Expert's Opinion

Unmasking Melasma

By Dr. Howard Murad, Murad Inc. | November 10, 2011

Howard Murad reports on skin care that treats this condition.

Many people have heard the word "melasma," but few know its meaning. So in an effort to “unmask” this skin condition, especially in the Fall when its symptoms are more obvious, here is an overview of its causes and treatment options.

Melasma is a common type of hyper-pigmentation that discolors broad areas of the upper face, creating a mask like pattern. Predominantly seen in women, Melasma can be triggered by hormone fluctuations, particularly the hormones released during pregnancy, which is why it is often called the “mask of pregnancy.” Because birth-control pills are treatments that work by shifting your hormones, the near universal use of oral contraception in women of child-bearing age in developed societies has dramatically increased the prevalence of melasma. However, melasma does not only occur in pregnant women. Many other people suffer from melasma, but the causes are unclear with common theories including family history, race and medications that make the skin sensitive to UV light.

As with most skin problems, melasma is often a symptom of some larger change or imbalance in the body.By incorporating topical care, internal care and emotional care into a comprehensive plan of treatment (an Inclusive Health approach), we can often accelerate resolution of what can be a very stubborn problem.

The first step to treating skin discoloration is topical care. Melanocytes are stimulated by hormones, sun and other inflammatory factors, triggering the melanin release leading to pigmentation change. Melanin release begins at the skin’s deepest layer, which is the reason most topical treatments take at least a month to take effect. Treatment products with hydroquinone, azelaic acid, bear berry and licorice root can be used to suppress and gradually lighten epidermal hyperpigmentation from melasma. However, when pregnant or breastfeeding, products containing hydroquinone should not be used as they have not been adequately tested during pregnancy. In addition to topical treatments, regular facials and a combination of gentle peels formulated with Vitamin C, salicylic acid, glycolic acid, retinol and niacinamide can contribute to improvement.

Because exposure to the sun stimulates production of pigment in the skin, one of the most important elements of topical care is sun avoidance and faithful use of a broad-spectrum sunscreen. Because the quality and effectiveness of sunscreens vary so widely, look for ingredients in the formula that will enhance skin health such as anti-inflammatory ingredients, botanical antioxidants, vitamins A and C, essential fatty acids and polyphenols all of which help combat melasma. Also, applying high concentrations of vitamin C prior to sun protection will help lighten pigment.

Assessing and addressing internal health problems that may be contributing to skin discoloration is also an important part of developing a treatment plan. Frequent triggers for melasma, other than pregnancy and hormonal fluctuation, include skin cancer, diabetes and obesity. Because every aspect of health is truly connected, a sound diet that is rich in the micro-nutrients needed to protect and promote strong healthy cells throughout the body, should be incorporated. Increase your intake of foods like watermelon and pomegranate; and since protection from sun is so critical to resolving Melasma, dietary supplements that can boost the skin’s natural ability to protect itself from UV damage, such as elegiac acid, should be included in the plan.

Additionally stress can contribute to a cascading cycle of cell damage that can make it even more difficult to resolve melasma; and melasma sufferers are typically dealing with the stress of a very prominent facial imperfection. It’s critical that patients seek out spa services that reduce stress, exercise regularly and avoid social isolation. I like to tell my patients, “Be imperfect; live longer” and this is a great case in point.

Although melasma can be a challenge to resolve because it requires time and consistent long-term care, the most effective plan of treatment for melasma, like most skin conditions, is based on an Inclusive Health approach that addresses the needs of the whole person through an integrated program of topical, internal and emotional self care.

About the Author
Howard Murad, MD, FAAD, is a trained pharmacist, Clinical Professor of Medicine at UCLA's Geffen School of Medicine, founder of Murad Skincare Inc., President of The University for Inclusive Health and a physician who specializes in both inclusive health and dermatology. He has been acclaimed as a "Beauty Genius" by ELLE magazine and an "Industry Visionary" by the International SPA Association. His research in The Science of Cellular Water™ has revealed the ability of cell membranes to hold water as the fundamental marker of youthful good health and offers the world's most comprehensive insights into health and aging. His advocacy of the use of dietary supplements to promote skin health has earned him international recognition as the "Father of Internal Skincare." Dr. Murad is the accomplished author of four books advocating practical lifestyle choices as the path to looking and feeling as healthy and beautiful as possible.

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