normal surrounding skin. Topical remedies such as bleaching agents, glycolic acid, and retinoids can help in cases of minor skin pigmentation but as they only treat visible skin pigmentation they do nothing to treat the underlying cause of dark spots and pigmentation problems.

Intense Pulsed Light (IPL) uses wavelengths of heated light which are directly aimed at the pigmented spots. The advantages of this technology include the fact that the pigment is able to be targeted precisely without damaging the surrounding tissue. Skin pigmentation in the face, neck, chest and hands can be treated safely and effectively. The added benefit of the Cynosure IPL Technology is that is also works to activate cells in the skin called fibroblasts which stimulate collagen remodeling and new collagen production. This added benefit is due to the fact that the laser works with a full spectrum light beam and a unique application tip. Effectively, this helps to rejuvenate the skin, improving its texture, visibly minimizing pores and reducing superficial fine lines and wrinkles to reveal a more youthfully hydrated appearance.

Protecting the Skin

Once you’ve got your skin smooth and hair-free you’ll want to make sure that it’s protected from photodamage and age-related changes such as wrinkles, liver spots, pigmentation problems and abnormal vascularity (spider veins). This involves nourishing the skin inside and out with a combination of nutrition and medical grade natural skin solutions like vitamins C, E, and A.

Vitamin A – What’s in Your Skin Cream?

Retinoic acid (vitamin A) is a powerful antioxidant that helps protect the cells of the skin from the visible signs of aging, including fine lines, wrinkles, sun damage, and skin spots. Not all creams containing vitamin A are able to actually deliver this nutrient to the underlying skin cells however.

This is why it’s important to choose a medical grade formula like those available from Zo® Skin Health which penetrates the epidermis to stimulate the production of collagen and elastin and boost the repair and regeneration of youthful, firm, and healthy-looking skin. The Zo Skin Care range is ideal to maintain fabulous skin.

Vitamin C – It’s Not All the Same!

Vitamin C is also vital for collagen production and applied topically it can improve the tone, texture and overall health of the skin. Vitamin C is a highly unstable molecule however, meaning that the vitamin C included in most skincare products has a very short shelf-life and is of practically no use for skin health. Luckily, there are forms of vitamin C, that are much more stable and able to penetrate deeper into the epidermis to support healthy collagen and melanin production (minimizing pigmentation problems such as dark circles), to brighten the skin and help repair UV damage.

Feeding the Skin

As well as ensuring that you choose medical grade skin care to spruce up your complexion, it’s also wise to ensure that your skin is well hydrated and nourished during these colder months. Try adding pomegranate juice into your morning breakfast regime to get a regular supply of anthocyanins and antioxidants. These strengthen blood vessel walls helping to maintain healthy circulation to oxygenate the skin and help clear skin toxins quickly and efficiently.

More Great Skin Foods

Try adding pumpkin seeds to your morning granola to boost levels of zinc, a mineral needed to produce collagen and elastin, to help skin heal and to maintain a healthy immune system to fight off skin infections and scarring. The oats in your porridge or granola are also great for the skin as these provide dietary fibre that helps lower inflammation and keeps the bowel regular to flush out toxins. Oats are also rich in silica, which is needed for strong and healthy skin, hair and nails.

Add a little flaxseed to your daily diet and this will also help control inflammation that can make skin look angry, red, and blotchy. The omega 3 found in flaxseed helps to keep cells flexible and strong and the fibre in these seeds even plays a role in balancing healthy hormones, which is great for anyone suffering from skin problems such as acne.

There are so many great foods for the skin but a good general rule is to eat organic, minimally processed, brightly coloured wholefoods that are high in fibre, plant-based proteins, healthy unsaturated fats, and antioxidants. That way, when you finally get to slip into that sun dress your skin will not only be smooth thanks to IPL laser hair removal but also healthy, happy and better protected against photodamage and pollution.


Skin Resurfacing Reduces the Signs of Aging

Skin or laser resurfacing is an effective and non-invasive way to reduce the signs of aging. It’s especially effective for reducing the appearance of wrinkles around the mouth and eyes, reducing brown spots or other changes in the skin, and treating precancerous growths. These are all unattractive changes in the skin that will prompt the need for resurfacing. It’s not for everyone, but for those who want to treat areas of their skin that they find unattractive, it’s one of the least invasive and effective methods out there. Continue reading “Skin Resurfacing Reduces the Signs of Aging”