I’ve has melasma for several years and heat becomes a major activator in the summer and I’m not sure how to get past it.

Question

I’m on Aviane birth control and have used various birth control pills; changing them hasn’t helped. I also use Obaji and that helps in the winter. I wear plenty of sunscreen and hats, but the hats seem to make the pigmentation on my forehead worse probably because they get hot. I’ve tried a Vi peel in the fall - that helped a little, but is too expensive to do regularly. Should I try changing to IUD? Is there anything else I could be doing? Is reapplying sunscreen better than wearing a hot hat?

Raffy Karamanoukian, MD, FACS · Answer

Melasma and age spots can be due to hormones, aging, sun exposure, thyroid dysfunction, and genetics. Treatments range from IPL to laser therapy; but pigmentation may recur if not complemented with topical creams to stabilize the pigment cells. 
I would suggest starting with Melarase Brightening Kit with Melaclenz, Melapads, Melarase AM, and Melarase PM to help stabilize pigmentation and reduce recurrence. Once started, an active protocol that includes Covalent peels, IPL, fractional laser, and microneedling can further remove pigmentation.
Best, Dr. KaramanoukianRealself100 Surgeon

Jeff Angobaldo, MD · Answer

Thank you for your question.  I would start applying hydroquinone morning and night and retinol in the evening.  Start those two ointments two weeks prior to a laser treatment.  I would recommend treating melasma with a fractional laser. The fractional laser will help to make the discoloration dissipate, shrink your pores and improve texture of your skin.   Stay out of the sun after the treatment and always wear spf 50.

Jason Emer, MD · Answer

Melasma needs a combination approach to get the best improvement and will need a series of treatments. In our practice, we combine Clear + brilliant, peels, Cosmelan, microneedling/PRP, aerolase, and sometimes erbium laser (coollaser) to get the best results. See an expert for a formal evaluation. Best, Dr. Emer

Travis James, DO · Answer

Thanks for your question. Melasma is a difficult condition that we are learning more and more about all the time. There are many factors that seem to contribute such as UV light, visible light, inflammation, and hormones. When we look at treatment all these factors need to be considered, it is often the light that is one of the biggest contributors so strict adherence with sunscreen that has zinc or titanium to protect you from UV light as well as iron oxide to help with visible light and an antioxidant serum is extremely important in managing anybody’s melasma. Reapplication of sunscreen is very important, a product I find many women like is Colorscience as this is in a makeup style brush and can be put on right over makeup and offers high SPF with protection from UV and visible light sources. Other agents I often use are hydroquinone, Heliocare (an oral supplement that as UV protective benefits), other non-hydroquinone lightening agents, and a newer agent to be used in the US is tranexamic acid. As you note with the area the brim of your hat rubs there is also an inflammatory component to melasma so controlling friction is important in your case as well. 
For many people birth control can contribute to their melasma but it isn’t always a fix to change types or even be off of the medicine. This is something you should discuss with the person managing your birth control but probably worth a trial of a different option.
After you have addressed the things you are able to that we know contribute to melasma then there are different treatment/procedural options that work quite well to help with the pigmentation. The options are wide, largely because none of them work perfectly for every person. Some of these options include chemical peels such as the modified jessner, microneedling, PRP, and different types of laser (ensure the person doing the laser understands melasma as many lasers can worsen melasma).
So in the end there are many other options to try but there isn’t a one size fits all answer. I would suggest you see a board certified dermatologist in your area. Good luck.

Susan Fox, DO, RPVI · Answer

We have amazing results with the Picoway laser for melasma.  Melasma can be worsened by your hormones so if you could come off the pill this may help.  I would recommend a sunblock like ELTA everyday.  As well, try to avoid sun as much as possible.  Consider a lightening cream as well for daily use such as hydroquinone ( beware the side effects) kojic acid or something of the sorts.

Ravi Jain, MBBS · Answer

HiThanks for the great question. Without doubt, after several years of using mulitple expensive treatments, I have found that a Dermamelan peel offers the most consistent results in all skin types. However - it must be applied in clinic and only get your products from the clinic as there are many fake products online.

Aurora DeJuliis, MD · Answer

Melasma is characterized by patches of dark pigmentation, and it is aggravated by sun exposure and female hormones. Being on birth control might be a risk factor. Fractional laser performed by an experienced physician works very well for correcting melasma. Prescription bleaching agents and strict sun block will prevent more discoloration.

Davin Lim, MBBS, FACD - Account Suspended · Answer

Melasma is a very common cause of skin pigmentation. It can not be completely cured, however effective treatment are possible. This is because your skin is extremely sensitive to UV and even the smallest amount can stimulate your pigment cells to produce colour. The mainstay of treatment is strict UV protection- hats, sunglasses and SPF every 4 hours. This forms the foundation of all treatments. 
I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams or Meladerm. I start my patients on laser (low dose Q switch or Picosure) as this has shown to decrease pigment production by decreasing the activity of the cells that produce pigment. Laser itself is not aimed at ‘blasting’ pigment, but to slow down the rate of melanin production. Another laser I use is the Clear and Brilliant in the 1927 Permea setting combined with creams. IPL should never be used to treat mixed melasma as it often worsens the condition (this is termed ‘Rebound Melasma’)

In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help. Melasma treatments should be tailored to each patient according the type of melasma. Majority of patients will have mixed dermal and epidermal melasma. Approach melasma as a medical condition and not a cosmetic concern, and the success rate will be much higher.

Consult a Board Certified Laser dermatologist with a special interest in disorders in pigmentation as well as one who has experience in treating all skin types, including darker Ethnic skin.

All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia.

David E. Berman, MD (retired) · Answer

the Picosure laser has great results with melasma and hyper-pigmentation due to hormones etc. It is hormonally related so perhaps switching off of the pill may be helpful. You should plan at least 3 picosure laser treatments, each done one month apart. You need an excellent sunblock that you reapply regularly. The Picosure fires 1,000 faster than other lasers so there is little to no downtime.david berman md

I’ve has melasma for several years and heat becomes a major activator in the summer and I’m not sure how to get past it.

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